Why society and medicine need the general practitioner
Key note lecture presented to the Royal Australian College of General
Practitioners, 50th Annual Scientific Convention, Sydney, 5 October 2007
By Per Fugelli, Department of General Practice and Community Medicine,
University of Oslo, Postbox 1130, Blindern NO 0318 Norway per.fugelli@medisin.uio.no
Accepted for publication in Australian Family Physician
Abstract
Based upon anthropological studies in Norway and Botswana, the author identifies five essential elements of health: Absence of disease, dignity, freedom, equilibrium and entirety. The author argues that:
specialized hospital medicine has a potential for undermining these basic health elements
general practice has a potential for promoting these basic health elements.
The health promoting capacity derives from the five foundations of our discipline: individualized care, whole person medicine, the-art-of- the possible-medicine, front-line medicine and continuity of care.
These characteristics also enable the general practitioner to promote the health of our society. We are in-the midst-of-society-doctors in a favourable position for early warning. Our patients carry messages from:
a safe or dangerous working place
a family in harmony or implosion
an economy that is equitable or polarised
a community that shows acceptance or stigmatisation
a nature in balance or disruption
Therefore the general practitioners should engage more in promoting political end ecological health.

The sun goes down. A bonfire flares up. People appear from the dark. In low voices and slow motions they start to sing and dance. The atmosphere intensifies. The songs become more suggestive. The dance grows wilder. The dancers aim at a crescendo where the Energy, the n:xum, is high enough for the
Healer to fall into trance and pass over to The Other Side. Here the Healer meets with the ancestors’ spirits, discusses the patient with them, and takes their prescriptions home to this world.
Colleagues,- we are in the Kalahari desert of Botswana, exploring health and healing among the San people. They have lived there for 30 000 years as hunters and gatherers. The Healing Dance is their main medical technology (1).
Together with a medical anthropologist, Benedicte Ingstad, I have done a qualitative interview study among 56 informants in Kalahari* and 80 in Norway, in order to explore peoples own perceptions and experiences of good health (2,
3).
So what is health - in the Kalahari, in Norway?
Five essential health elements emerge in Arctic Norway as in Sub-Sahara
Africa:
absence of disease
dignity
freedom
equilibrium
entirety
In this lecture I will perform a health check on medicine with regard to these essential health resources.
My hypothesis is twofold:
1.
Specialized biomedicine has a potential for undermining these basic health elements.
2.
General practice has a potential for promoting these basic health elements.
Now,- let us test these postulations.
* In the Kalahari study, Robert Selato, Ministry of Health, Botswana, also took part.
2

A health check of medicine
Absence of disease
Absence of disease is a strong precondition for good health according to our
Norwegian informants:
“Good health – of course, is to be free from disease.”
Good health for a young San man requires air, not disease in the body:
“When you wake up in a good health, you will feel the air through your body.”
These statements crystallize the very essence of medicine’s mission: To heal the ill. And we are devilishly good at it. Medical science has evolved like a revolution providing us with new technologies and enormous clinical power.
Today modern medicine has an unprecedented capacity to prevent disease, relieve suffering, improve quality of life, enhance functional capacities, prolong life. In short: We make life better for millions of people every day and night.
Modern biomedicine is a mighty project. It represents a unique symbiosis between intellectual brilliance, technological refinement and humanitarian values. We, the GPs, are proud of taking part in this enterprise.
But health is not merely absence of disease - health requires presence of positive values - biological, spiritual and social, greatest among them is:
Dignity
To be or not to be met with respect, to be or not be confident in yourself, these to be’s or not to be’s, named dignity, are the major determinant of health according to the drums from the African jungle and the Arctic tundra.
When we did fieldwork in an arctic fishing community, the local priest interviewed the three candidates for confirmation, aged 14 – 15. He asked:
“What is most important for you to have a good life?” They answered in a chorus: “To be seen and accepted as me.”
The San people provide contrasting proof. Their dignity is stolen. During the last decades they have lost land rights and are now impoverished and suppressed. A man of 21, feeling lost and confined in an isolated settlement has sweet memories of participating in a dancing contest in the capital. He says he would like to live a modern life in Gaborone: “Because the health there is very good and the water is good and nice. When I can stay there, I could change color and be like the white people.”
3

