A twenty-year practice, written down slowly.

I have worked almost my entire clinical life in the NHS; I began running a small private practice alongside it, for two half-days a week, in 2019. That decision came after a long argument with myself — I come from a family where private healthcare was a reproach — and I have never fully resolved the argument, which is, I think, why I can write about it.

Three things are different when the fee is paid by the person in the room. The first is the most obvious: time is honoured with a care that NHS practice has had to abandon. The fifty-minute hour is fifty minutes and is extremely rarely anything else. I am aware that this will read as a boast, and I do not mean it that way: in the NHS we were not given, for many complicated reasons, the material conditions in which to honour the fifty-minute hour, and honouring it privately has obliged me to look, with some shame, at how I had adapted to not honouring it before.

The second is harder to write down. When a fee is paid by the person, the person's sense of their own authority in the room is different. Not necessarily better. Not necessarily easier. Sometimes, in the early weeks, much harder. But different in a way I could not have anticipated from reading about it, and I had read about it…