I first remember hearing Auden’s poem during an after-dinner speech by one of the founding fathers of the hospice movement, Eric Wilkes. It describes the poet’s preference for a doctor, whose portly habitus betrays his understanding of patients’ weaknesses (1). The ideal physician is gentle in his approach, calm in adversity and explicit in his care of fellow mortals. The poem is succinct, affectionate and a rare example of consolation for short professionals of the endomorphic tendency.
Marie Campkin, a London GP who published on medical education and the consultation, wrote a parody at a time when family medicine was changing (2). She imagined a thin family physician steeped in the rhetoric of health promotion, audit and financial efficiency, who had lost interest in poorly people. The nineties were difficult years for those of us in UK primary care that thought like Campkin.
However, something much worse lurks in the current wave of NHS policy. We could never have imagined the vision of a GP promoted by our Health Minister in the English health reforms of 2011. For readers beyond our borders, it is difficult to convey how appalled we are at the jeopardy that our slightly flawed, but improving, system is in. It is with these thoughts that I turn to Auden once again.
Give Me a Doctor
Bill Noble 2011, after W H Auden
Give me a doctor, tanned and smooth
Bright in the eye and white in the tooth,
An entrepreneur on top pay,
Commissioning a care pathway,
To get me any willing provider,
Of quality, throughput and wider
Access to metrics of health gain.
But who will take away the pain?
1. The Ideal W H Auden Collected Poems (1991) BMJ 319:163 (Published 17 July 1999)
2. Parody by Dr Marie Campkin