ProfessorPavlov

2011-01-27T04:16:00.000-08:00

NHS Reforms
This is what I sent in as a response to the proposals for health reform by the coalition government:

"I retired as a GP just over 5 years ago after working in Castleford, West Yorkshire, since 1978 and before that in Cheltenham. I was a trainer, course organizer, GP Tutor and latterly Associate Director of Postgraduate General Practice Education at the Yorkshire deanery until I left to take up my PCT post.

I was employed part time by the PCT, until my retirement at the end of May this year, as GP Adviser, Protected Learning and Appraisal Lead. I ran the education programme for 250 GPs and locums and supported and developed 17 local GP appraisers. I was an appraiser myself and also a Quality Outcome Framework Medical Assessor. I have mentored many GPs in trouble. No one has ever doubted me when I say that I have talked face to face and at length to more GPs than anyone else working in the Wakefield District.

When fundholding was introduced I joined a group called “The Five Towns Family Doctors Forum” (I have left out the apostrophes on purpose!!) This was a group that was vehemently anti fundholding on ethical grounds We were forced to become fundholders - and I really mean forced - by the threat and actual withdrawal of staff by the then Health Authority. From 1994 to 1998 I was a board member and vice chairman of the Wakefield Multifund. The multifund was essentially a fundholding consortium of the anti fundholders. We had our own manager who did all the work. I got on with teaching and clinical work and was not the slightest bit interested in our fundholding status. We forfeited big money with this approach.

Some of the fundholders in this area made a serious financial killing. Any fundholding monies put into buildings owned by GPs would be a future personal financial gain.

I undertook mobility and attendance allowance examinations during the time of fundholding. I came across several patients of fundholding practices that I felt should have been referred to a consultant but had not been. There were patients I saw who had not had investigations undertaken. When the 1997 election was approaching I asked the then chief executive of Wakefield Health Authority whether he had any plans for fundholding being abolished by an incoming Labour government. He replied that they could not do that as it was well “set in”. The abolishing of fundholding was announced soon after the 1997 election results were declared. I was really happy with that.

As I mentioned above, I worked for the PCT part time for 6 years. The people I worked with were truly concerned about improving patient care. I have read the manifestos of both the Conservative party and the Lib Dems as well as the coalition document. There is no mention of abolishing PCTs. Rather there is a load of platitudes. What is the point of these documents with regards to helping one decide for whom to vote? They are a farce.

Andrew Lansley keeps repeating that the GPs he talks to don’t like the behaviour of the PCTs telling them what to do etc. Of course they don’t. It is normal for GPs to bellyache about management. (I gave a farewell presentation to the people I worked with at the PCT called “working for the enemy”!!)

What do I know about the GPs working in the NHS Wakefield District area?

There are about 250 GPs (and this includes locums) working in the Wakefield area. I have read each of their personal development plans for the past 6 years. I have also undertaken appraisals of over 40 different GPs over these years. I can count on the fingers of both hands the number of GPs interested in “management”. The vast vast majority are only interested in clinical care and improving their clinical knowledge and skills. The less than 10 GPs interested in financial stuff are the “old fundholding gang”. The majority of GPs in our area did not want to engage with the PCT in planning services despite being offered money for this work. Pockets will be lined again. GP Commissioning Groups will be mandatory and I imaging GPs handing over the responsibility for commissioning etc. to private companies. It will take 10 years for this change to be functional and cost billions. Fundholding, total purchasing, PCTs, PCTs merging, strategic health authorities and now this. I am glad I am retired.

One group of GPs in one practice has set up a company and it has bought practices in Leeds, practices further afield and out of hours centres.
Another GP, with a huge annual income, is also purchasing practices out of the area. I must say that all these activities are legal and have been allowed by the Labour government and the PCT. I know that the business activities of some GPs take them out from clinical activities and put a strain on the remaining clinicians in those practices. This will happen with working in consortia.

There are some reports that say that the Local Medical Committees (LMC) are mostly in favour of these proposals. That may be so. Our Wakefield LMC (of which I was a member as a GP educator for many years) does not truly represent GP’s views, in my opinion. It does not seek views. However, it certainly helps GPs in trouble and answers GP’s questions. Not one of my partners ever mentioned the LMC or its newsletter. I am sure they are typical.

The Labour government introduced targets for improving health care in the form of the Quality Improvement Framework (QOF). I was a PCT medical assessor for the past 6 years. I must have assessed over 30 different practices over the years. My job was to check that they had achieved the clinical targets they claimed they had achieved. The GPs did not complain about having to achieve targets. The main complaint of GPs was that “ticking the boxes” intruded into the consultation. If a patient goes along to the GP with a depression problem and has not had their weight, blood pressure etc measured according to the warnings put up by the QOF software these measurements are doe as they are linked to GP’s income – and it is a seriously huge amount of income. (It is interesting to note that being involved with the QOF is voluntary). However, I never came across a single GP who thought these targets were a bad thing as they were evidence based and led to seriously better outcomes. I personally think that the QOF was one of the best things the labour government did for patients and that this boosted GP’s incomes considerably was worth every penny.

There are some fantastic people working for the PCT and they truly have only one motive and that is to improve patient care. When fundholding was abolished, I think I can count on the fingers of one hand the number of primary care managers that lost their jobs. These were in practices that had used fundholding savings to pay for salaries. The abolishing of Primary Care Trusts will demotivate those working there in the transition period and result in huge unemployment. I have already been asked to give a reference for one of my ex PCT colleagues. Most GPs are unaware of the role of PCTs in improving patient care. Most GPs, for example, are unaware that there are 4 or 5 expert people managing the quality of care of the 100 plus nursing and residential homes and this includes looking at costs. I worked in the same open plan office as these people and they work extremely hard.

The proposals in this white paper if enacted will destroy the NHS.

18 members of my family have worked in the NHS as doctors

I know my comments will make not jot of difference to anything.
Here are the first and last lines of Ben Okri’s poem “Dancing with Change” 2007

"Change is good, but no change
Is better............

No change is good, but dancing
Gracefully with change is better”

Richard E G Sloan MB, BS, BSc, PhD, FRCGP
RSloan7798@aol.com"

2011-01-16T22:59:00.000-08:00

I retired from my part time job at NHS Wakefield on 31st May 2010. I have had a fantastic working life and below is my curriculum vitae.

CURRICULUM VITAE

October 2010

RICHARD ERNEST GEORGE SLOAN

DATE OF BIRTH: 26 November 1945

PLACE OF BIRTH: Leeds, West Yorkshire

MARITAL STATUS: Married, no children

ADDRESS: Hill House
Airedale Drive
Airedale
Castleford
West Yorkshire
WF10 2QT

TELEPHONE: 01977 558935 - Home
07879 663540 - Mobile
RSloan7798@aol.com - e-mail

EDUCATION: Queen Elizabeth Grammar School,
Wakefield 1952 - 1963
8 O levels
4 A levels (AABD)

University College, London 1963 - 1966
B.Sc.(Hons) Anatomy, 2.2

The London Hospital,
London 1966 - 1969
M.B., B.S.

