For the pleasure of their company

BMJ 2004; 329 doi: (Published 12 August 2004) Cite this as: BMJ 2004;329:380
  1. Marga Hogenboom, general practitioner
  1. Camphill Medical Practice, Aberdeen

    It was a normal surgery, nothing exciting, the usual complaints. Patients came and went. On looking back, however, I find that three patients stand out.

    One patient gave me a hug, another told me that I was the best doctor in the world, and the third played a song for me with great care and feeling. Such encounters are not common; in fact, they are unique. The hug was given before I had time to anticipate it; the compliment was well meant without any hidden agenda; and the song—well, that was quite a treat on a grey winter morning.

    It so happened that all three men had Down's syndrome, and any concern about having a too familiar relationship with their doctor wouldn't cross their minds. What they also had in common was their total dedication to and enjoyment of the moment, of an encounter with me. I know they will bring the same quality of human awareness and directness to the next person they meet, and the next doctor will be the best ever. These three men, with ages from 22 to 60, are all healthy, have a good lifestyle, don't have many worries, and take pleasure in family and social life. In short, they are a delight to meet.

    On reflection, I feel troubled. These are exactly the people whom we medics try with all our skills to prevent being born. What is so awful, so dreadful about their destiny that it is not worth living?

    The likelihood that one of them will commit a crime or become a drug addict is quite slim. All three are in need of guidance, which will cost society money, but is such money less well spent than on the military or the new parliament building in Scotland? And I even refuse to believe they give their family so much heartache, after the initial shock at birth.

    I am in the unusual situation of seeing patients with Down's syndrome quite regularly in my surgery, as more than 3% of our practice population have this condition. And I can tell you, I don't mind a bit.

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