A selection of comments received on The Paradox of Progress

"My opinion is that you have written a wonderful book. It was by turns exciting, inspiring and moving (I actually cried on page 63)..."
Medical academic 9.2.95

"Your book arrived at Porters this morning and I have just finished the second, careful reading. I did a quick ‘skim’ before lunch.
I am utterly amazed at the depth of the philosophy about ‘the world, life, and everything’. At a guess, I would have said the book was written by a theologian, not a GP"
Patient 9.2.95

"James. Again — thank you very much for writing a book which has helped to lift my spirits. Because I’m sure it will be reprinted I enclose copies of the pages on which I found a tiny number of typographical errors."
Epidemiologist 9.2.95

"Specialists beware — despite its light and fluently entertaining style this book has an important message for our age. It is presented in so enjoyable a manner, however, that although its price reflects the publishers view that the book is a ‘specialist text’, I would strongly recommend this book to all.
Simon Sinclair. Cambridge Medicine Vol. 11 Number 2

"I am finding the book quite fascinating and more absorbing than anything I have read for years. It has already made me look back on events that happened many years ago in a quite different light to that which I regarded them at the time …"
Author’s ex-GP Trainer 17.2.95

"I read very slowly these days but I have already delved into it far enough to know what a good book it is. It is beautifully written (where did you acquire such a smoothly flowing, deceptively simple, style?) … "
Author’s ex-headmaster 19.2.95

"What a delight to find your book on my return — indeed, it is about the only jolly item in a mound of post.
It really is a remarkable achievement. I read it, straight off, almost at one sitting — you have a wonderful gift for making the subject accessible to a wide audience … "
Military writer 23.2.95

"I really would like to congratulate you on an absolutely magnificent book. I do so agree with most of what you say and I found the style as readable as I found the content stimulating … "
Medical journalist 1.3.95

"You have wrapped up your serious and important arguments in such an attractive, light hearted parcel, with so much humour, as to make a fascinating read … "
Retired GP/researcher 6.3.95

"I really enjoyed ‘The Paradox of Progress’ and wanted to write and thank you for articulating the quiet howls of protest that many of us feel."
Young GP 14.3.95

"Just a note to say how much I enjoyed reading your book, which held me in my chair till 1.30 this morning. Although I am not a medical man I could relate to something on nearly every page. It also reminded me why I gave up being a computer consultant and opted for the less lucrative but more satisfying life of a self-employed author!"
Writer 21.3.95

" … It was immensely refreshing to read such common-sense observations on general practice — and indeed on life in general! I was particularly pleased to see that kindness and sympathy could at least honourably be regarded as part of our profession — sometimes this seems to be forgotten."
GP Trainer, Midlands 23.3.95

" … thank you for writing it. It is wonderfully and enviably readable … your use of analogy to make things root in the mind is brilliant and deceptively simple …"
Member of Council, RCGP 26.3.95

" … a quick note to say how much I enjoyed reading your book …"
Oxford Undergraduate 12.4.95

" … as I’m reading I find myself nodding in agreement and even startled at the almost ‘a priori’ sense of truth there is to many of the concepts you are developing. I’m looking forward to the opportunity of using your book to help balance the perspective that the medical students get from their disproportionate exposure to the subspecialists. BRAVO! For a much needed work well done."
Associate professor, USA 30.4.95

"If the late John Fry’s book General Practice: the facts was about how it is in general practice, this is the book about how it feels. Both are bookshelf companions which nobody concerned with healthcare in the UK today should be without. Both are accessible, enlightening and enjoyable …
For anyone who needs to recover from the dry and difficult instructions from the centre, for example, on the rules of the market, this book can make you laugh and cry, but brings you back to the real reasons why many people stay working in healthcare despite all the obstacles."
Annabelle Mark The Health Service Journal 4.5.95

"(¼ of putative guides to general practice¼ ) only a few — Epidemiology in Country Practice is a good example — give the impression that they evolved within general practice. Yet those are the books that I treasure and I have just acquired another one: The Paradox of Progress by James Willis …
At heart, this book is both a definition and a defence of the values of the ‘generalist’, but it is much more than that. Willis illuminates his argument with incidents from his own experience — many of which will generate echoes in the memories of other GPs — and, as the book progresses, you realise that these incidents are not mere illustrations but part of the argument itself …
The book is a delight to read because Willis writes with a clarity of style that can only be achieved through clarity of thought — a commodity that grows increasingly rare in medical writing.
Near the end, he explains that he set out to explore ways of retaining respect for human value in an increasingly systematised world.
By reading the book you become a partner in that exploration. I found it a rewarding experience, as, I suspect, will any GP who yearns for a more sustaining philosophy than the managerial and scientific pseuderies now inflicted on us."
Michael O’Donnell Monitor Weekly 11.5.95