FURTHER
QUALIFICATIONS: Ph.D. (Medicine) 1976
University of London

M.R.C.G.P. 1984

Postgraduate Certificate in Primary Care Education 2001

F.R.C.G.P. 2002

EMPLOYMENT: House Officer, Medicine 1969 - 1970
The Mile End Hospital,
London

House Officer, Surgery, Casualty 1970
The London Hospital,
London

Lecturer, Physiology 1970 - 1973
The London Hospital Medical College

Principal, General Practice 1973 - 1978
Cheltenham, Gloucestershire

GP Assistant, Roehampton
London (5months) 1978

Principal, General Practice 1978 - 2005
Castleford, West Yorkshire

MEMBERSHIPS: Member, British Medical Association

Fellow, Royal Society of 1975 - 1988
Medicine

Member, Institute of Advanced Motorists, 2008 –

Fellow, Royal Society of
Medicine 2009 -

POSITIONS HELD (General):

Vice Chairman Cheltenham General Practitioners’ Association 1975

Secretary Postgraduate Centre Committee, Cheltenham 1975

G.P. Users’ Secretary Hesters Way Health Centre, Cheltenham 1976-8

Member Gloucestershire Disablement Resettlement Committee 1977

Committee Member Pontefract and Castleford Age Concern 1982

Council Member Wakefield Metropolitan District Council 1982-3

Secretary Wakefield Area Social Democratic Party 1983-5

Chairman Wakefield Area Social Democratic Party 1985-7

Secretary Pontefract and Castleford S.D.P. 1985-7

Delegate Council for Social Democracy 1985-7

Chairman Wakefield and District Dyslexia Committee 1983-6

Council Member British Dyslexia Association 1984-6

Chairman Castleford Choral Society 1982-1993

Member Wakefield Medical Audit Advisory Group 1991-5

Press Officer and
Occasional Secretary The Five Towns Family Doctors Forum 1993-5

Member Pontefract Hospital Trust GP Liaison Committee
1993-4

Member Working Group, integration of medical and geriatric
departments, Pontefract Hospital Trust 1993-4

Local Medical Committee Representative, Joint Group Palliative Care 1994-7

Member Steering Group, Kings Fund Organisational Audit
for six Wakefield District General Practices 1994-5

Board Member and
Vice Chairman Wakefield Multi Fund 1994-8

Member Clinical Advisory Group, Yorkshire Cancer
Organisation 1995-7

Patrons’ Secretary Castleford Choral Society 1997 -

Vice Chairman Castleford and Normanton Locality Board 1997-9

Board Member and
Vice Chairman Castleford and Normanton PCG 1999 to 2000

Co-lead Organisational Development Subgroup, Castleford
and Normanton PCG 1999 - 2000

Trustee and Director Prince of Wales Hospice, Pontefract 2000 to 2002

Member Grievance Panel, Prince of Wales Hospice, Pontefract 2000 to 2001

Member Shipman Enquiry Taskforce, Wakefield Health Authority 2000

Trainer Pontefract VTS, now West Riding GPEC 1988 to 2003

Trainers’ Representative Pontefract Postgraduate Education Subcommittee
1990-2

CME Tutor Pontefract District Feb 1992 to 2000

CME Tutor Representative Yorkshire Regional Postgraduate Medical
Education Committee 1993 to 2000

Vice Chairman Yorkshire Regional Postgraduate Medical
Education Committee 1994 to 2000

Tutor Summer School, Ethics 1993-6

Member Suicide Audit Steering Committee 1994-5

Co-opted Member Wakefield Local Medical Committee 1995 to 2004

Member Wakefield Health Authority District Drugs and
Therapeutics Advisory Committee 1996-9

Joint Project Manager Pilot for Yorkshire Mentoring Scheme in the
Wakefield District 1996

Member Wakefield Health Authority Secondary Care
Approvals Panel 1996-2000

Board Member West Riding General Practice Education Centre (GPEC)
1997 to 2000

Lead Accreditations, West Riding GPEC 1999 to 2000

Co-ordinator West Riding GPEC Mentoring Scheme 1999 to 2001

Video Assessor Second level 1997 to 2000

VTS Course Organiser West Riding GPEC 1998 to 2000

Member Local Medical Committee Professional Support Group 1997 to 2004

Tutor “O” Course (then Introductory Seminar 1) for Prospective Trainers 1999 to 2002

Manager and tutor Introductory Seminar 2 2002 to 2004

Clinical Educator Nurse Practitioner M.Sc student 2002 to 2004

Associate Director of Postgraduate General Practice Education (Yorkshire)
Dec 2000 to 2004

Lead Educator, Written Element of Summative Assessment (Yorkshire)
Manager, National Project Marking Schedule (UK) Dec 2000 to 2004

Observer (National Project Marking Schedule)
National Summative Assessment Board 2001 to 2003

Board Member Yorkshire Faculty of the Royal College of General Practitioners 2003 – 2007

Chairman Clinical effectiveness and Audit subgroup of the Clinical Governance Committee (Eastern Wakefield PCT) 2005 - 2007

Member Wakefield Area LMC (Castleford and Normanton)
2004 – 2005.

Independent Complaints
Adviser to the EWPCT for the Wakefield Area LMC 2004 – 2005

GP Adviser –
Protected Learning Eastern Wakefield PCT May 2004 – 2007

GP Adviser –
Protected Learning Wakefield District PCT 2007 - 2010

Chairman Target Executive Board, EWPCT 2004 – 2007

Chairman TARGET planning Group, WDPCT 2007 - 2010

QOF Assessor Eastern Wakefield PCT 2004 – 2007

QOF Assessor WDPCT 2007 - 2010

GP Appraiser Eastern Wakefield PCT 2004 – 2007

GP Appraiser WDPCT 2007 – 2010

GP Appraisal Lead Eastern Wakefield PCT 2004 – 2007

GP Appraisal Lead WDPCT 2007 – 2010

Education Adviser Spanish GP recruitment scheme 2005 – 2006

Chairman Clinical effectiveness and audit group, EWPCT, 2005 – 2007

PCT Dignity in the Workplace mentor 2006 – 2010

NHS Mentor, Yorkshire and Humber Mentoring for Success Scheme 2007 -

(The Eastern Wakefield PCT merged with Wakefield West PCT on 1st April 2007 and became the Wakefield District PCT (WDPCT) .
The above job titles all changed from Eastern Wakefield PCT to Wakefield District PCT on that date).

Member West Yorkshire Appraisal Leads Group 2007 – 8

Member Yorkshire and Humberside Revalidation and Appraisal Development Group 2008 - 2010

Member, Airedale Neighbourhood Management Board (ANMB), 2008 -

Chairman, Health Group, ANMB, 2008 –

Pupil Mentor, Airedale High School 2008 - 10

PUBLICATIONS:

Sloan, R.E.G. Letter: Afternoon Surgeries. B.M.J. Feb 73: 294-5.

Keatinge, W.R. & Sloan, R.E.G. Cooling rates of young people swimming in cold
water. J.Appl. Physiol. Sep 73;35(3):371-5.

Keatinge, W.R. & Sloan, R.E.G. Proceedings: Measurement of deep body
temperature from external auditory canal with servo-controlled heating around ear.
J. Physiol. Oct 73; 234(2):8P-9P.

Sloan, R.E G. Letter: Acute pancreatitis and diabetic ketoacidosis in hypothermia.
B.M.J. Feb 74:1(5901):245

Sloan, R.E.G., Horrobin, R. & Wiffin, E.M. Letter: Antenatal Battering. B.M.J.
Dec 74;4(5945):655.

Sloan, R.E.G. & Keatinge, W.R. Depression of sublingual temperature by cold
saliva. B.M.J. Mar 75;1(5960):718-20.

Keatinge, W.R. & Sloan, R.E.G. Deep body temperature from aural canal with
servo-controlled heating to outer ear. J.Appl.Physiol. May 75;38(5): 919-21.

Ph.D. Thesis. The effect of age and sex on body cooling rates. University of
London, 1976.

Sloan, R.E.G., Norman, M. & Adams, D. The cost and advantages of establishing
an age-sex register. J. Roy. Col.Gen.Pract. 1977;27(182):522-3.

Sloan, R.E.G., Letter: Multiple authorship. B.M.J. Mar 77;1(6064):838

Sloan, R.E.G. The XYY Man – spreading unjustified fears. Opinion Article.
Sunday Times. Sept 11 1977.

Sloan, R.E.G. Letter: Cervical Cytology. B.M.J. May 79;1(6174):135.

Sloan, R.E.G. Obituary Gerda Laura Clara Alice Sloan BMJ April 1990; 300: 937

Sloan, R.E.G. Food for thought. Yorkshire Medicine. 1996.

Sloan, R.E.G., Napper, M. & Bahrami, J. Mentoring. Yorkshire Medicine. 1997

Sloan, Richard, Our Ben. Rapid response to Battacharjee et al., Do animals bite
more during a full moon? BMJ, 321 (7276) 1559 – 1561, 2001.

