Month: August 2025

“A Fortunate Man” is a bit of a hard book to categorize. In part, because of Jean Mohr's photography distributed throughout, which resonate with the compositional loveliness of paintings¹; in part because, unlike John Berger – whose classic art series, “Ways of Seeing,” is free to watch on YouTube – novelists/art critics do not typically write medical biographies. But here we have Berger attempting to capture the unique outlook of country doctor and personal friend John Sassall.

The role of a "visiting doctor" – like Sassall – probably peaked around the time of Doctor Watson and was already nearly extinct by the essay's original publication in 1967, let alone today in 2025.

So, with all of the book's peculiarities, can a modern medical student get something from reading A Fortunate Man? Well, at least one author (published in British Journal of General Practice) considered it the "the most important book about general practice ever written," so it's worth considering.

For starters, let's return to the aforementioned photography:

How many medical biographies begin with landscape photos?

Mohr reveals the enchanted quality of the English countryside, with unsettling hugeness and trees disappearing into fog. More importantly, by portraying landscape first, A Fortunate Man emphasizes the doctor's place within a particular community.

As an outsider to the medical field, I can't imagine that landscape factors heavily into residency ranking, but perhaps it's less strange than an initial impression might seem. Location affects more than general opportunity levels; place affects likely occupations, levels of cultural homogeneity or diversity, and maybe even aspects of personality. While it's unlikely that any modern doctor will solely serve a population à la John Sassall, extreme examples can illuminate the "normal" – and afford the chance to think about them. What size population do I wish to serve? How closely do I wish to work with patients? Like Sassall, can I be a part of the community I serve? Or is 21st century life too atomized? Too sprawling? Too detached? Is it possible to make it less so?

Throughout the book, Berger attempts to elucidate Sassall's philosophy, both to answer why someone would pursue the white coat at all and why they would choose to serve a small, secluded community after they've done so.

As a child, Sassall considered becoming a mariner and later served as a navy doctor. At least through the pen of John Berger, Sassall approached illness like the sea: a force of unknown and unimaginable ferocity that one can only sometimes learn to navigate. But Sassall was possessed with a desire to know – and to confirms things for himself: the clear hallmarks of a scientist. Both the sea and illness present a practically unlimited horizon of the unknown.

Of course, absent a moral compass, this could easily become deranged. However, Sassall fascinates Berger specifically because of his fraternity with his patients (p. 76); Berger speculates, in fact, that the public measures a "good" doctor not by their cures but by this sense of fraternity, of striving to recognize the patient (and not just their illness).

In discussing medical practice, much of the book examines this recognition. The doctor must sift through information to make a diagnosis, distinguishing the individual from the general. "GPs are rare," Berger opines, "because few can take in all the possibly relevant facts" (p. 73). Sassall attempted to assess the patient in their unique entirety, mirroring the early psychoanalysts in doing so.

Sassall's evergreen example of bedside manner applies across the medical field. And mixed with Berger's analysis of the doctor's role both in and outside of society,² the book's esteem starts to make sense. Throughout, Berger considers, "What is the consequence of facing the extreme anguish of persons five or six times a week" (p. 113)?

That answer doesn't come easily.

In many ways, Sassall is not a "fortunate man," and Berger clearly sympathized with the cost: Sassall faced not only the grief of the community but the impossible task of healing the unhealable. But ultimately, he faced these "consequences" because he loved his work, and so like the man who finds a treasure hidden in a field³, was willing to sell all he had to pursue it.

For anyone on their own medical journey and wishing to understand the drive of someone who came before, I recommend "A Fortunate Man."

References:

Berger, J. (1995). A Fortunate Man. Vintage

1. Of course, Mohr also photographs Sassall and his patients. The remarkable naturalness of these photos suggests either the photographer's skill at staging or the doctor's skill at conversing with his patients. Some emotions, like distress, require no acting (obviously), but other emotions, like inquisitiveness, shine through just as clearly ↩︎
2. Berger has a particularly interesting meditation on the shaman as the first figure removed from the general duties of the tribe, the advantages and disadvantages of that (p. 64) ↩︎
3. An allusion to Matthew 13:44 ↩︎