"I enjoyed it hugely and I suppose the best praise that I can give it is that page after page I kept saying to myself ‘that’s just what I would have liked to have written’. Indeed I can’t think of a book about general practice that I feel more closely towards …"
GP, Cumbria 19.5.95

"This is a superb piece of writing; 132 pages of clearly and deftly expressed ideas around the theme of ‘retaining respect for human values in an increasingly systematised world’. James Willis’ love for his work and for his patients shines through in the book. I am grateful to him for expressing and explaining some of my own ill-understood feelings about my work and for the encouragement from his validation of the role of generalist, of common sense, and of being quite good at a lot of things, if not an ‘expert’ at any."
Tom Heyes Review Quid Novi? (The Sheffield Faculty’s newsletter) May 1995

"Dear James
Bravo for ‘The Paradox of Progress’. I brought it with me to read on holiday and found it as refreshing as 2 weeks in the med! If only it was required reading at the DOH.
Many thanks"
Winchester GP Trainee 1988-89 13.6.95

"I have enjoyed reading your book which I bought because of the foreword!
You have put into print exactly what many of us have been feeling for years.…
The invasion of the NHS by the business world has been particularly abhorrent to those of us who studied medicine during the war. We knew that a National Health Service was coming and we all shared a sense of joy that we could give patients any necessary treatment without regard to means.…
Carry on with the quality writing."
Retired GP 3.7.95

"…his book is wonderful (yes, I know you’re not supposed to say that sort of thing in a book review, and, no, I’m not on a commission). It’s about the vital importance of humanity, common sense and generalists in our increasingly technological, regulated and specialist world. It is both witty and serious, and very easy to read, so would appeal to almost anyone. However, GPs are particularly likely to enjoy it because he writes from his experience as a GP, encapsulates much of the essence of being a GP, and includes some lovely anecdotes. ‘I think he’s dead, doctor’ is probably my favourite, but you’ll have to read it to find out why."
John Temple Review Trent Bridge (Trent faculty newsletter)

"The best way I could describe this book is a mini Zen and the Art of Motorcycle Maintenance for doctors. Rather as Pirsig used motorcycle maintenance as the practical expression of his philosophy, so Willis uses his professional experiences in general medical practice as the medium through which he comments upon contemporary life. It is philosophy as  autobiography.
This is a difficult trick to pull off, but here it works well. The result is a substantial achievement which, because it has been done well, is easy to under-estimate…
I agree with his diagnosis that the distinctive malaise of modern life in Western democracies is the problem of judgement and its legitimacy. Judgement is everywhere being denigrated and replaced with committees, regulations and market mechanisms. There is a conflict between the explicit, the managed and the procedural on one hand,; and the implicit, the autonomous and the improvised on the other. In philosophical terms, Willis’ concerns are continuous with those of Michael Oakshott in Rationalism in politics, with the difference that Willis approaches the problem from the side of practice.
Yet this sophisticated and humane critique is achieved with a lightness of touch and a degree of accessibility which is quite remarkable (and is, I would guess, the fruit of much toil). User-friendliness is increased by Willis’ nice use of aphorism (‘the tidiest place to store information is in your head’) and his gift for the memorable metaphor (patients are kept in ‘boxes’ in the practitioners mind; and initiating a consultation is opening a box and zooming in on the contents). Several of these turns of phrase have already entered my vocabulary.
This care with which clarity has been sought, and the sheer readability of the text, indicate that Willis hopes for a readership among those who, like himself, are obliged to grapple on a day to day basis with problems demanding a response. Indeed it comes through clearly that the family physician must make vast numbers of decisions — quickly and on the basis of incomplete evidence. Even a decision to defer a decision must be an active one. The span of responsibility is vast, there is no fallback upon the certainties of narrow specialism or expertise; and yet there are good reasons to suppose that the job of a personal physician is better done by one generalist than by a team of specialists. It is in this sense that the family doctor can stand as a metaphor for Everyman, and the job of general physician as a model for life itself.…
…this is best illustrated through narrative, and the stories here are superbly told. Some are tragedies, quite exquisitely observed (I was actually moved to tears at one point). But Willis also has a real gift, of a Chestertonian kind, for highlighting the miracle of the mundane. I particularly liked his story of the blissfully free Saturday which began with an oppressive list of jobs and conflicts of priorities — and ended, totally unexpectedly, as dedicated to fixing an old door lock. This was, as it turned out, the best possible use of time — satisfying, useful, and impossible to predict. Without the space for lock-fixing, life would be lost in its living…"
Bruce Charlton Review Theoretical Medicine