Sloan, Richard. Obituary Geoffrey Ian Mair BMJ, Jan 2003; 326: 107i.

Taylor, G.T. & Sloan, R.E.G. Yorkshire: ready to meet the challenge of supervision
In the 21st century? Education for Primary Care (2003) 14: 230 – 232.

Sloan, R.E.G. SARS: screening, disease associations and response. Letter.
Lancet. 2003 361(9370):1701-3.

Sloan R.E.G & McMillan J. Developing mentoring skills for general practitioners
using a simulated doctor. Medical Education 2003; 37;1025-1049

Sloan, R.E.G. & Taylor, G. The impact of General Practitioners trained as mentors
a study of mentoring activity and potential. Mentoring and Tutoring.
2003;11;No3;321-330

Evans, A., Sloan, R., Tinker, M. & Taylor, G. A comparison of results achieved
when audit submissions are marked using the COGPED and NPMS methods.
Education for Primary Care (2004) 15: 344-51

Sloan, R, Nicholas, A & Lambe, M. Fifth National Protected Learning Time
(PLT) conference: A valuable resource or a waste of time?
Education for Primary Care (2006) 17: 506 – 10.

Sloan, Richard, Rapid response to Peel et al., Self monitoring in type 2 diabetes,
BMJ, 2007, 335 (7618) 493

Research:

In the early part of my career I had a significant involvement in research to Ph.D.
level. I worked in the Stazione Zoologica in Naples with Professor J.Z. Young
measuring nerve conduction velocities on the giant axons of squid. I worked with
Professor W.R Keatinge for 3 years in a full-time teaching and research post and
together we developed the prototype of the Zero Gradient Aural Thermometer. I
worked closely with Muirhead Ltd. on the manufacture of this device, which sold
worldwide in the 1970s. I was the first person at the London Hospital to work in such a way with industry and obtain royalties for my employers. I demonstrated the device for Muirhead Ltd. at an Anglo-Italian Congress in Florence in 1974. Whilst a General Practitioner in Cheltenham I undertook a regionally funded Locally Organised Research Project on “Febrile Convulsions in Children”. This was funded for 2 years and I worked one session a week within the practice with a research assistant. I also did a study on Age/Sex registers. I have undertaken qualitative research on the Yorkshire GP Mentors. I write this to demonstrate that I have a very broad foundation in research and have collaborated with colleagues and teams in a rewarding manner. I have always undertaken collaborative research and have found this more fruitful than researching alone.

Computer literacy:
I have been deeply involved with computers since 1970 when, as part of my research, I wrote and published a computer programme in the Fortran IV language which did a statistical analysis of variables presented in graphic form. Our General Practice was one of the first in the district to use a computer and we are now paper light and connected to NHS Net. I have constructed simple web pages. I am familiar with spreadsheets, word processing and PowerPoint presentations.

Liaison with others in the Yorkshire Education Network and other organisations:
I have worked closely over the years with the Health Authority, the LMC, acute Trusts, my PCG, PCT and other organisations such as the Hospice and local government. These contacts have been very important to keep the profile of the GP education network at a high level. I have worked at various levels of the Yorkshire Education Network for many years and with many people and think that my commitment to teamwork, collaboration and corporacy is appreciated by each of my colleagues. I hope I have a reasonable sense of humour as I feel this can defuse tense situations as well as maintain personal mental health when working in difficult circumstancesI resiged my jobs associated with the PCT in May 2010.

Innovative approach to postgraduate education:
While working as a GP Tutor, Course Organiser and trainer in the Pontefract district, I have adapted to change both within the NHS and the Yorkshire Education Network and have always supported to the full the strategic direction the latter organisation has taken. I am a keen supporter of modernisation and organisational development and hope I have an enthusiastic vision for the future. I have tried to be innovative in my approach to postgraduate medical education. I have organised two large-scale debates using Pontefract Town Hall – one on fundholding and the other on spiritual care with the retired Bishop Jenkins of Durham. I set up a series of joint meetings of GPs with pharmacists and have run multi-disciplinary meetings with vets, clergy, nurse, CPNs and others. I have organised a series “training for trainers” for consultants and GP trainers.

Activity in Primary Care:
I started work in the Practice in Castleford on November 1st 1978. At that time the area was under-doctored and I built up the practice from a base of zero patients as a single handed practitioner. Castleford was an “open” area at that time.
Tieve-Tara Surgery is an Investor in People, has undertaken the Kings Fund Organisational Audit and became a Beacon Practice for its work with drug addiction. The practice is now a PMS training practice with a list of just under 5100 patients.
I retired as a principal GP from the practice on December 2nd 2005. I do not intend to see any more patients but I enjoy organising and attending the educational support group for GPs without a base ( mainly retired GPs). I continue to run this after I retired from the PCT.

Tieve Tara Surgery was modernised and enlarged in 2004 and has training facilities of the highest order.
I was proud that the practice has called this training area “The Sloan Education Suite” as part of my leaving gift. I was Chairman of the board of directors of Motorstep Ltd., the company that owned Tieve Tara Medical Centre until December 2008 when it was sold.

I have undertaken, recently, some voluntary work at the Prince of Wales Hospice and with some refugee doctors. This work has now come to an end.
I am an active member of the Airedale Neighbourhood Management Board and chair the health subgroup.

Hobbies:
My main hobby is music and I have been a member of Castleford Choral Society for the past 20 years. I have a broad musical taste and I like opera, Hoffnung. Al Jolson and Queen. Despite being a very distant relation of Mendelssohn, my favourite composer is Mozart. I enjoy gentle walking, travelling and holidays. I enjoy cooking and good food. I am a computer and gadget nerd. My wife and I have learned a little Italian because we love that country and hav

2011-01-16T08:56:00.002-08:00

I was browsing the Youtube video website and came across two of my undergraduate teachers, J Z Young and Andrew Huxley.

John Zachary Young was the Professor of Anatomy and was seriously famous and is one of my heroes. I have mentioned him elsewhere in this blog. After I had completed my preclinical studies, I was fortunate to be selected to study for a further 18 months in his department of anatomy tfor a degree in that subject. A major attraction of the course was that for a six week period of the summer vacation six of us joined him in Naples, Italy, to assist him in the study of the nervous systems of octopuses and squid. 5 of us worked on octopuses and I was the squid man. What I had to do, twice a day, was to dissect out a giant squid axon, and measured the speed of nerve conduction using a stimulator and an oscilloscope. JZ, as he was known to everybody, showed me how to dissect out the nerve. Despite this, I did not get a single recordable result for about 2 ½ weeks. I was damaging the nerve. The dissection had to be undertaken using a microscope. He was trying to provide further evidence for the Hodgkin Huxley formula:

cv = sqrt(K a / 2 R_2 C_m) Hodgkin and Huxley 1952
cv : conduction velocity
K : 10470
a : radius of axis cylinder (238um)
R_2: specific resistance of axoplasm (35.4 Ohms)
C_m: capacity per unit of area of membrane (10^-6)

Click on the link below to see JZ demonstrating the anatomy of the giant squid axon.

http://www.youtube.com/watch?v=pw6_Si5jOpo

Andrew Huxley was the Professor of Physiology At University College London when I was an undergraduate there. He was my physiology tutor for a term. He knew the logarithm tables by heart and showed us this when he marked our practical calculations! He was quite a boring lecturer and we used to count how many times he said “er”. However, it was announced that he had been awarded the Nobel Prize for his work on discovering how nerves conducted electricity. This work could not have been undertaken without JZ Young’s discovery of the giant axon in the squid. A huge number of us crowded beneath his window and chanted his name until opened the window and waved. After that his lectures were packed with all sorts of students from different faculties other than medicine. He demonstrated the sound of nerves conducting by inserting electrodes into his own arm.

Click on the link below to hear Professor Huxley explaining his work for the Hodgkin.

http://www.youtube.com/watch?v=W4Lys3STeq0

2008-12-16T10:54:00.000-08:00

Education Essay

Adult Developmental Learning and Change – an essay.
This essay is a narrative of my thoughts after reflecting on my learning and teaching experiences over the past 4 or 5 decades. It was written as an assignment for the Postgraduate Certificate of Primary Care Education in September 2001.

