A PERSON, says Dr Peter Dorward, is a thing that remembers, so I ask him what he remembers. The man who made him a doctor, he says: his wise uncle Morrison.

And sitting in a truck in Nicaragua, next to the banana workers with their machetes and the soldiers with their guns.

And the day he climbed a mountain and suddenly was falling, falling – and the pain, the extreme pain.

And the patients: the child with a fever, the young man who’s worried he’s dying, the alcoholic with the scar on his face. Dorward says all of these moments are like coloured beads, strung on a thread of memory.

Today, we’re going to work our way along that thread and talk about Dorward’s life and career as a GP in Edinburgh, as well as how he thinks we could make general practice better. This is definitely the job to do if you’re interested in humanity at the edge, he says. You can also, pretty much, determine the hours you work. And you have lots of autonomy. As stress of course. And risk (Dorward was once attacked by a patient and it profoundly changed the way he works). This is not easy, he says, but it’s worth it.

Some of the details of his work are explained in Dorward’s new book, The Human Kind, which explores the dilemmas, stresses and challenges he faces through the patients he treats. The names have been changed, but the details, the tears, tensions, trauma, life and deaths are all there. And the pain. Dr Dorward has a lot to say about pain. He thinks all of us – including some doctors – are misunderstanding it, and the misunderstanding has led to a crisis of over-prescription. Sometimes, it’s easier to prescribe painkillers and then increase them and then increase them again, says Dorward, and doctors should be ashamed of themselves for letting it happen.

Dorward’s own direct experience of pain comes from his climbing accident, in which he broke his leg, although he says there are many different types of pain. It’s taken him a while to work this out, because that’s the way medicine works: you start at the bottom, knowing not very much, and then work your way up. He remembers being a junior doctor, the long hours, and thinking: I never want to feel this tired again.

But things have improved since he was a junior doctor 30 years ago, haven’t they? “Yes and no,” he says. “We worked very long hours – we were very under-trained. We found ourselves dealing with situations that were frankly unsafe to deal with and we found ourselves having to swallow a huge amount of risk.

“On the other hand, when I was a junior doctor, I worked in a small team, I knew who my boss was, and my boss knew who I was. I knew my colleagues really well. And I was valued. I also had a ward of 30 or so patients and I knew them all. Junior doctors now work shifts, they don’t know their patients. They often don’t know who their boss is – there’s no incentive to take responsibility. In fact, there are incentives not to take responsibility because if you don’t take responsibility, the mistake is never going to be yours.”

Dorward says all of this means the morale among junior doctors is terrible. “And one of the reasons is because, although they’re working shifts, they’re working within systems where they feel as if they are a cog in a machine; they feel themselves to be jobs monkeys rather than valued members of a team.”

Dorward particularly remembers the last day of his training because that was the day he was attacked by a patient. He says he didn’t see it coming but suddenly the man had a chair in his hands and was swinging it. Dorward hid under his desk, he tried to find the emergency bell, the chair broke on the desk and then someone came into the room and the incident was over.

The whole thing only lasted for a few seconds but Dorward said it left him with a fear and prejudice about certain types of patients, the ones that might attack him - ex-cons, people on a trigger fuse – and he was only cured of the prejudice when he over-heard a patient saying to another doctor: “thank goodness it’s you, and not that Dr Dorward. He really looks down his nose at you.”

That moment was a real shock for Dorward, who sent himself on a course to improve his communication skills, but he thinks this is a healthy thing: to constantly learn, and to examine what you’re doing. When he finished his training as a junior doctor, he took six months out and went to work in Nicaragua, Belize and Bolivia with NGOs; he has also written a novel, Nightingale, and continues to see himself as both a doctor and a writer. And the man who learned has become the man who teaches too: he regularly takes young doctors into his practice for training.

There is one message he particularly likes to get across to his students – other than the fact that being a GP can be a rewarding career, whatever the snobs at medical school might say – and it’s that we must do more to better understand pain, and treat it better.

“Something went terribly wrong in the medical profession with respect to pain, maybe 15 or 20 years ago,” he says. “A revolutionary idea, the palliative care movement, said that pain had to be treated and that pain in cancer sufferers should be objectively scored and vigorously treated to reduce suffering. That was a revolutionary idea and doctors were encouraged to use pain killers, particularly opiates, to the extent that was necessary. Before then, doctors were phobic about opiates – there was a cultural idea, quite a deeply religious idea, that pain was important part of life and death. There were theologians writing up to the 60s and 70s about being careful about treating pain in people who were dying in case it interfered with the possibility of salvation.

“In the 80s and 90s, there was a move away from that, but at some point in the 90s, this idea of pain as an objective thing that could be measured and had to be treated became over-generalised to all pain and a lot of pain just isn’t like that – a lot of it has very unclear origin and a lot of it, from the outsider looking in, looks emotional and much more complicated than the pain of a broken leg. It’s like social and cultural pain. Part of what has happened is that pain has become, for reasons I don’t understand, a very common way of being unwell.”

This has led to a problem with over-prescribing, says Dorward. “If you go to a doctor who has internalised this idea that pain is intolerable and has to be treated vigorously until it goes away and patients have a right to be pain-free, then you get into a bit of a dance where the doctor is going to prescribe more and the patient is always going to need more because, of course, the pain is not going to go away, and you get the beginning of an epidemic.”

Dorward also thinks opiates are often prescribed even though they’re the wrong option. “If you have widespread back and muscle pain with no clear origin – it’s been going on for years and you’re also unhappy perhaps you have problems with employment, your relationships at home, and you might have substance issues, one of the effects of opiates is they will cure your pain, at least for a week or two, but they will also make you more depressed, they will make you less able to, for example, to exercise or be physically active and the one thing we know about chronic pain is it responds well to physical activity but opiates make that hard to do.

“Plus opiates make you more sensitive to pain so you get this escalation effect where people end up being on higher and higher doses or more and more diverse drugs for pain. We see pain on this narrow bandwidth of a broken leg or cancer pain but we tend to overgeneralise it and that leads to over-prescription.”

The answer is not easy, says Dorward, particularly if a patient has become used to being prescribed a particular drug, but in some cases, he prefers a social, rather than medical, treatment. He might encourage more exercise, or socialising, and even gives his patients homework. He still sometimes signs prescriptions that he knows, in the long term, will not work, but it is soul-destroying. “In a way,” he says, “it’s fundamentally dishonest because you know in your heart that it’s just making the situation worse.”

Dorward has other concerns about the modern medical system, particularly social care which he thinks needs to be bigger and better funded, but he still believes in what he calls the glory and the satisfaction of being a GP. I ask him who’s been in his surgery recently and he runs off a long list of medical problems, some trivial, some serious. It sounds stressful, I say. Yes, it is, he says: stressful but exciting.

The Human Kind: A Doctor’s Stories from the Heart of Medicine by Peter Dorward is published by Green Tree (an imprint of Bloomsbury) at £16.99