"I started to read our book on the very day you came to sign it at school and found it one of the most compulsive reads I have enjoyed in the past few months. I simply could not put it down. I had imagined it might be dry or maybe beyond people out of the medical profession but found quite the opposite.
Reading the anecdotes drawn from personal experience and from a sphere fairly alien to a layman (if one discounts watching T.V. series which can all too often make us feel we could all be doctors!!) only made it clearer that behind each and every calling we all need to think more clearly about what is happening around us. You have FOCUSED on what many of us feel deep down but can’t express. As a linguist I applaud the honesty. I love the chapter analogies and the double meanings…"
Secondary school French Teacher

"Max and I have both read James’ book. It really is like a breath of fresh air, a great delight to read, but also full of original insights, compassion, and sheer common sense
James comes through a someone who really enjoys his work & has a vocation for general practice. I like the way he emphasises that all his practice descriptions of his everyday patients have actually occurred!…
I do hope James will go on writing books like the Paradox of Progress — the title is so apt and maybe GPs will get a better chance to practice like James in the future."
Management consultant and author whose husband is a retired senior civil servant.

"I have, over the weekend, read your book, The Paradox of Progress. Most importantly, can I say how much I enjoyed it and how many thoughts in it struck a sympathetic cord…
I welcome your emphasis on the individual and on the pluralism of experience. I agree that both of these factors tend to be eclipsed by the bureaucracy and rule making that seems to surround us so restrictively in the current service.…
Congratulations on what you have achieved and expressed."
Chief Executive Special Hospitals Service Authority 12.6.95

"Look at his chapter headings and anyone who stops to think occasionally will feel the head starting to nod…
What it comes down to in the end is that you have to decide; who rules? Will it be the machines or the humans…
Go and read this book. And when you’re finished you can start on Pirsig’s two books. And after that you can read (if you can find it) Ivan Illich’s ‘Medical Nemesis’ And when you’ve done that you will have the intellectual ammo to blow any six-pack of NHS administrators out of the water."
Declan Fox Review GP Writer Autumn 1995

"Why does Dr Willis write at the moment? Because we are being assailed all around by ‘progress’. Management consultants using new information technology have shown that we are only performing well if everything can be measured and quantified. Thus in hospital ‘we can have nurses who deal personally on a daily basis with life and death situations, spending hours of each week tapping codes into computers…
A marvellous example of this, and witness to Willis’ sense of irony and humour, is the 1965 Morris Minor manual which required daily checks of the tyres for stones and their removal. Was this ever really possible for anyone? His summary of this is that ‘rules are not solutions at all — they have become the problems’…"
David Watt Review Journal of the Balint Society September 1995

"Staying with Alec and Aline and have just finished reading your delightful book. Most entertaining and your conclusions worthy of much thought. I shall draw the attention of my GP to it - he is responsible for ‘training’ in Abergavenny. Your ‘ocean’ and ‘shores’, congruities and incongruities distinctions are very valuable & your comments on the capacity and brilliance of the human brain reciprocate my own reading on the matter…"
Engineer 6.7.95

"It is just the same for us - it makes you want to scream out ‘STOP!’"
Teacher in a Special-needs School (verbal comment)

"PS Very much enjoyed your book — but must take issue with you re manipulators saying GPs shouldn’t manipulate — my only concern is that on the whole GPs use far more force than is actually necessary — though that does not make them ineffective!!"
Registered Osteopath 7.7.95

"We have exactly the same problems!"
Young ballet-dancer working in Swiss ballet-company assailed by the modern business ethos. (Verbal comment)

"My copy of PARADOX is now out on loan as per your recommendation. I fully endorse all you say, local government is as bad as the health service.
For many years I have used the phrase "conspiracy of mediocrity", which is a comment on attitude, not ability — Although the ‘system’ does nurture the acquiescent, uncreative and trivial.
Is there any hope? Despite so many young people wanting to be accountants I think the younger generation will not stand it in the long run. Certain elements of the current youth culture support that view, I believe. I am an optimist by nature!
Arts and Community Manager, East Hampshire District Council 3.8.95

"Apologies for the late return of your book. I began by reading the bits that you suggested and then put it aside meaning to read more (exactly as you describe!)
I took it on holiday meaning to find the time and salve my conscience. Halfway through the second week I was still guiltily moving it around the bedroom!
However, then I picked it up for real and had read over half without pause. The rest followed the next morning — very unusual for me. I thoroughly enjoyed it and, you will not be surprised to hear, was delighted to read your cry for the generalist — my profession, as with so many others, is suffering just as yours is.
Many, many congratulations on producing such a well-written and thought provoking book.
Chartered Accountant Autumn 1995

"Sue. A real plea for "Common Sense"! It should be required reading — with Christopher Brooker’s "The Mad Officials" and "Parkinson’s Law" — for all civil servants and pushers of paper mountains. I could not put it down. Anna"
Note passed to author by a friend (Sue) who had lent her friend (Anna) a copy. Autumn 1995