An essay is a composition and as such allows thoughts, theories and ideas to be described, reflected upon and developed. An essay is, therefore, different from a scientific paper, a review of evidence or a historical account of events.
I have been a learner, teacher and facilitator of education in varying degrees all my adult life. The people I have encountered throughout this time have had a great effect on my direction and development.
Gollanz (1923) pointed out, in his preface to Shakespeare’s ‘As You Like it’, that the division of life into 14,10 or 7 periods is found in Hebrew, Greek and Roman literature and that in the 15th century the seven ages became a common theme in literature and art (the mosaics on the pavement of the cathedral at Siena). Appendix 1 shows 3 versions of “ages of man”.
Levinson’s Developmental Periods described by Daloz (1986 p 55) is the structure I will use to organize my thoughts. Appendix 2 is a transcript of the figure from that page.
What is an adult and when did adult learning start for me? In law, an adult is one who has reached full legal age, the age of majority – 18 years in this country. It also means mature or grown up. Brookfield, 1986, outlined his 6 principals of adult learning and I feel these are stated in appendix 3.
I went to Queen Elizabeth Grammar School, Wakefield from the age of 6 to nearly 18. Assessment took place in the basic form of term reports. I can be described, on some of those early days, by one of Shakespeare’s seven ages of man from his comedy, As You Like it:
“ Then the whining schoolboy, with his satchel and shining morning face, creeping like snail unwillingly to school”.

Termly assessments were written throughout school and these were read by one’s parents. The assessments were both a threat and a motivator. They were both summative and formative.
School was in no way voluntary and the aims and objectives of the curriculum were teacher and exam driven. It is an axiom of American education that parents are partners in their children¹s education. The pupil can end up with parents acting as coaches or tutors. This role of parents may embrace some adult learning principals as the environment of the home may be freer than school.
As one progressed through the sixth form, there was a feeling of mutual respect between teacher and student. Praxis, collaboration and empowerment
were introduced. If one behaved as a child one was treated as a child and punished as a child despite attempts of the teachers to treat us as adults. Perh
The objectives of sixth form learning that were strongly shared by teachers, parents and me included passing A levels such that I got a place in a medical school.
Levinson described the stage of me about to enter Medical School as moving from pre- to early adulthood and he stated that this begins at about age 17 and is called the early adult transition.
On the 30th September 1963, not yet 18 years old, I attended my first lecture at University College, London. The lecture was by the Professor of Anatomy, J. Z. Young and I can remember the content of that lecture, as well as it’s objectives, well and clearly to this day. He was eminent, charismatic, a communicator and a “lecturer extraordinaire”. He delivered the Ferrier and Croonian lectures at the Royal Society in 1950 and 1965 respectively. He was a Fellow of the Royal Society. He used lectures, tutorials and written material as his main ways of communicating but also the radio. Indeed, he was the Reith Lecturer for the BBC in 1951 and he said in one of those broadcasts:
“Whether we like it or not, we can be sure that societies that use to the full the new techniques of communication, by better language and by better machines, will eventually replace those that do not”. (Young 1951 p 7).

The advantage of a lecture is that it lets an expert share his or her knowledge, attitudes and skills with a large number of people in a short time (Chambers and Wall 2000 p 79). The disadvantages are that there can be passive listening, the pace is the same for all, and attention is lost after a few minutes. A good lecturer, like J. Z. Young, on that first day for us at medical school, knew the level of expertise of the audience, had rehearsed and timed it, used appropriate visual aids in the form of colour slides and sparked the imagination of the audience, keeping their attention with his style and subject matter. He used better language and machines to communicate. He had the full text of his Reith Lectures published in a book so we could reflect on these in our own time. All these ways of improving a lecture are known today (Chambers and Wall 2000 pp 81-83), but often ignored.
The educational methods used at Pre-clinical medical school were mainly lectures and group tutorials on specific topics. There were also Physiology and Biochemistry practical classes with roaming supervisors. The dissection table encouraged teamwork and friendship as well as dealing with the morbid - all relevant for General Practice.
After pre-clinical I took 18 months out to undertake a B.Sc. in Anatomy and this is where I learned what adult learning was all about and how I appreciated it. The head of department was Professor J Z Young and he employed the Oxford Tutorial System as a teaching method.
“The foundation of undergraduate teaching at Oxford is the tutorial system. It is not a system of spoon-feeding. Undergraduates are expected to pursue a course of independent study under the guidance of their tutors, who set problems to solve or essays to write, and suggest books to read and university lectures to attend. Teaching is also sometimes carried out in classes of larger numbers. The tutor provides constructive comment on the undergraduate's written work and a discussion is opened up. The success of the tutorial system depends on the undergraduates; they must organise their time effectively, work steadily, and contribute fully to the dialogue.” (Merton College, Oxford University, Web Site, 2000).
We were encouraged to question, doubt, discuss ideas with our tutors as equals and socialise with them. I realised that interactions with both my teachers and fellow students were as important to me as knowledge and skills acquisition. I spent 6 weeks in the Stazione Zoologica in Naples researching the conduction velocities of the giant axons of squid as part of this course. While there we visited all the famous Roman sites as well as enjoying many meals in the company of visiting researchers. This trip gave me a life long-interest in Italy as well as science and I experienced the interaction of environment, art, history and social intercourse on learning – the visible and invisible words (see page 12 below).
In 1966, aged 21, I started my 3 years clinical studies at The London Hospital followed by a year of house jobs there after qualification. This was not a happy experience. I was not yet in Levinson’s adult world but still in early adult transition (Levinson 1978 p 57). Yet, on reflection, during the B.Sc. course, I had just experienced adult education at it’s very best and felt I needed serious adult learning experiences in order to progress with my medical education. However, I entered the world of the apprentice, with masters and pupils, paternalism and teaching by humiliation being commonplace. This way of teaching creates doctors with attitudes and behaviour disliked by their patients. Brookfield’s mutual respect was notable by its absence.
Smith complained that the apprenticeship system was still employed significantly in clinical training, especially in surgery (1996). Wass realised there was something wrong but stated, weakly,
“the time-honoured apprenticeship system of medical training should be improved by a more structured approach and better supervision.” (1996)
Paternalism was deeply ingrained in General Practitioners in the late 40’s and early 50’s (MacGregor 1997). Despite increasing openness throughout the 1990s, there now exists widespread dissatisfaction with the attitude of some doctors because of their paternalistic approach and poor communication skills (Irvine 1997). The President of the General Medical Council, commenting after the Ledward case said, “ some doctors still think they’re playing God (Irvine 2000). It is a view that the attitudinal problems of our profession were as a direct result of the educational methods used in clinical schools and postgraduate medical education in teaching hospitals. Despite many changes in medical school and postgraduate hospital based courses radical improvements are still required.
Clinical teaching delayed my entering the adult world of exploration of the possibilities of adult life (Levinson 1978 p 82) until the age of 25. I became a Lecturer in Physiology at The London Hospital Medical College and researched hypothermia to Ph.D. level. Appendix 5 is the preface of my thesis (Sloan 1976). I learned so much from all the people I worked with and one can see from this appendix that the learning involved a supervisor as well as critical reading and publishing work which was assessed by journal editors. The job also involved my lecturing, facilitating tutorials and running and supervising practical classes. For the latter aspect of the job I had no training and no opportunity to learn about educational theory and methods. This was the norm for both pre-clinical and clinical teaching. It was assumed all doctors could teach. I was persuaded that the lecture was the best method of teaching and concentrated my efforts on these rather than learning how to run groups or undertake educational needs assessments or evaluation.
For the research aspect, I chose my supervisor after 2 months in the department. I chose the area of work I wanted to research. The relationship I had with my supervisor was of guide and mentor rather than apprentice and master. Bill Keatinge had the attributes of a mentor described by Chambers and Wall - “an experienced, highly regarded, empathic person” who “guides an individual in the development and re-examination of their own ideas, learning and personal and professional development” (2000 p 146). The education I experienced embraced closely all 6 of Brookfield’s principals of adult education, just as I am experiencing now with this postgraduate certificate.
I entered General Practice as a Principal in 1974 without vocational or any other training. I could hardly remember how to treat a sore throat and had not dealt with patients for 3 years. The practice and I were happy with this situation! On reflection, my learning needs would have better been addressed by a period of training. I wrote up my Ph.D. over the next two years and this involved the reading and writing that I loved. I gave a few lectures in postgraduate centres. I went to a few courses and lectures at the local postgraduate centre. I was in the “Age thirty transition” (Levinson, 1978, p 58). General Practice was to be my career. Levinson points out that for some, this can be an “age 30 crisis” and indeed that period of 4 or 5 years in Cheltenham, London then Castleford, involved my moving house 5 times, getting divorced, leaving General Practice and resigning after one week as a lecturer in Physiology.
I went through what I call my educational dark age from 1977 to about 1983 – aged 32 to 38 – The Second life Structure: Settling Down (Levinson 19783 p 59). I remarried, bought a house in which we still live but was working as a single-handed practitioner with an increasing list. It was my dark age because of the nature of being single-handed. I attended a few courses and lunchtime lectures and read a bit and that was it. By the end of this period I decided to become a trainer and was taking on a full time partner.
In 1985, aged 40, I entered the mid-life transition, the beginning of middle adulthood, which is a period of advancement within a stable life structure (Levinson, 1979, p192&201). This was the start of my deep involvement with the Yorkshire Education Network. I became a trainer, then Continuing Medical Education (CME) Tutor for GP Principals and then a Course Organiser for the Vocational Training Scheme (VTS) for the Pontefract District.
To become a Trainer the Practice had to be set up as a learning environment of excellence according to National and Regional criteria. There is a course for prospective trainers called the “O Course” which allowed one to reflect on one’s potential training skills and feel what training is all about. This was facilitated by an educationalist with senior tutors from the Yorkshire Education Network. My assessment started there and reassessment for training is every one to three years. This involves an inspection of the surgery by a team of fellow and senior educationalists who also examine tutorial skills by assessing a video of these. Reassessment of CME Tutors and VTS Course Organisers involves an annual appraisal. Trainers have to attend workshops monthly and residential courses at least every 2 years. Tutors and course organisers attend residential seminars about three times a year. Here I have learned about running a group, course planning, time management, learning styles, learning needs assessment, facilitation, motivation and other elements important in postgraduate medical education.
Mentoring and being a member of a local Professional support Group that looks at under-performing and ill GPs and GP Registrars has been my “Age 50 Transition”. I nearly feel I am an expert in postgraduate medical education. Nearly!
This course, the people on it and running it, have got me back to the academic way of thinking, researching for evidence, writing referenced accounts, essays and praxis.
I am at the start of the ‘culmination of middle adulthood’.
“For men who are able to rejuvenate their selves and enrich their lives, the decade of the fifties can be a time of great fulfilment.” (Levinson 1978 p 62).
I realise that I have picked up the academic approach that I left behind after I had completed writing my Ph.D.
“The wheel is come full circle” (Shakespeare 1608 King Lear).
There have been such circles throughout my adult life and not only at the end of my educational development.
· I was a medical student and then a lecturer teaching medical students.
· I have been on the “O Course” and now I am a tutor for this course.
· I researched the literature for my Ph.D. and now again I am researching the literature.
· My first lecture was from a Reith lecturer and I have just met another Reith Lecturer in my role as a Trustee of our Pontefract-based Prince of Wales Hospice.
Many of the people I have had the good fortune to be associated with in my adult life have been versed in art, music, languages, ethics, philosophy, history and politics. These people have had a significant, albeit unquantifiable, effect on my knowledge, skills and attitudes. There is more to education than meets the eye.
“Surely, therefore, we need to look towards the creation of greater balance in the way we educate people so that the practical and intuitive wisdom of the past can be blended with the appropriate technology and knowledge of the present to produce the type of practitioner who is acutely aware of both the visible and invisible worlds that inform the entire cosmos.” (The Prince of Wales 2000.)

I look forward with relish to late adult transition and late adulthood in the company of my wife Kath who has taught me more than anyone else. I hope to have a similar enthusiasm in that age of my life as J Z Young did. He died aged 90 and was in the middle of writing a book on the cephalopods (Tucker 1997).
(2400 words)

REFERENCES.

BROOKFIELD S (1986) Understanding and facilitating adult education Milton Keynes: Open University Press.

CHAMBERS R and WALL D (2000) Teaching Made Easy – a manual for health professionals Radcliffe Medical Press Ltd Oxfordshire.

DALOZ L A (1986) Effective Teaching and Mentoring San Francisco: Jossey-Bass.

GOLLANZ I (1923) As You Like It Preface Shakespeare J M Dent and Sons Ltd London p xii.

Appendix 1.

Ages of man.

1. Shakespeare. As you like it. Act 2, sc. vii, lines 139 – 166.

Jaq. All the world’s a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurses arms.
Then the wining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sanse taste, sans every thing.

Appendix 2.

Figure 1. Levinson’s Developmental Periods.

Late Adulthood
65
LATE ADULT TRANSITION
60
Culmination of Middle Adulthood
55
Age 50 Transition. Middle adulthood
50 Entering Middle Age
45
MID-LIFE TRANSITION
40
Settling Down
33
Age 30 Transition
28 Early Adulthood
Entering the adult world
EARLY ADULT TRANSITION
(Childhood and Adolescence)

Appendix 3.

Brookfield’s Principals of Adult Education.

6 principals applying to teaching-learning encounters or to curriculum development. The six principals of effective practice in facilitating learning
1. Participation is voluntary
2. Respect among participants of each other’s self worth. Attention to increasing adult self worth underlies all facilitation attempts.
3. Facilitation is collaborative - setting objectives, curriculum development, and evaluation. Continual renegotiation of priorities.
4. Praxis is placed at the heart of effective facilitation
5. Facilitation aims to foster in adults the spirit of critical reflection. Adults will come to question many aspects of their professional, personal and political lives.
6. The aim of facilitation is the nurturing of self directed empowered adults.

IRVINE D (1997) The performance of doctors. i : professionalism and self regulation in a changing world Education and Debate British Medical Journal 314 p 1540.

IRVINE D (2000) Editorial The Sunday Times Newspaper 4th June.

LEVINSON D J (1978) The seasons of a man’s life Alfred A Knopf New York.

MACGREGOR S (1998) From paternalism to partnership British Medical Journal 317 p 221.

MERTON COLLEGE Web Site (2000) Oxford University
http://www.merton.ox.ac.uk/prospectus/tutorial-system.html.

PRINCE CHARLES The Prince of Wales (2000) We must go with grain of nature The BBC Reith Lecture The Times Newspaper 18th May Section 2 p 7.

SHAKESPEARE, W. (1599) As you like it ii, vii, lines 145 – 147.
SHAKESPEARE, W. (1608). King Lear. v, iii, line 174.

SLOAN R E (1976) The effect of age and sex on body cooling rates Ph.D. Thesis, University of London pp 9 – 10.

SMITH T (1996) Apprentice Surgeons Soundings British Medical Journal 312 p 1223.

TUCKER A (1997) John Zachary Young – Broad grasp of the Brain Obituaries The Guardian Newspaper July 14 1997.

WASS J (1996) The core curriculum for senior house officers Career Focus British Medical Journal 313 p 7054

YOUNG J Z (1951) Doubt and Certainty in Science. A biologist’s reflections on the brain Oxford University Press.