How does medicine connect to the existential health element called dignity? Do we promote or impair dignity in our patients? Modern biomedicine dances in the trance of science. Modern techno-medicine approaches the patient as a bodily thing, as an object (4,5).
The human right to be seen and recognized as the one and only me on Earth, is violated by medicine. Standardization is our tradition, while modernity calls for individualization. An old woman in Norway expresses the feeling of being made an object in elegant words: “When I go to see my doctor, I feel like a transport medium carrying my disease to him. But I am not my disease. I am me, a human being.”
Dignity may be further eroded when medicine displaces religion as the moral tribunal of postmodern society. Today sin, guilt, purity and dignity reside in medicine not in religion. Medicine designs ideal norms for bodies, lifestyles, souls and functional capacities. People who deviate from medicine’s normality may fall prey to stigma, shame and blame.
Furthermore medicine is deadlocked in the epidemiological trap. Results from research on the masses are brought to action on a totally different unit: The unique human conundrum called The Patient. Results from the big N are transplanted back to original me. That is a hazardous and sometimes disastrous operation.
The general practitioner may counteract medicine’s theft of dignity (6). Because general practice stands for the opposite of standardization, namely the noble art of personal doctoring. Like Dr. Rieux in Albert Camus’ The Plague (7) the GP has discovered that “there are more things to admire in men than to despise”.
Like John Berger’s The fortunate man (8), every general practitioner accumulates admiration for the patients will to live, cope and fight even when existing at or in the abyss. The doctor’s respect builds dignity in the patient.
Freedom
Freedom, to be in command of ones life and future is an essential quality of health. A woman in her mid 60ties associates health with “daring to believe in yourself and making your own choices in life.”
In the Kalahari freedom to health is stolen. In 2002 the last San were deprived their freedom to live, hunt, love and die in The Great Thirstland. They were deported to government settlements. Their new life was described like this by an
4

old San man: “It is as if you have tied a donkey around its front legs in order to control its movements. So how will they survive in such a situation?”
So how does medicine take care of this precious health resource – freedom?
There is a strong conviction in medicine anticipating: We know what is best for the patient. Medicine’s intentions are good. But for the patient the result may be suppression. The patient may feel imprisoned in a clinical cage. The people may feel oppressed by a public health tyranny (5,9).
Medicine restrains freedom of health in one more way. Medicine sentences health to death in a prison of fear. Protection, prevention, plights, duties, selfdenial are the mantras of health promotion. Lost in the wilderness of risk is health as joy, courage, meaning and freedom to do experiments in life.
The general practitioner emerges as medicine’s freedom fighter. Because the general practitioners can do nothing but confess to democracy. As a near life doctor for 2000 different human aliens, the GP has learned to cooperate with the one and only expert on me, my life, my world, my past, my future, my health:
The patient. The GP complies with one of our arctic fishermen praising health as an individual property: “Good health – it depends on who you are, where you live, the society around you, - and in particular on the person you are. There is no common denominator. What is good for one, cannot help two thousand.”
Equilibrium
Equilibrium is the essence of health in many cultures. Our informants in
Kalahari and Norway confirm this medical wisdom. A man in his 40ties in
Norway associates good health with “Yes, you are in harmony, are fond of yourself, like the people around you, then your life is in balance.”
An old San man agrees “People with healthy bodies are people who stay with others harmoniously, without quarrels, in good cooperation with each other.”
Now, to gain harmony, you have to adapt, cope and endure. Finding the balance requires a pragmatic, not an utopian approach to life. The health experience of an old man in a Norwegian mountain village is: “That you are balanced, and settle well. To find balance, you have to adapt to a life in change.” The mountain man has experienced the truth of Rene Dubos’ definition of health (10): “Health and happiness are the expression of the manner in which the individual responds and adapts to the challenges that he meets in everyday life.” Health is not a heaven-like condition of sweet nothingness. Health implies confronting stress
5

