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There is hope yet for the development of primary health care in deprived areas.

Each episode of illness in a patient is described by doctors in letters or medical notes which build into a history of the person's medical life. No general practitioner summarizing case notes or hospital specialist reviewing notes can fail to be struck by their biographical aspect. This is particularly so as the entries often go beyond a factual account of illness and comment on personality and personal relationships. For example, patients have been described in medical notes as 'tall, thin, anxiety prone, introspective' and 'wily'. It is not just by chance that these comments exist because the context in which patients live is of great importance to the ways in which they react to illness. The significance of these comments as biography should not, however, be overstressed. The patient makes no direct contribution to the descriptions and the entries are a doctor's view of the patient in a situation of stress; from the patient's point of view, illness events may be of little significance in the totality of his or her life. Anecdotes and stories, therefore, are integral to medical practice7 and to the education of those practising it. Learning the scientific basis for understanding people is only one part of the holistic approach to which students must aspire. Downie has pointed to other types of understanding, including the narrative, historical and sympathetic modes.5 Anecdotes and stories involve narrative and historical understanding but also contribute greatly to sympathetic understanding. However, anecdotes and stories can only achieve this if the doctor appreciates their importance and takes time to listen. Although knowledge obtained through scientific endeavour in medicine is being vaunted as superior to knowledge obtained in other ways, leaming from anecdotes and stories and being alert to their use by patients are essential to good medicine. This kind of knowledge enables doctors to deal with patients as individuals and to respect their uniqueness as persons. As George Eliot in her novel Middlemarch said of Dr Lydgate: