It was the summer of 1992 when we first met. She was a retired nurse, aged 76, recovering from a heart attack. I was new to the practice, and we talked at some length. She told me about her work in the hospital, her children and grandchildren. And we talked about my experiences on the same wards and my growing family. She was checking out the new doctor, while I was putting into practice the “bio-psychosocial” approach drummed into us as we prepared for our college membership exams.

A few months later I was called to see her at home. She was short of breath and showing the first signs of heart failure. We talked about medication, investigations, or outpatient referral. She wanted as little “interference” as possible—preferably never to go near hospital again. We worked our way through various treatments and her symptoms improved a little. But gone were the daily walks to the baker or the newsagent—a few steps down …