and coping with the vicissitudes of life. Health is also to accept pain and coexist with imperfection.
Seneca, the stoic, teaches that there is only one way to health (11): To reject the craving for heaven on Earth, to embrace life with failures and torments. A woman in a small town demonstrates Seneca’s point: “Well, my husband is 71, he has had a by-pass operation and has high blood pressure, but I would not dream of calling his health bad. And I myself broke my back in an accident 10 years ago. Now I have an invalid pension. I wake up in the night with pain, but I would not say that my health is bad.”
Our informants do not expect to be clones of superman or superwoman. They reconcile with life and health as blend of opposites:
of joy and sorrow
of wellbeing and pain
of confidence and fear
Critics accuse medicine of infecting people’s minds with utopian ambitions
(12,13,14). Medicine advocates zero risk. Consequently people demand zero risk. Medicine promises optimal physical, mental and social well being, consequently people expect to be better than well. Disease mongering, not healing, may be the effect of a hyperactive medicine. There is a danger that medicine by promising too much prevention and too much cure can distort the sobriety of peoples own health management and seduce them into medical miserabilism.
Here, we need you, the general practitioners as wise go-betweens. You are raised to mind and bridge the gap between health on the Parnassus of medicine and health in the wildlife of humans. The GPs try to redress disease and illness, but the general practitioners also enlighten the bright sides of life (15). We search for potentials, opportunities and resources in the mixed lives of our patients.
You have specialized in translating the medical textbook into everyday life.
“Nobody knows the trouble I have seen,” complains the negro spiritual. Wrong.
The GP knows some of your troubles, your constraints, your fears, and his noble and humble aim is, together with you, to make the best health possible out of it.
We are reality doctors. You are all colleagues, brothers in name, of a healer I met in Africa, he called himself professor Goodenough. The general practitioner is Master of imperfection. That is a brave mastery to hold. Hold on to it – it ought to qualify for the Nobel prize in medicine.
6

Health as entirety
The very word health stems from old English hal meaning the whole. The experiences of our informants confirm that health is wholeness. A woman in her
30ties, mother of two children, conveys this holistic health picture: “Good health for me, - of course I think of my health, but as a mother I feel that good health for me implies that my children are in a good state. So if I handle my children well, have money for the healthy food I want to give them, can enjoy good company with friends – this is good health. And in addition good health is to have somebody to laugh with, - and one to love.”
This young mother expresses the validity of Piet Hein’s poetic definition of health presented at the 40th anniversary of The World Health Organization (16):
Health is not bought with a chemist’s pills nor saved by the surgeon’s knife.
Health is not only the absence of ills but a fight for the fullness of life.
Also the San people report health as a holistic experience: A good life including freedom to hunt, access to ancestors’ spirits and water. They perceive health in the same universal dimension as the Aborigines according to Reid (17): “Health to the Aborigines, is not a simple matter of prudent lifestyle and good diet. It is the outcome of a complex interplay between the individual, his territory of conception and his integrity: His body, his land and his spirit.”
Now, - how does medicine approach health as wholeness? There are now 72 recognized specialities and subspecialities within modern biomedicine. There are now according to the latest international classification of diseases, 22 117 diagnoses (18). The cutting up of the living human corpse has been medicine’s principle method since Descartes 400 years ago. It has brought great advances to the part, but at the expense of the whole. Modern biomedicine is double blinded for the soul and the whole.
Many patients feel belittled when they meet fragmented techno-medicine. They experience a kind of deconstruction. Suddenly they find themselves lost in the medical factory as bits and pieces. They miss a doctor who can restore health as a whole. They long for you, the Masters of generalist medicine. Our approach is to diagnose and treat an illness or a disease in an organ, in a body, in a human being, in a family, in a working place, in a society, in an environment (19).
According to Ian McWhinney (20), general practice “is the only discipline to define itself in terms of relationships… .” The GP oscillates between the part and the whole, commutes between the body and the soul, explores between the person and the environment. This is our most distinguished competence: To make medicine work, grounded in the totality of this unique patient, on this strange Friday, in this peculiar spot on Earth.
7

Nature and society
Speaking of entirety, sometimes, not every day, but on this Friday, we must discover the myriads of feedback-loops between man, nature, and society.
The patient does not live in splendid isolation. The individual’s health interacts with the health of nature and the health of the society.
Nature
Our informants regard a healthy nature as a condition for good human health.
Some have a strong spiritual relationship with nature. A young Norwegian woman confides: “The one I believe is the Creator, I meet him out in nature.
There is a force out there, and I get energy from nature. Enormously. I do.”
People also feel a kind of organic solidarity with nature. A San informant states:
“As I see it, - our health is connected to the health of all living beings.”
To be healthy requires that your territory is healthy. A man in Oslo loves the city: “I am on my own territory. I am in love with this city.” And then he tells how he became physically ill when the trees in his street got sick and died from traffic pollution.
For Norwegians as for the San, nature gives identity, self-confidence and sense of coherence (21).
So what is it in it for me, asks the general practitioner. Shall I enrol Nature on my list? The answer is yes. Global warming represents an urgent and immense threat to human health. The climate hazard calls upon ecologically attentive doctors. Nature is an essential health resource. Therefore medicine is obliged to participate in the rescue operation for the Patient Earth. Doctors have a moral responsibility to prevent disease and relieve suffering. In 1986 International
Physicians for Prevention of Nuclear War received The Nobel Peace Price. In his Nobel Prize lecture Dr. Lown said (22): “It may be argued that nuclear war
(the climate crisis) is a social and political issue and we may address it only as concerned citizens. But we physicians have taken a sacred and ancient oath to assuage human misery and preserve life. This commitment imposes social and moral obligations on us to band together to make our collective voices heard.”
What can we do in our own practice on a Wednesday?
- We can gradually colour the practice green and perform a sustainability check on all procedures and consumptions.
- We can be clinically observant so that we can diagnose medical signs of climate changes and act as early whistle-blowers.
8