2008-09-30T10:55:00.000-07:00

Advanced Motorist

A month or so ago, I passed my Institute of Advanced Motorists (IAM) Test at the second attempt. I had been working at it for about a year. It really is one of the better things I have done recently as I feel I am driving better, more safely and anticipating hazards.
At the beginning one is allocated an “observer”. Mine is called John Convery and is a senior nurse working in the accident and emergency department at Pinderfields hospital, Wakefield. The road traffic accidents he deals with are the motivators for him doing the observer work.
One arranges to drive your own car every couple of weeks or so for about an hour with John teaching and observing. I volunteered to make a commentary about what I was doing and seeing. This I found easy as I simply rambled on. There were books to study and these included the Highway Code, a book on road signs and the IAM handbook. I became a very sad person and was reading the Highway Code whilst eating my breakfast.
One has to stick to the speed limits. This means that one has to know what the speed limit is at any time and it took me a while to be able to do this. There can be a change of speed limit on a sign hidden behind the leaves of a tree. One should be able to tell what the limit is if one has missed the sign. Generally, if there are lamp posts it is 30 mph. There are repeater signs for 40, 50 and national speed limits on roads that have such limits and lamp posts. Isn’t this fascinating? One drives up to the limit if it is safe. In 30 limits I experienced serious road rage from tailgating vehicles and sometimes pulled over to let them overtake. I also had, in the early days, some heated discussions with Kath when I was dawdling along. I did a lot of practicing by myself. Having an observer talking about his job got me used to driving in an advanced manner with a passenger – a normalized situation.
I could write at length about what I learned about every aspect of driving. Suffice it to state that I feel I am a better and safer driver in Italy, which we visit a lot. There are some serious lunatic drivers there.
On the first Sunday each month one could go along to Halford’s car park in Pontefract and have a drive with a senior observer, usually retired police drivers. The first session I had was with Gerry (whom I knew as he was in our Italian language class. He got me into all this). He was excellent and it was early days for me. He got me reversing in to a parking space (I was hopeless) and doing a three point turn (I had forgotten how to do that properly). He taught me, as did John, to drive “with sparkle”.
I went with another senior observer, Graham, later in the year and had another drive with me before my test. He told me I was OK and did not need wishing luck. How wrong he was!!
The test is one and a half hours and my first examiner was Phil. He is a sergeant in the traffic division of Wakefield police. We met in Morrison’s car park in Wakefield. I got there well before him so he did not see me park. It was a cloudy day and he arrived wearing shades and reversed his car immaculately into a parking space. I thought there was going to be trouble here! Before we got into the car he said he presumed I had done a cockpit check before I left home and he proposed an external car check. He asked me what the minimum tred on tyres was. I had no idea. He asked me how to check that both brake lights were working and I gave a hopeless answer to that. We set off and he took me on some seriously narrow country roads on Emley Moor. I was driving with too much “sparkle” i.e. too fast and I completely mucked up a bend, committing the sin of having to brake whilst in the bend. I made an inappropriate merry quip about the police at one point. He got me reversing downhill round a bend first on one side of the road and then the other. I completely mucked it up. I had not practiced reversing apart from into a parking space. He talked a lot and I got the feeling I had done everything wrongly. When we got back to Morrison’s and parked up he told me he could not recommend me for membership of the IAM. I was shaken as I thought he might forgive a few errors. He advised me how to change gear differently and all sorts of other things.
We were going to London later that day. I seriously felt I had let my observer John down as he had taught me such a lot and spent so much of his free time with me (all unpaid). I texted him and he replied that he thought the examiner was a swine. It did not spoil the weekend but I talked about it with Kath a lot and that did me good. I have failed all sorts of tests and exams over the years. I failed my driving test the first time. As the time went on I realized Phil was absolutely right to fail me. I was determined to pass the next time. There are two examiners and I did not know which one I would get next. I decided to practice all the things Phil had told me about. I wrote an article on “failure” which is on one of my blogs. I went out and did as much of the test route as I could remember. Our garden has a curved flower bed one has to drive past to get out. I practice over and over again reversing first with the curve next to the driver’s side and then next to the offside. I tilted the mirrors down to see what I was doing.
I decided that I was OK at the advanced aspects of the test but had not revisited what one has to be able to do in the basic test. I bought yet another book that was very good. It talked about tyre tread, pressures. I read and learned about my car from it’s manual. I bought a tread meter and a gadget that measures the tyre pressures and is also a pump powered from the cigar lighter.
I applied to go in for the test again as soon as was feasible. I decided to take the test and not tell John Convery this time. One evening the phone rang and it was Phil!! Better the devil you know.
I was seriously nervous the morning of the test. Phil told me he had not slept beacuase of his irritable bowel. Like last time, he fixed his own reversing mirror on to the windscreen by means of a sucker. He got out his notepad and we set off. After 10 minutes he said “let’s get the reversing over with”. We did and it was OK. Not downhill this time. As I was “rambling on” I pointed out how I had taken on all the things he had told me and that I had bought a tread meter and tyre pump. I was very open and honest about my approach. We were only out for an hour and I had the strong feeling I had passed. I had. I thanked him and gave him a copy of my essay on failure on which I had hand written “thanks, Phil”.
So I phoned Kath and texted John. He replied “you slimy bastard” but was obviously pleased.
I arranged to meet him to thank him and took a card and a present. He is a very decent man with a great family who were very nice to me.
What conclusions have I come to? Wel, I am a qualified educationalist and I learned that you can never stop learning even about something you have been doing every day for decades.

2008-07-27T23:01:00.000-07:00

Failure – a learning experience?

There are some people I have met who have never failed an examination or test in their lives - so far. I believe some of these have missed out on something. Failing at something or feeling a failure should be a learning experience. Passing every examination or test may lead to over-confidence. Some of the people who have passed everything may also have never failed at interview for a job. In my experience, the latter can result in an arrogant and ambitious approach to work as well as problems dealing with those responsible to them as employees.
There is sometimes a sense of failure when one questions what one is doing at work and the possible guilt feeling if one has not a “proper job” We have to move on from these feelings and progress our thoughts. We should not allow failure feelings to become set in or prolonged. We should look back on our experiences and relationships and be positive. Some failures take longer than others to put on the back burner.

This piece was going to be mainly autobiographical but that is too easy. I have written the autobiography of my failures in another essay. I will start by listing my perceived failures and then discuss failure in a more general sense.
I failed: to pass O level English Literature; to pass mock O level chemistry; to pass my driving test first time; to pass an exam called “conjoint” (a final examination in medicine and surgery that would have enabled me to practice as a doctor); to obtain a higher degree in my Anatomy B.Sc than a lower second; to, in my mother’s eyes, become a consultant; to get higher marks in a postgraduate certificate in primary care education completed in 2001; get re-elected as a metropolitan district councilor in 1983; to pass the Institute of Advanced motorists test, recently; to write any fiction.
Let me describe “rich pig’s worries”. After that you will understand that it is ridiculous for me to worry, at this stage of my life, about the above list of perceived failures. A number of years ago, I was working on postgraduate medical education based at Pontefract General

Infirmary. I was a General Practitioner and I worked closely with a consultant physician, Mick Peake, who was the hospital educationalist. One afternoon I was in the Postgraduate Center at the hospital and he came in looking flustered and worries. He told us that the forthcoming weekend was going to be a nightmare to him. He had to travel all the way to London to buy a new cover for their swimming pool. His partner is a consultant paediatrician. Need I write any more about “rich pig’s worries”?

So what about my list of failures? They are luxury failures. I did not fail to have a fabulously interesting and fulfilled career. I was very upset each time I failed but, in the fullness of time, regarded each failure as a learning experience. At the time of writing, I am learning how to reverse my car round a bend on a road going downhill and how not to go round corners on country roads too fast. I am looking forward to re-taking my advanced motoring test again. I realised that the guy who failed me was right to fail me. Again, failing the advanced motorist’s test is a luxury. I own a great car and have the time to indulge trying to drive better.

What do other sources say about failure? Can we learn anything from these?
Wikipedia (accessed 26th July 2008):
“The criteria for failure are heavily dependent on context of use, and may be relative to a particular observer or belief system. A situation considered to be a failure by one might be considered a success by another, particularly in cases of direct competition or a zero-sum game. As well, the degree of success or failure in a situation may be differently viewed by distinct observers or participants, such that a situation that one considers to be a failure, another might consider to be a success, a qualified success or a neutral situation.
It may also be difficult or impossible to ascertain whether a situation meets criteria for failure or success due to ambiguous or ill-defined definition of those criteria. Finding useful and effective criteria, or heuristics, to judge the success or failure of a situation may itself be a significant task.”

