Book Review: Secrets from the Black Bag by Susan Woldenberg Butler RCGP Publications This collection of short stories is about GPs working in various different parts of the world; ranging in time from the early twentieth century to the 1990’s. The focus is on doctors who practise in isolated, rural settings and who hold unique positions of responsibility within their communities. Their work is all-encompassing in a way it rarely is in England these days; there is nobody to step in and no one else to cover nights and weekends. Most of the doctors featured are men, the majority of whom are married and rely on the support of their wives in order to be able to function at work. This takes its toll on some marriages. In one short story, a doctor’s wife talks about her feelings of bitterness towards her husband’s job and towards some of his more demanding patients. When work and life become so inextricably linked, it seems that there is almost always some kind of fall-out and it is often the doctor’s family who suffers. Many of the stories describe memorable home visits, some of which take place in an era when the doctor was called in not just to resolve medical problems but also social and moral disputes. In one case, a GP is called in to smooth things over when a husband becomes so exasperated with his wife’s extravagance that he threatens to shoot her if she returns home. Another doctor makes a visit to a farmer’s wife and ends up treating a bull with indigestion. Some patients have particularly poignant stories –for example the young girl who hides her baby under a wardrobe because she is so ashamed of its illegitimacy, another who never forgets her first love and never discovers why he left her. Reading it now, it is apparent how ingrained medical paternalism was; and how new the discipline of medical ethics is. For example, a young GP working as a locum in New Zealand in the 1950’s is required to give a course of penicillin injections to the wife of a local politician who has contracted gonorrhoea from one of his mistresses. When the wife asks the locum what her diagnosis is and is given an honest answer, the locum is furiously berated by his senior partner and almost dismissed. Primary care as described in this book is light years away from our brand of evidence based, guideline driven medicine. The doctors practise according to what they perceive the individual patient’s needs to be and are often more interested in quality of life than in quantity. Continuity of care is a given. For better or worse, the type of doctor featured in this book is a dying breed. To be all things to all people is simply unsustainable, perhaps particularly in the modern world. Mistakes are inevitable, and are less likely to be forgiven in our litigious times. What is encapsulated so beautifully in this book is the importance of the human touch in medicine, a quality which can’t be measured or audited. I would highly recommend it to anybody who practices or has practised medicine. Dr Rupal Shah MRCGP, Honorary Editor The New Generalist