Society
Man belongs to nature - and man belongs to a society. Politics always accompany the patient to the doctor. “It is in a way the whole development of society that tailors your health,” states a young woman in Norway. The San are voices from a world of brutal inequality. Their political bodies bear the marks of suppression and poverty. Seventy years ago General Smuts, then Prime Minister of South Africa, considered the bushman “mentally stunted” and “a desert animal” (23). Today a young San woman embodies this long story of heavy discrimination: “We are just like sand, everybody step on us.”
Now, what is medicine’s response to the political shaping of health or making of disease? Traditionally medicine has hailed “no stand”, a neutral apolitical position. An apolitical medicine favours what our Welch colleague Julian Tudor
Hart calls “The inverse care law” (24). A social unconscious medicine may be exploited by the affluent and healthy majority who demands zero risk and to be better than well.
A further adverse effect of an apolitical medicine is that of medicalising political pathology. Signs and symptoms of poverty, unemployment, racism, of stolen dignity and lost freedom - these political ills are transformed to medical diagnoses and transplanted from the political to the therapeutic society.
In the state of Mississippi 200 years ago a common diagnosis was
Drapetomania, conferred to slaves with a repetitive tendency to run away. What are the run-away- diseases of today? Chronic fatigue syndrome? Attention
Deficit Hyperactivity Disorder? Bipolar mood oscillations?
Now,- from whom in the House of medicine should we expect political awareness? From us, from the general practitioners because we are in-the midstof-society-doctors. We are the scouts at the front-line of medicine in a favourable position for early warning. Our patients are messengers carrying messages:
from a safe or dangerous working place
from a family in harmony or implosion
from an economy that is equitable or polarised
from a community that shows acceptance or stigmatisation
from a future inspiring people to contribute or paralyzing them with apocalypsis now.
9

Not only in the Kalahari Desert, also in wealthy Norway and affluent Australia, do we experience an escalating medical class society fuelled by neoliberalist politics. Confronted with the political epidemiology what can we, the general practitioners, do?
We can bear witness to society. We can reveal the political pathology and report our findings back to the public and the politicians, instead of participating in a medical cover up project. So let us go boldly out with our medico-political knowledge accumulated through thousands of clinical encounters.
But: “The change you want to see in the world, you have to be yourself,” whispers Gandhi. The general practitioner can implement sane political ideals in her own practice by giving priority to patients that are most in need. It is possible as Julian Tudor Hart has pioneered in Glyncorrwg in Wales, to combine personal doctoring with social medicine, and to take a population approach to clinical care (25).
It may seem utopian to encourage GPs to enrol nature and society on their list, full as it is already. But engaging in the health of nature and in the health of society may be a win-win strategy. When people experience that doctors care for basic ecological and political health resources, they build trust and trust is, as you know very well, the most effective tool in the clinical encounter (26).
Investment in collective social medicine will therefore pay back in individual, clinical medicine.
The paradox of medicine
Colleagues,- we have now explored the bright and dark influences of medicine on health. A paradox emerges: Inherent in the execution of clinical power is a potential theft of vital health elements: Dignity, freedom, equilibrium and entirety. My conviction is that general practice may counteract the pathogenic propensities of medicine. We are part of main medicine, but we are also different (19,20). We are personal doctors, near-life-doctors and art-of-the possible-doctors. Main medicine needs these doctor personalities, these general practice qualities. So in a more courageous way, we must smuggle our professional diamonds into main medicine - for the sake of the health of the people, for the sake of the sanity of medicine herself.
The prescription
Colleagues,- it is of vital importance to preserve general practice, without whom medicine will crumble. So our last question is: How can we ensure a sustainable
10