“It is possible to fail in many ways...while to succeed is possible only in one way.” Aristotle. (384 BC – 322 BC)

“You may be disappointed if you fail, but you are doomed if you don't try.” Beverly Sills. American Opera Singer. (1929 - )

“Don't be discouraged by a failure. It can be a positive experience. Failure is, in a sense, the highway to success, inasmuch as every discovery of what is false leads us to seek earnestly after what is true, and every fresh experience points out some form of error which we shall afterwards carefully avoid.” John Keats. Poet. (1795 – 1821)

“A minute's success pays the failure of years.” Robert Browning. Poet. (1812 – 1889)

“Success is the ability to go from one failure to another with no loss of enthusiasm.” Sir Winston Churchill. (1874 – 1965)

“I remember and reflect on my failures more than my successes. That reflection has made me a better person.” Richard Sloan. (1945- )

2008-02-01T22:49:00.000-08:00

Mentoring

2/2/08 Last week I:

spent an hour mentoring a person in the PCT who was having trouble in her job - I am a mentor in the Dignity in the Workplace Scheme
mentored a GP who was having trouble with a partnership
spoke to a solicitor who was representing a mentee of mine and I am to be a witness in a County Court case this Wednesday
gave a reference for a General Practice which wants to take a project foreward
wrote a character reference for a refugee Iraqui doctor and sent it to the GMC

Mentoring has been a love of my life and I have published some stuff on the subject.

1 Mentoring & Tutoring, Vol. 11, No. 3, December 2003
The Impact of General Practitioners
Trained as Mentors: a study of mentoring
activity and potential
RICHARD SLOAN1 & GEORGE TAYLOR2

2008-01-13T10:45:00.000-08:00

Political thoughts

I have always been interested in national and local politics and on occasions been very active. This is my political autobiography.

As a teenager at school was not very interested in politics. My German mother told me her experience of having to get out of Nazi Germany and my protestant Irish father read a lot about the history of Northern Ireland. There were quite a lot of books on political history in the house. However, at Queen Elizabeth Grammar School, Wakefiled, my form master for 3 years running when I was 10 to 12 years old was Nigel Barnet. He became the MP for Greenwich and I wonder whether he influenced my values. However, I can not remember politics being mentioned on any occasion by him. Unfortunately, he died prematurely but did some great work in the background as an MP.
I became a member of the Humanist Society which I regarded as an anti-religious political movement. I read their regular publication for members and I also had the “Soviet Weekly” delivered. Was this simply me as a teenager trying out a bit of rebellious behaviour and attention seeking? My parents were long standing conservative voters and indeed my father only voted labour once and that was in the landslide general election of 1945. I thought their voting conservative was a class thing and inconsistent with their values. My father was one of the few, if not the only doctor to support the creation of the National Health Service.
Two of their patients, when they lived in Airedale, were Walter and Enid `Harrison. They moved to Wakefield and Walter eventually became the MP for Wakefield and a labour whip. My parents took me to visit the House of Commons just after Walter had been elected. We met him and he told my father which hook to hang his overcoat on. Immediately my father had hung his coat up a man in a very elaborate uniform came up to us and informed us that the coat hook that had been used was for the sole use of ambassadors. That was the first of several occasions I heard prime Minister’s questions. Walter came to my father’s funeral and sent the only flowers that were at my mother’s funeral. What a great bloke. Why he never got an honour I shall never understand.
At University in London in the 60s I was again not involved in politics. I can not remember what I voted in the first general election that I was allowed to vote. Is this because I have repressed it from my mind because I actually voted conservative! David Frost and the satire of the time had a great influence on me. Indeed at the time of writing this (2007) I have relistened to Peter Cook’s imitating Harold Macmillan reading out the letter from “the old aged pensioner from Fyfe”. It makes me laugh out loud every time I hear it. As a medical student in London I went to debates and heard one in which David Frost took part and another in which Julian Amery featured (he had the plumiest accent I had ever heard).
During an election campaign went to a Hustings in Marylebone town hall where Mr Quinton Hogg (Lord Hailsham) made a speech. He started to answer a question with “We in the conservative party do not think……” and was cut off in his prime by chanting “We do not think. We do not think. We do not think.” Many years later, he visited Nostell Priory where Kath was the manager and I have a great photograph of them chatting together. I think the student unions were pretty left wing at the time and Jack Straw was the President of the National Union of Students.
The first letter I wrote to a politician was to Lady Sear, the Liberal peer. I had heard her on the television talking about the unfairness of the student grant situation. I married my first wife when she was still a medical student and this resulted in her being regarded from the grand giving point, as living at home. Her grant was drastically cut. Baroness Sear did not reply to my letter to the House of Lords. I thought this was very bad and I wrote to her at her home address and pointed this out. She wrote back to me by hand apologising and answering my points to my satisfaction. I really do believe that letting politicians know one’s view may have some influence but I have tried not to overdo this. The only politician not to reply to me was David Owen when I wrote to him very upset that he would not join the Liberal Democrat Party despite a vote in favour of merging. Most undemocratic of him. However I am still a great fan of his. Many years later when I was working in Castleford I wrote something about the NHS to our MP Geoffrey (now Lord) Lofthouse. He phoned me up and told me he was writing to the then mister of health, Harriet Harman. He said “ What do you think of this? Dear ‘Arriet ……” Despite the dropping of the aitch, which amused me and which I also do, it was great of him to go to all that trouble. He was a superb constituency MP.
I became a GP in Cheltenham in 1973. Cheltenham had another excellent constituency MP, the Conservative, Charles Irving. I first got involved in a bit of local politics when a new friend, Bill Bullingham, invited us round for dinner. One of the objectives of this invitation was to get me arguing with a Councillor Dudley Aldridge. Bill was heavily involved with the local Conservative party. Bill eventually became the mayor of Cheltenham. Another prominent conservative councillor was a fellow GP, Clive Froggart. He was personally involved at the highest government levels in developing GP Fundholding. He even had talks with Mrs Thatcher. Again Bill invited me to dinner so I would start arguing and I did.
I have given Bill a couple of signed books. The first was Harold Wilson’s autobiography. I bought two copies of the book and stamped addressed packages. My covering letter explained about Bill and his Conservatism and that I was a member of the Labour Party. The books were duly returned and signed. In the one to Bill, Mr Wilson had written: “To Mr Bill Bullingham” and in mine he wrote” To Richard Sloan with the writer’s best wishes” The second was one I gave to Bill at his 40th birthday party held at the house of Lords. It was book signed by David Owen. I was a member of the Council for Social Democracy and attended the Party Conferences of the SDP. I bought a book written by David Owen and gave it to a colleague who was on the “front bench”. He passed it along to David Owen with a note from me requesting him to sign it. Bill had a friend who was Lord Mulloy. In order to be able to book a dinner party in the House of Lords one had to do this through a peer. Lord Mulloy was an expert in groundnuts and the Gambia. After the meal he drove us back to our hotel in his merc and we had a nightcap. I paid for this. Cash for questions? Bill gave me a book signed by Edward Heath. Indeed, I have quite a collection of signed books. Last week (October 2007) David Owen returned another `book I had asked him to sign – “The Hubris Syndrome”. It had a very nice message in it.
After I left Cheltenham Kath and I went to work in Castleford in 1978. I joined the Labour Party but was not an active member.

