Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: Living above the shop

BMJ 2019; 367 doi: (Published 22 October 2019) Cite this as: BMJ 2019;367:l6031
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

“I saw you out running the other day, doc.” Given the choice, would you prefer to work in a practice near where you live or opt for the anonymity that distance provides? Laziness won out over privacy when I joined my practice, so I live in the community I serve, and my commute is three minutes by bike.

The disadvantages are obvious: it’s harder to keep public and private personas separate. If I want to let my hair down I need to put a little distance between myself and my surgery, or I risk comments the following week about my graceless dancing or ill-advised Catwoman fancy dress. As doctors we’re expected to practise what we preach, so it’s good to be seen exercising but bad to overindulge in alcohol in public. And a poker face is necessary when gossip at the school gates touches on people or situations you know about from the surgery. When you’re privy to personal details—not only physical and mental illnesses but also domestic violence, debt, and despair—some social gatherings can be uncomfortable.

Not everyone chooses to live and work in the same neighbourhood, and it would feel claustrophobic to some. In years gone by many GPs consulted in their front room, lived at their surgery, and were on call day and night. Although our long hours culture can make home seem like just somewhere to sleep, I’m still grateful that “living above the shop” is no longer the norm. One worry is that patients may try to consult with you on street corners or in local shops. In reality this rarely happens, as there are unwritten rules that most people respect. On the occasions I’ve been present at a minor accident I’ve found that the gratitude offered for simple advice is disproportionate to the effort involved.

When I was a student a friend of mine worked as a GP in a rough part of Amsterdam. Walking home one evening, she was accosted by a stranger, but help rapidly arrived and her potential mugger was sent packing with cries of, “Leave her alone, she’s our doctor!” In my neighbourhood I’m unlikely to need that kind of protection, but I do benefit from the sense of belonging that her story encapsulates.

It’s not merely a matter of geographical rootedness, by virtue of having been here so long, but a feeling of connectedness to the community because of the multiple overlapping relationships with my neighbours. Over the years I’ve helped them look after their health while they’ve taught my children at school, offered advice about vegetables down at the allotments, and stayed open all hours for when I run out of milk.

If I ever do feel the need to escape there’s the option of becoming a dis-located doctor in cyberspace, consulting by smartphone app—but for now I’m grateful for community, continuity, and that sense of belonging.