Review: A Fortunate Man

BJGP JonesProfessor Roger Jones is editor of the British Journal of General Practice.

A Fortunate Man: the story of a country doctor. John Berger and Jean Mohr. Canongate, London, 2015

First published in 1967, this is one of those must-read general practice books, essential for every trainer, trainee and practice library, and one, I suspect, which has been more frequently recommended than read. It has been re-issued this year in a new edition with an introduction by Dr Gavin Francis.

Anyone coming fresh to A Fortunate Man, expecting a paean to idyllic country general practice, will be disappointed, because the romanticised hero of John Berger’s extended essay is a deeply troubled individual to whom the epithet “fortunate” can be applied, at best, with irony.

Berger, now 88, is a distinguished critic and Booker Prize winner. He met the central character of the book, Dr John Eskell, as a patient in St Briavel’s, in the Forest of Dean, Gloucestershire, and became close friends with him. Eskell had been a Royal Naval surgeon during the war in the Mediterranean, and was now in single-handed practice following the death of his GP partner. Some time after Berger had left England for Geneva, Eskell, who becomes Dr John Sassall in the book, invited him and the photographer Jean Mohr to spend six weeks with his family and to shadow him round-the-clock in  his surgeries, on his many house calls and, presumably, in his domestic life, although this is not mentioned once In the book. Sassall was clearly a revelation to Berger, and the degree of connection, empathy, and acceptance that he showed to his patients, and the lengths that he went to, literally, to care for them are clearly regarded by Berger as both astonishing and exemplary. In describing Sassall’s actions and thoughts, and it is more often than not very difficult to know whether Sassall or Berger is doing the thinking, many of the core qualities and responsibilities of a general practitioner working in an isolated rural setting are perfectly captured.

However, Sassall’s hyper-commitment to his practice and his patients was, at least in part, a function of his manic-depression. Berger rather coolly describes Sassall’s lows, but doesn’t seem to quite understand the highs. Sassall’s wife, who ran his practice, died in 1981 and Sassall shot himself the following year. His professional life was troubled and he practised with little professional or, indeed, social contact. Whilst being admirably reflective and sensitive, he appeared to lack, or at least managed to avoid, any real recognition of his wider role as a general practitioner as an advocate for his practice population’s health or as a medical scientist. I can’t help making comparisons with Julian Tudor Hart, working wonders in Glyncorrwg, and John Fry laying the foundations of general practice research from his little practice in Beckenham.

I started reading this book 30-odd years ago and was put off by Berger’s often convoluted, freewheeling writing and Jean Mohr’s dreary photographs. I grew up in the Forest of Dean and, while recognising its comparative social isolation, bridled at Berger’s patronising depiction of Forest folk as uncultured half-wits, and still do. However, re-reading it at one sitting very recently, I recognised the limpid beauty of some of Berger’s prose, the subtlety of his descriptions of nature and of human interactions,  and his insights into the needs of ordinary people faced with illness, anguish and loss. His – or is it Sassall’s? – understanding of the role of the general practitioner as a witness and a “clerk of record”, needs to be widely understood, and never more so in these days of therapeutic miracles and performance indicators, when the unmeasurable essence of patient care can so easily be overlooked.

Roger Jones

Roger Jones

Roger Jones is Emeritus Professor of General Practice at King's College, London and is the Editor of the British Journal of General Practice.
Roger Jones

One thought on “Review: A Fortunate Man

  1. mfw1948

    I have just finished reading ‘A Fortunate Man’ – literally fifteen minutes ago – and did a quick internet search as I wanted to find out whether others felt about it as I did. As an ordinary reader with no medical connections I felt that I was being made to feel inadequate, that I should have a great deal more knowledge of philosophy before I should allow myself to read it. I think quite genuinely that the unadorned story of his life among his community, although a very common subject, would have told us a great deal more about this dedicated doctor.

    I suppose that what came over to me was that the book was far more about John Berger than it was about Dr Sassall. I wonder whether the reader is supposed to acknowledge Berger’s superior intellect, particularly when one compares it to the low-brow status of the local hoi polloi. My impatience with John Berger reached a crescendo when I first realised how he despised the local people, how he suggested that a visit to the nearest town, or heaven forbid, to London, might be the highlight of their dull, plodding lives! The use of the generic description ‘foresters’ made me see red, reminding me of Hardy’s ‘The Woodlanders’.

    No, all-in-all I closed the book with a feeling of anger, a feeling that Dr Sassall had been used by Berger as a vehicle for his own knowledge, his own views. Cynically, I wondered if this had anything to do with Sassall’s subsequent suicide! But having said that, there were many passages which I thoroughly enjoyed and seeking out one to copy into my book of quotations I chose ‘The privilege of being subtle is the distinction between the fortunate and the unfortunate’. It’s also fair to say that Berger did successfully convey to me the dedication and single-mindedness of the local family doctor and that alone would make the book worth the read.

    As a keen amateur photographer however, I really couldn’t appreciate Jean Mohr’s photography. Some of the images did successfully illustrate the text – I particularly liked the out of focus figure leaving the consulting room on shown on page 52, which I felt put over well the comings and goings of all these anonymous people. Otherwise I found his pictures dull and uninspiring, the sort of ‘rule-breaking’ that only a famous photographer could get away with!

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