"Re: The Paradox of Progress
I read the above while on holiday this summer and felt I must write and simply say how much I enjoyed it. It’s writing reflects its subject matter: a triumph of both common sense and the human spirit! Whilst I inevitably felt at times that your views of managers such as myself was grossly simplistic, I did find myself in full agreement with your basic points about the need for a generalist approach, which is sympathetic to the complexities and often idiosyncrasies of the care environment in which we operate…"
Director of Purchaser Performance Management, NHS Executive (South and West) 7.9.95

"I wanted to let you know how very much I enjoyed your book "The Paradox of Progress" when I eventually managed to obtain a copy (two went astray in the post!).
There was lots of déja vu — the Harrogate PGEA farce and the leaking sphygmo in particular — and I liked your models of the way our minds work. Most important though I think you are absolutely right about the definition and the role of the generalist…
Thank you again for your stimulating ideas."
GP Cheltenham 29.9.95

"I have put your book on the reading list for my course, and called one of the modules "The Paradox of Progress" — with an acknowledgement!"
Lecturer at Civil Service Staff College (Verbal comment)

"Edgar and I want to congratulate you on the publication of your book, and to let you know how much we have enjoyed reading it. Our health care system is quite different from yours, but the problems that you describe plague our system as well, although the details are different, of course. Even from a layman’s point of view I was able to relate to the situations you described, and to empathise with your frustrations. I only hope that the policy makers in the health care profession will hear, truly hear what you are saying and take action accordingly. Thank you for autographing the copy Ellen brought us. We treasure it, as we treasure the memories of a lovely visit in your home."
Retired couple, Louisiana, USA 10.10.95

"The author argues against the trend to define, document and record in the name of progress. General practice is full of problems without absolutely correct answers or logical solutions. This book provides anecdotal examples. The GP’s traditional role is now being threatened by the growth of central controls. Information technology is dehumanising society, and producing rules that are in themselves problems. Dr Willis argues that progress is detrimental to human values and motivation, and that the need for new ideas lies where common-sense practical studies prevail. This book should be read and discussed by every GP, and even more widely by those in other professions."
Keith Thompson Review: Update 1.11.95

"Thank you for a magical Christmas present. James Willis’ book is a poetic account of the beauty of the real world. Congratulations on having published it."
Letter to publisher Christmas 1995

"I was given your book - ‘The Paradox of Progress’ - by a friend (whose mother-in-law is a patient of yours - I only know her Christian name & I’ve forgotten it) back in August, & read it with delight and excitement, & put it down liberated. You say things that needed saying: how often since have I said to a colleague or parent ‘Trust your Common sense!’ You put in a plug for ‘generalists’ (who are a majority of the population?) & you question and challenge so many assumptions, thank God & thank goodness.
Your book has been a discovery, a joy, & a confidence-booster. It has also helped liberate me from false attitudes, various imprisonments, & from feelings of inadequacy. Bless you for that - for telling your truth in your own way. One can always relate to another’s story, & your book has helped me to do my job a bit better & more decisively, as well as to affirm for others their worth…"
Headmaster West Country 3.1.96

This beautifully written little book is really a series of themed paragraphs. In these, the author, who is an experienced GP and former trainer and course-organiser, gives his personal opinions on the way that the NHS and general practice in particular has changed in the last few years. It is a very easy book to read and is packed with personal reminiscences and anecdotes to illustrate the author’s point of view. The language used is clear and succinct and the reader is left in no doubt that Dr Willis does not always agree that the new NHS, with its accent on management techniques and targets, is necessarily better than the old system. The book will appeal to all general practitioners from trainees to those who, like Dr Willis, are approaching the end of their medical careers. It is at times quite humorous. The reader is transported effortlessly into the author’s surgery, to the local hospital, and to his patients homes in situations with which we can all easily identify. The book can be read cover-to-cover with ease or one can browse through it as each paragraph stands on its own merits. Altogether, a very good read.
Review: Journal of the Association for Quality in Healthcare. Autumn 1995

"You have probably not read Linn Getz and Steinar Westin's Norwegian handbook for specialist education in general practice, as it is in Norwegian. As a psychologist I haven't read it in full myself, but amongst the chapters I have read is the chapter on recommended literature. In this chapter the authors recommend that every GP practice should have what they call a "nucleus library for general practice", containing certain handbooks, manuals, textbooks etc. As GPs need more knowledge than what can be found in those kind of books, the authors also recommend what they call a supplementary library for humour, scepticism and thinking - wherein you'll find "a pearl of a book" by James Willis."
Email from Prof. John-Arne Skolbekken July 1998

....And in May 2003, cometh the BLOG:  Psybertron Knowledgebase Blog