general practice? There are three remedies on my prescription for eternal life for general practice:
to thyne own self be true
faith
research
To thyne own self be true
Shakespeare has prescribed the essential medicine for persons as for professions:
“To thyne own self be true.” Iona Heath writes (27): “General practice is a power for good but it is threatened by the process of accelerating change and will only have a future if it can explain and justify itself.” We cannot just say
“General practice”, as a mantra and expect patients and politicians to bow in awe and say hail. The trademark general practice must have a solid content.
Behind the brand patients, colleagues and politicians must discern a specific product. We must do like Hamlet, hold the cranium in our hand and state: “This is us, this is general practice from dawn till the end of times.” So what do we see then, when we hold the cranium of general practice in our hands? I see a person.
Personal doctoring is our most distinguished competence. Sir William
Osler states (28): “It is more important to know what person has a disease than what a disease a person has.” But personal doctoring is more than knowledge. There is also a moral quality in personal doctoring. The GP cares and wants to do the patient good. Personal doctoring has a flavour of moderated love. Healing is person and passion - combined with science and technology.
Pragmatic doctoring, which means together with the patient to identify
The-enough-point when it comes to prevention, diagnosis and treatment.
Generalist doctoring, which means reading the patient’s signs in the context of her history, her relationships with family, God, the bank and her broken dreams.
Magic doctoring. The GP can be the “drug doctor”, ignite hope, inspire courage and induce confidence. The famous Swedish doctor Axel Munthe held the ability to inspire confidence in high esteem. He said (29): “The doctor who has this gift, can almost raise the dead.”
Joyful doctoring. Personal bonding with patients is gratifying. The-art-ofthe-possible-medicine stimulates courage. Meeting the tales of the unexpected, the manifold of lives and illnesses fuels curiosity and
11

provides variation. The hidden magician gets a chilling feeling of being sinful. So a smile of joy belongs to the GP cranium.
I saw the same smile of joy and wisdom in the face of our colleague in the
Kalahari. We share smiles and foundations with healers from all times: Personal bonding, continuity of care and common ground with the people (8,30,31).
The next two remedies on my prescription for a viable future general practice are seemingly antagonists, but we do need both faith and research.
Faith
Sustainable general practice depends on faith in our core values. Sir William
Osler states (32): “…. But faith in ones powers; in ones mission, is essential to success.” Colleagues, I have a feeling of declining spirits in general practice world wide. If we adopt a self perception of being Masters of none, Jacks of all trades, money driven opportunists, puppets on governmental strings, - then we will soon be gone with the wind. Within 50 years GPs may be an extinguished species. Therefore we must believe in our cranium.
Research
So, faith we must have in our ideals, but modern minds demand more. They do not trust psalms of praise. They crave evidence. With research we must explore our diamonds. With scientific brutality we must define the carat of our diamonds
– are they real, are they glass, are they hollow plastic? With research we must refine our tools for personal doctoring, pragmatic doctoring and generalist doctoring. And with research we must scrutinize the outcomes of personal, pragmatic and generalist doctoring. What are the effects, the gains and losses on patient satisfaction, on health economy, on clinical outcome, on epidemiological endpoints?
The last dance
Colleagues,- general practice may be in trouble now (33). We need n:xum, the
Energy, the vital power, guarded and provided by the ancestors’ spirits in the
Kalahari, as in Norway, as in Australia.
A bonfire lights up. General practitioners emerge from the shadows. Gradually they start to sing, clap and dance, monotonously, compelling, to build up
Energy. Finally the Healer enters trance and passes over to The other side. Here he consults with the spirits of great healers. He presents the case: “There is
12

confusion in the universe of general practitioners. They are bewildered between old, some say antiquated virtues, and new, some say modern sins - imposed upon them by market economy, by new public management and by rigid scientism. The ancestral spirits and ancestral spirits to be, contemplate and negotiate for a long while. Then they write their prescription to heal their fellow general practitioners:
William Osler (28):
And from the standpoint of medicine as an art for the prevention and care of disease, the man who translates the hieroglyphics of science to the plain language of healing, is certainly the most useful.
Ian McWhinney (20):
If we are to be healers …. we have to walk hand-in-hand with our patients through the territory.
Iona Heath (27):
Each person and each context is unique and this is the joy and the challenge of general practice care.
Julian Tudor Hart (14):
…to use medical science, doctors and patients will both have to learn that diagnoses are not beasts in the jungle to be hunted, but human stories within real lives to be understood.
Theodore Fox (34):
… we give Mrs. Smith and Mr. Aboyu precedence over the whole of Science.
So far from being dedicated scientists, we can say, like the dwarf in the fairytale: “Something human is dearer to me than all the wealth of all the Indies”.
Colleagues,- the last words of this lecture, I give to my inspirator, the healer in
Kalahari. His last words, spoken in a voice of velvet and nuclear power, was:
We still dance - and it will never end.
13

