Doctors are male, of course. Generically and, in the eyes of most patients (and, for that matter, most doctors), genetically. The female doctor is considered inadequate and inferior but, as far as the still male-dominated world of general practice is concerned, great for dumping the endless (and so, so tedious) parade of "women's problems" on.
Preferably without paying her adequately. The despicable system of the "doctor's retainer scheme" was supposedly a way of subsidising women GPs who had taken time out to do appallingly inconsiderate and irresponsible things like having children, but wished to keep their skills up to speed without returning to the full-time jobs that had been snapped up by men. It was misused, in many cases with casual fraudulence, as a way of getting surgeries covered for nothing. The contribution that the practice was supposed to make to the retainer's pay was ignored.
As a doctor's "wife", I have lived through the sheer ignominy heaped upon the woman doctor by the junior and senior dinosaurs of a male-dominated profession. It still happens, despite my (personal, not professional) partner's position as a single-handed practitioner, responsible for her own chunk of the Shetland Islands from accident and emergency cover right through to dispensing. She, at least, has the luxury of being able to establish genuine personal patient care. But there is the pressure of 24 hours on call and the necessity for absolute self-reliance, not to mention co-operative significant others. It's all preferable, they say, to the poisonous mire of medical politics, where medical services are discussed in terms of formulae . . .
The telephone rings: I am, literally, holding the baby. It is a distraught inhabitant of a local residential caravan site who has a man apparently bleeding to death from stab wounds in his caravan. The doctor, meanwhile is already at the caravan site. She has been called, it will later emerge, by the man who stabbed the bleeding man, before inflicting minor injuries on himself so he can claim self-defence.
Welcome to the wonderful rural idyll of Shetland medicine.
That was all a decade ago, by the way. The caravan site has disappeared, the Glaswegian knife-wielder is either dead, in prison,or has changed his name yet again; the police arrived after an hour and the stab victim didn't die. The baby went to sleep of his own accord about 3.45am. The doctor talked her way out of knife-point trouble and stopped the bleeding.
I think of that incident, and dozens of equally traumatic, utterly dissimilar ones, when talk turns to Professor Sir John Arbuthnott's report into NHS funding in Scotland, Fair Shares For All. Because one of the obvious implications of the Arbuthnott funding formula, on the face of it, would be a reduction, in real terms, in resources for Shetland - small population, remote, rural, scattered, comparatively well-off compared to places like the Western Isles. There was no question where the rationalising procedure seemed set to start: with a merger of our practice (tiny community scattered over a large, inaccessible area) with the adjoining one (much larger numbers, including semi-urban developments associated with the Sullom Voe oil terminal, stretching halfway to Lerwick). This could conceivably have left an emergency call-out distance of up to 50 miles to be covered, on marginal roads, perhaps in almost inconceivably bad conditions. One doctor on call for the whole damn lot, too, including the biggest oil and gas terminal in Europe. Call that fair shares for all? Call that healthy?
No wonder the local health board went quietly and measuredly berserk at a health committee on the Mound. Last week, Professor Arbuthnott himself was promising the Shetland Times further consultation, and that Shetland was, well, probably a special case. Unforgettably, he told the paper: "There's remoteness . . . and there's remoteness." Well, quite. "In Shetland they're a very long way away." True. "The health department is looking into that at the moment" - what with? A telescope? - "and I have no real problem in saying if there's something to be looked at there it will be looked at." Now that's what I call reassurance.
Meanwhile, I have the dinner to cook, having just convinced the patient who phoned five minutes ago that I am not the locum and that I cannot give her any advice on what to do about a vaginal discharge. These women's problems . . .
