"Specialists beware - despite its light and fluently entertaining style this book has
an important message for our age. It is presented in so enjoyable a manner,
however, that although its price reflects the publishers view that the book is a
'specialist text', I would strongly recommend this book to all."
For anyone who needs to recover from the dry and difficult instructions from the
centre, for example, on the rules of the market, this book can make you laugh
and cry, but brings you back to the real reasons why many people stay working
in healthcare despite all the obstacles."
At heart, this book is both a definition and a defence of the values of the
'generalist', but it is much more than that. Willis illuminates his argument with
incidents from his own experience - many of which will generate echoes in the
memories of other GPs - and, as the book progresses, you realise that these
incidents are not mere illustrations but part of the argument itself -
The book is a delight to read because Willis writes with a clarity of style that can
only be achieved through clarity of thought - a commodity that grows
increasingly rare in medical writing.
Near the end, he explains that he set out to explore ways of retaining respect for
human value in an increasingly systematised world. By reading the book you become a partner in that exploration. I found it a rewarding experience, as, I suspect, will any GP who yearns for a more sustaining philosophy than the managerial and scientific pseuderies now inflicted
on us."
I agree with his diagnosis that the distinctive malaise of modern life in Western
democracies is the problem of judgement and its legitimacy. Judgement is
everywhere being denigrated and replaced with committees, regulations and
market mechanisms. There is a conflict between the explicit, the managed and
the procedural on one hand,; and the implicit, the autonomous and the
improvised on the other. In philosophical terms, Willis' concerns are continuous
with those of Michael Oakshott in Rationalism in politics, with the difference
that Willis approaches the problem from the side of practice.
Yet this sophisticated and humane critique is achieved with a lightness of touch
and a degree of accessibility which is quite remarkable (and is, I would guess, the
fruit of much toil). User-friendliness is increased by Willis' nice use of aphorism
('the tidiest place to store information is in your head') and his gift for the
memorable metaphor (patients are kept in 'boxes' in the practitioners mind; and
initiating a consultation is opening a box and zooming in on the contents).
Several of these turns of phrase have already entered my vocabulary.
This care with which clarity has been sought, and the sheer readability of the
text, indicate that Willis hopes for a readership among those who, like himself,
are obliged to grapple on a day to day basis with problems demanding a
response. Indeed it comes through clearly that the family physician must make
vast numbers of decisions - quickly and on the basis of incomplete evidence.
Even a decision to defer a decision must be an active one. The span of
responsibility is vast, there is no fallback upon the certainties of narrow
specialism or expertise; and yet there are good reasons to suppose that the job of
a personal physician is better done by one generalist than by a team of
specialists. It is in this sense that the family doctor can stand as a metaphor for
Everyman, and the job of general physician as a model for life itself.
This is best illustrated through narrative, and the stories here are superbly
told. Some are tragedies, quite exquisitely observed (I was actually moved to
tears at one point). But Willis also has a real gift, of a Chestertonian kind, for
highlighting the miracle of the mundane. I particularly liked his story of the
blissfully free Saturday which began with an oppressive list of jobs and conflicts
of priorities - and ended, totally unexpectedly, as dedicated to fixing an old
door lock. This was, as it turned out, the best possible use of time - satisfying,
useful, and impossible to predict. Without the space for lock-fixing, life would be
lost in its living..."
Simon Sinclair, Cambridge Medicine Vol. 11 Number 2
"If the late John Fry's book General Practice: the facts was about how it is in
general practice, this is the book about how it feels. Both are bookshelf
companions which nobody concerned with healthcare in the UK today should be
without. Both are accessible, enlightening and enjoyable...
Annabelle Mark, The Health Service Journal 4/5/95
"(of putative guides to general practice) only a few - Epidemiology in Country
Practice is a good example - give the impression that they evolved within
general practice. Yet those are the books that I treasure and I have just acquired
another one: The Paradox of Progress by James Willis...
Michael O'Donnell, Monitor Weekly 11/5/95
"This is a superb piece of writing; 132 pages of clearly and deftly expressed ideas
around the theme of 'retaining respect for human values in an increasingly
systematised world'. James Willis' love for his work and for his patients shines
through in the book. I am grateful to him for expressing and explaining some of
my own ill-understood feelings about my work and for the encouragement from
his validation of the role of generalist, of common sense, and of being quite good
at a lot of things, if not an 'expert' at any."
Tom Heyes, Review Quid Novi? (The Sheffield Faculty's newsletter) May 1995
"-his book is wonderful (yes, I know you're not supposed to say that sort of thing
in a book review, and, no, I'm not on a commission). It's about the vital
importance of humanity, common sense and generalists in our increasingly
technological, regulated and specialist world. It is both witty and serious, and
very easy to read, so would appeal to almost anyone. However, GPs are
particularly likely to enjoy it because he writes from his experience as a GP,
encapsulates much of the essence of being a GP, and includes some lovely
anecdotes. 'I think he's dead, doctor' is probably my favourite, but you'll have to
read it to find out why."
John Temple, Review Trent Bridge (Trent faculty newsletter)
"The best way I could describe this book is a mini Zen and the Art of Motorcycle
Maintenance for doctors. Rather as Pirsig used motorcycle maintenance as the
practical expression of his philosophy, so Willis uses his professional experiences
in general medical practice as the medium through which he comments upon
contemporary life. It is philosophy as autobiography.
This is a difficult trick to pull off, but here it works well. The result is a
substantial achievement which, because it has been done well, is easy to under-
estimate.
Bruce Charlton, Review for Theoretical Medicine
"Look at his chapter headings and anyone who stops to think occasionally will
feel the head starting to nod
What it comes down to in the end is that you have to decide; who rules? Will it
be the machines or the humans
Go and read this book. And when you're finished you can start on Pirsig's two
books. And after that you can read (if you can find it) Ivan Illich's 'Medical
Nemesis' And when you've done that you will have the intellectual ammo to blow
any six-pack of NHS administrators out of the water."
Declan Fox, Review GP Writer Autumn 1995
"Why does Dr Willis write at the moment? Because we are being assailed all
around by 'progress'. Management consultants using new information
technology have shown that we are only performing well if everything can be
measured and quantified. Thus in hospital 'we can have nurses who deal
personally on a daily basis with life and death situations, spending hours of each
week tapping codes into computers
A marvellous example of this, and witness to Willis' sense of irony and humour,
is the 1965 Morris Minor manual which required daily checks of the tyres for
stones and their removal. Was this ever really possible for anyone? His summary
of this is that 'rules are not solutions at all - they have become the problems'..."
David Watt, Review Journal of the Balint Society September 1995
"The author argues against the trend to define, document and record in the
name of progress. General practice is full of problems without absolutely correct
answers or logical solutions. This book provides anecdotal examples. The GP's
traditional role is now being threatened by the growth of central controls.
Information technology is dehumanising society, and producing rules that are in
themselves problems. Dr Willis argues that progress is detrimental to human
values and motivation, and that the need for new ideas lies where common-sense
practical studies prevail. This book should be read and discussed by every GP,
and even more widely by those in other professions."
Keith Thompson, Review for Update 1/11/95