'I've always been deeply in awe of musicians. They seem to hold some mysterious secret that the rest of us mere mortals can only marvel at. Music of all kinds matters hugely to me. Despite this passion, the only things I can really play with any proficiency are my iPod, CDs and my residual and much treasured vinyl collection. Over the years I have attempted to play all manner of musical instruments – including the most recent bizarre trilogy of bluegrass banjo, ukulele, and dulcimer – but none of them will release their treasures to me. I am well aware that the musically proficient among you would barely consider any of those three a proper instrument anyway. The closest I’ve ever got to any proficiency was when I brought a sitar back from India when I travelled there overland as a student. By proficiency I simply mean that I was as absolutely useless as almost every other amateur sitar dabbler at the tail end of the sixties...'

'The more I study depression the less I think I understand it. The fact that someone has massive social problems doesn’t automatically mean that he or she can’t be suffering from a biochemical depression and vice versa. However, discerning the point at which medication is appropriate can be ludicrously difficult, and full of unintended consequences. For instance, if a GP offers treatment to someone who is distressed by their living conditions and the intransigence of an unsympathetic council housing department, and as a result of medication he or she feels better, then will those living conditions ever improve? But how can we be certain that the cause of the depression really is the living conditions? Could it not be that the cause is infinitely more complex? When do we become agents of the status quo?...' Professor David Haslam, President of the BMA, Past President RCGP, National Clinical Adviser, to the Care Quality Commission

'It’s long intrigued me how the world seems to be split into those who are desperate for a prescription, despite all the medical profession’s advice to the contrary, and those who will do anything to avoid a prescription, and want to ‘leave it to nature’. I am fascinated by this perception of nature as being fundamentally benign. You can’t get anything much more natural than salmonella, or cholera, or even man-eating sharks. But still there are those who believe that the adjective natural bestows a healthy glow on whatever noun follows it. And aren’t you also fascinated by the way that general practice seems to revel in situations that set us up for an inevitable fall. How many times have you waxed lyrical about a particular treatment, only to hand over the prescription and have the patient say: ‘Oh, but the other doctor gave me that and it was useless?’ ' 

I hate to think how long ago it all happened, but I’m guessing it was some 30 years. It’s not that I remember everything I did that long ago, but the occasional situation remains unforgettable, and this was one. I was doing a fairly routine surgery, in which 20 patients had expected me to make some sort of sense of what was going on in their lives. One of these patients was a young woman whose problem I don’t recall, but as she was getting up to leave I clearly remember her asking, ‘Oh, could I possibly have a look at my medical records?’ I passed them to her. She looked at the envelope, weighed them in her hand, and then – without opening them or reading a word, she passed them back.

I’ve long enjoyed a cartoon in which a doctor is saying to a  patient: ‘No, you're not a hypochondriac. You only think you're a hypochondriac.’ Well, I quite often think that I’m a hypochondriac. I don’t know how medical school was for you, but I well remember that almost every symptom or sign of serious disease that I heard or read about, with the probable exception of haemorrhage and convulsions, made me panic. ‘I think that I’ve had symptoms like that,’ I thought to myself. As a male, it was a massive relief whenever we did obstetrics or gynaecology. I could sit back and relax, whatever we were studying couldn’t happen to me.'...

'Don't you find it fascinating how fashions in medicine change? What is dreadful practice one year can become exemplary practice the next. Many years ago, when I was chairing the MRCGP Examination Board, I was contacted by a medical lawyer who needed to know how serious a crime it was to prescribe a beta-blocker to someone in heart failure. Now it's considered to be good practice. That's the glory of science, constantly checking and questioning, turning hypotheses upside down, refining the evidence. It's exactly how it should be, but it doesn't half make life confusing at times...'

'The secret is probably in the caring bit. I don't mean it in some soft and fluffy psychobabble way, I mean just be interested in, and really engaged with, the human being in front of you. If you do that, and you combine this with knowledge and some skill, you're almost there.'

I think I started this column way back in 1996. Since that time in England we have had eight Secretaries of State for Health. Since I started as a GP we have had a total of sixteen. Throughout the decade and a half that I have been writing this column - during which I have found myself knee deep and bloodied in the politics of the NHS - I have steadfastly ignored every single development that has come along when choosing what I should write about. Whether it has been fundholding, total purchasing, practice based commissioning, the role of the health authority, FHSA, PCG, PCT or whatever that year's great new idea has been, I have ignored the lot.Partly that's because you can read quite enough about medico-political shenanigans elsewhere, but mainly it's because what has gone on in my consulting room has been resolutely unaffected by what has gone on in Whitehall.My patients kept on coming with their dis-ease and disease. They were worried, and frightened, and puzzled. In the privacy of the consulting room, in that extraordinary intimate exchange between doctor and patient, they shared their hopes and fears.

'There are great advantages and disadvantages in having English as one's native tongue. There is so much less incentive to study a foreign language when so many people around the world have apparently mastered English. But it's all too easy to assume that understanding exists when it doesn't. If America and Britain are two nations divided by a common language the same can also be said about doctors and patients.'

'I have known patients ask after a blood test if they can be told what their blood group is, and are surprised to discover that this was not tested. Many of our patients appear to believe that a blood test will test for everything - a not unreasonable expectation in these high-tech days. What does this potential misinterpretation really mean? If a doctor performs a blood test to measure the haemoglobin level, and simply informs the patient that his or her blood test was normal, might not the patient assume that everything - including maybe even the HIV status - was normal? If so, the public health implications of blood testing are enormous...'

The problem with writing any column like this is the inevitable gap between my writing it and you reading it. As I write, it is bitterly cold outside. As you read, the sun may be shining and you may be revelling in the most beautiful of crisp winter days. But my guess is that you will be shivering too. It looks like it's going to be a long and very cold winter. Indeed, whatever your views about the cause, there seems little doubt that the changes to our climate seem likely to become more and more dramatic as every year goes by. We are having hotter summers and colder winters. The impact on our lives as GPs may be very considerable, particularly when it comes to home visits, and even more so for those of us who live in the country - though having seen the devastating effect that an inch of snow can have on central London, rurality may not be the sole marker of transportation chaos...