Kieran Sweeney

Joyful adventure

Breaking with family tradition, he moved south to Exeter, in England, to train as a general practitioner. For him medicine was a joyful adventure: if he could play in France, why not work there? So he did, as a junior hospital doctor for 18 months in Bordeaux, Paris, and Brittany—the first general practice trainee to have hospital posts in France recognised as part of his UK vocational training programme.

Returning to Devon, he married the love of his life, Barbara; raised their four children; and practised there, with strategic interruptions, until he died.

Sweeney joined an illustrious Exeter practice where, in Denis Pereira Gray, he found a colleague with the vision and influence to nudge him in fruitful directions, this time west. In 1991 he won a Harkness fellowship from the Commonwealth Fund of New York, the first UK general practitioner to do so. In his year at the University of Washington in Seattle, he learnt to research and to write. Blessed with the engaging wit of a Celt abroad, he was already the complete networker.

He returned on fire. From 1993 he worked with a bewildering array of collaborators, inspiring them and making them laugh. He published with philosophers; mathematicians; general practitioners; nurses; physicians; health service researchers; his partners; and most recently with his third son, a medical student. They have a joint paper, to be published posthumously, an essay on Asperger’s syndrome.

Value of complexity

Sweeney wrote for two years as a health correspondent for the Times newspaper. He published more than 100 articles and four books, his most recent on understanding the value of complexity in primary care. He was elected fellow of the Royal Society of Arts. He gave invited lectures in France, Spain, New Zealand, and Australia as well as at home, and in 2004, at the age of 53, he wrote his doctoral MD thesis on explanatory models in modern medicine. He was a member of the health complexity group in Exeter, a collection of philosophers, practitioners, and researchers who look for insights from the complexity sciences to explain the processes of change in healthcare organisations.

After a four year sortie into health policy in London with the Health Care Commission, Sweeney returned to Exeter in 2004 to set up from scratch an experimental practice in a tough part of town, in partnership with a nurse. Last year he was appointed professor of general practice at Peninsula Medical School, an honour long due. Most recently he had achieved national influence in his work as director of the Royal College of General Practitioner’s leadership programme for the next generation of movers and shakers.

A few weeks before he died I asked him what was the essence of his work. “It’s in the essay with Domhnall and Denis on personal significance in the Lancet,” he replied without hesitating (1998;351:134-6). They had proposed a third hurdle of significance, to kick in if the first two hurdles of statistical significance (is it real?) and clinical significance (does it matter?) are satisfied. An action would achieve personal significance if it took into account the experience of this particular patient’s suffering, style, circumstances, and beliefs. Then and only then “go and do it.” He later described this approach as metaphysical and in a prescient piece he wrote, “The clearest examples of this transition to the metaphysical level occur when someone starts to die or accepts that death is near. Here both the doctor and the patient are confronted by the question ‘When is enough, enough?’ This,” he wrote, “will be the defining question for the next generation of practitioners.”