Literature
1. Katz R. Boiling energy: Community healing among the Kalahari !Kung.
Cambridge (Ma): Harvard University Press, 1982.
2. Ingstad B, Fugelli P. “Our health was better in the time of Queen Elizabeth”.
The importance og land to the health perception of the Botswana San. In:
Hitchcock RK, Ikeya K, Biesele M, Lee RB, eds. Updating the San: Image and reality of an African people in the 21 st
century. Tokyo: Senri Ethnological
Studies 70, 2006: 61-79.
3. Fugelli P, Ingstad B. Helse – slik folk ser det. Tidsskr Nor Lægeforen 2001;
121: 3600-4.
4. Illich ID. Medical nemesis: the expropriation of health. London: Calder and
Boyars, 1975.
5. Skrabanek P. The death of humane medicine end the rise of coercive healthism. Suffolk: Crowley Esmonde, 1994.
6. Malterud K, Hollnagel H. Avoiding humiliations in the clinical encounter.
Scand J Prim Care 2007; 25: 69-74.
7. Camus A. The plague. London: Penguin Books, 1965.
8. Berger J. A fortunate man: the story of a country doctor. New York: Vintage books, 1997.
9. Fitzpatrick M. The tyranny of health. London: Routledge, 2002.
10. Dubos R. The mirage of health. London: Allen & Unwin, 1960.
11. Seneca LA. In: Cooper JM, Procope JF, eds. Moral and political essays.
Cambridge: Cambridge University Press, 1995.
12. Elliot C. Better than well. American medicine meets the American dream.
New York: W. W. Norton & Company, 2003.
13. Fugelli P. The Zero-vision: Potential side effects of communicating health perfection and zero risk. Pat Educ Couns 2006; 60: 267-71.
14. Hart JT. Expectations of health care: promoted, managed or shared? Health
Expectations 1998; 1: 3-13.
15. Hollnagel H, Malterud K. From risk factors to health resources in medical practice. Med Health Care Philos 2000; 3: 257-62.
16. Hein P. Prologue at the Celebration of WHOs 40 th
Anniversary.
Copenhagen: WHO, 1988.
17. Reid J. Body, land and spirit. St Lucia: Queensland University Press, 1984.
18. International Classification of Diseases an Related Health Problems. 10 th edition. Geneva: World Health Organization, 2004.
19. Sturmberg JP. The foundations of primary care. Daring to be different.
Oxford: Radcliffe Publishing, 2007.
20. McWhinney IR. The importance of being different. Br J Gen Pract 1996; 46:
433-6.
21. Næss A. Deep ecology of wisdom. In: Glasser H, Drengson A, eds. The selected works of Arne Naess. Volume X. Dordrecht: Springer, 2005.
14

22. Lown B. Nobel Peace Prize Lecture. A prescription for hope. N Engl J Med
1986; 314: 985-7.
23. Lewis-Williams D, Dowson T. eds. Images of power. Understanding San rock art. Cape Town: Struik, 1989.
24. Hart JT. The inverse care law. Lancet 1971; i: 405-12.
25. Hart JT. The political economy of health care: a clinical perspective. Bristol:
Policy Press, 2006.
26. Fugelli P. Trust – in general practice. Br J Gen Pract 2001: 51: 575-9.
27. Heath I. The mystery of general practice. London: The Nuffield Provincial
Hospital Trust, 1995.
28. Bean WB, ed. William Osler. Aphorisms: from his bedside teachings and writings. Springfiled, Ill.: Thomas, 1961.
29. Munthe A. The story of San Michele. London: John Murray, 1929.
30. Brody H. The healer’s power. New Haven: Yale University Press, 1992.
31. Helman C. Suburban shaman. Tales from medicine’s frontline. London:
Hammersmith Press, 2006.
32. Osler W. The faith that heals. BMJ 1910; june 18: 1470-2.
33. Heath I. Only general practice can save the NHS. Why have governments been intent on undermining the morale and status of general practitioners? BMJ
2007; 335: 183.
34. Fox T. Purposes of medicine. Lancet 1965 Oct 23; 2(7417): 801-5.
15