When the SDP was founded in 1981, Kath and I immediately joined. We were very active indeed. We met some great people through the SDP. One of my GP colleagues, Lutfe Kamal, was already a councillor for the Wakefield Metropolitan District Council and changed parties from Labour to the SDP. Alan Mills was another sitting councillor who defected. The ex MP for Goole, Edmund Marshall became a member. Terry Walsh from Wakefield was our chairman of the Wakefield Area Party and I was eventually the secretary. John Little, painter and decorator and second cousin to Gordon Brown, still paints our house 25 years later. Colin Strange (a distant relation of Basil Faulty) was great fun. Geoff Driver was an engineer who later became a vicar. Then there was a smashing local gang we got together for our ward of Ferry Fryston. Tommy Burns, Maud and Martin Raftery, Maureen Wood, Terence Guile, Edna Neil, Margaret Corfield, Joan Ella and others I am sure I have missed. We decided that I should stand for the council. This was a fascinating experience as I had no hope in hell of getting on. We had a major fund raising effort in our garden with 7 bar-b-qs on the go and stuff for sale. There were two seats up in the ward where we lived – Castleford Ferry Fryston Ward 11. Joan Ella, who also worked for the NHS, was to stand with me. She was born and brought up in the ward and I was brought up there. Alan was fighting his seat in Pontefract South and Lutfe’s was not up for election. We were part of the Wakefield Metropolitan District Council which had a population of well over 300000. Our ward had 11000 residents and over 5000 houses. If elected, this would only be for one year and then there would be another election. If elected that time it was for a 4 year term. There were three sitting labour councillors who had never been seriously challenged.
It was not too difficult to get nominated by a number of people living in the ward. We had to learn about the rules and law surrounding local elections so we did not get in to trouble. There were leaflets to be printed, folded and put in to 5000 letterboxes. Joan and I worked very well together but we thought we had no hope of getting elected. Kath was fantastic. Leafleting was a major and tiring exercise. One was so tired after leafleting a block of houses that one could not remember which ones had been done. There are letter boxes and letter boxes. Letter boxes that try to cut your fingers off, letter boxes with brushes, letter boxes with accompanying dogs, low letter boxes, high letter boxes etc.
Door knocking (canvassing) I found stressful. There could be quite unexpected responses. Middle class households turned out to be staunch labour supporters and coal miners tended to support the SDP.
For Election Day, we got hold of a loudspeaker and fixed it to a car. Joan and I took it in turns to speak into it as we went round the ward. We did not have enough manpower to give people lifts to the polling stations like the labour party did. We did not, like it, have enough people to man each polling station. We managed to get a bit to eat in the evening and then go to the count. What an experience that was! As I have mentioned, we felt it was impossible to win. No one had ever won a seat from labour in that ward. We had to go to the front, at the end of the count, to the returning officer and decide together about spoilt papers with our labour opponents. We were generous as we thought we had no chance. We gave them a few votes from the spoiled papers. Poor Joan had lost but she was great in defeat. I had won by 4 votes. The labour party demanded a recount. There had never been a recount ever. After the recount I was on by7 about 4 votes. They demanded another recount and after I won by 3 voted they conceded. Fantastically exciting. We were over the moon. I was the only SDP person to win a seat in the whole patch. Alan lost and Kamal got defeated the following year.
The next day we went to London and stayed at our friend, Gill’s, before going away on holiday. She was working on the election for the BBC at the time. Neither she nor we knew any details of the election because we had been so immersed in our own part of it. What brought me down to earth was when I told a taxi driver that I had been elected he was not the slightest bit interested. I last met Joan Ella a couple of months ago. She was out shopping with her mother and sister in Castleford. We greeted warmly as usual. We have met a few times as our paths crossed because of our both working for the NHS. I feel honoured to know such a great person as Joan.
In 1984 was the miners strike and it lasted a year. I can not remember whether I was elected before or after that. I experienced the 1970’s miners strike in the 70s when I was in London. Mr Heath’s 3 day week with power cuts. I realised that I would never be out of a job if I stuck to medicine. The surgeries in General Practice continued in candlelight.
The 1984 strike started amicably with great family cohesion and community spirit. I had to occasionally cross a picket line when doing home visits. I knew most of the blokes on the picket line. I always slowed down, wound my widow down and said the same thing – “I only want to get some coal out of that pit”. The reply was always “Go on. Help your self” There was a painted sign at the trop of the picket hut that read “Thatcher has one. McGreggor is one”.

I took them a bottle of whiskey one night. Our house and the surgery is about half a mile from that picket line and the mine. Towards the end of the strike things got nasty. Men from outside of the area manned the picket line. One night we were awoken by the sound of serious fighting – a riot. There was more noise that night than during the Second World War, I gather. I don’t think anyone was seriously injured.
There were some different medical problems that we saw during the strike. One man lost significant weight because he could not eat properly because of a dental problem and could not afford to see a dentist. We saw a lot more children. This was because the men were at home and did not realise what their wives were coping with when they were at work. The men would insist their child with a minor illness be seen by a doctor. There was a lot of stress and some men “threw on the sick”. I have never seen any statistics about this. Most GPs I knew gave out medical certificated readily to striking miners. These were proud men “salt of the earth”, as Harold MacMillan described them
One weekend during the strike we had Gill and Wendy, Kath’s former flat mates from London, stay with us for the weekend. Wendy has a particularly loud voice and a definite southern accent. They wanted to go for a drink at a working man’s club. One of our neighbours, Martin Raftery, a retired miner, took us. I warned Wendy and Gill not to mention Mrs Thatcher in the club. After a while there, Wendy turned round to a group of men on the next table and said in her loud voice “Richard has told us not to mention Mrs Thatcher. Why’s that?”. Well, you never heard such foul language!
After the strike was lost, the local pit in Fryston closed. Men who had gone back to work early were “blacklegs” and were never spoken to again. Some left the town. I was please that the pit closed because it was a horrific place that caused horrific illnesses and accidents.
In 2007, Castleford is thriving. This is because of the fantastic efforts over the last 10 years by the Labour Government and the Labour Metropolitan District Council.
This brings me back to describe what it was like to be a metropolitan district councillor.
There were only two of us out of about 65 who were in the SDP. There were about 4 Liberals and 6 Conservatives and a couple of independents. Lutfe Kamal was the leader of the SDP Councillors. We had to share out the committees between the two of us. Thank goodness he was good at financial matters as the budget was huge and complicated. The leader of the council at that time was Sir Jack Smart and the mayor Colin Croxall. Two of my school friends were councillors – Frank Ward and Peter Box. Peter is the excellent leader for the past few years. We could always annoy Sir Jack by taunting him that he obtained his knighthood from Mrs Thatcher. He received his knighthood partly because he was chairman or leader of the Association of Metropolitan Councils. Despite our political differences he became a patron of the Castleford Choral Society and we had a mutual respect for one another. I posted a stop watch to Colin Croxall, the mayor. This was because he always cut our speaking down in council and gave his fellow labour members extra time to make a speech. He sent it back to me. The thing that amused me about the mayor was that if he wanted to go to the lavatory in the middle of a council meeting we all had to stand up and he was led out by the macebearer. He was often cheered when he returned. On the whole, Labour members were not very friendly and the SDP were regarded as like blacklegs. The only one to teat me civilly from the start was Roy Widdowson. He ended up leader but then left the labour party. I was pleased to work recently in our Primary Care Trust where Roy was the chairman of the board. Indeed he and his wife along with Alan and Bron Mills asked us to join then for an evening meal in a mason’s lodge some years ago. The chairman of the finance committee was Bill O’Brian later to become MP for Normanton, now Ed Ball’s constituency, soon to disappear because of boundary changes. I used to have nightmares about Bill O’Brian. He was a real politician. He occasionally made a statement in council about what I had said and I hadn’t said a word about that particular area. What he said often ended up in the press. I could not be bothered to deny it. Again, political enemies end up behaving civilly to one another. I have met Bill of late on three occasions. The first was at our silver wedding anniversary celebration at Wentbridge House Hotel when he was at another function and he was very friendly. The second was recently (2007 is the year of writing this) when he came to a Castleford Choral Society Concert at St Joseph’s church, Pontefract and again he was very friendly. The third might have been before the latter other two and this was the Labour party Christmas do at the civic centre when Gordon Brown was the guest of honour. Kath and I went with George and Jean, who are longstanding friends from round here. I think George is somewhat right wing. He had a couple of questions written on a piece of paper to remind him what he wanted to say if he met Gordon Brown. He did meet him and put the questions to him. The point of this, though, is that George knew that Bill O’Brien had been somewhat rotten to me when I was on the council. When Bill walked in to this Christmas do, George jumped up and approached hi. He chastised Bill and told him I was a “pillar of society” and that it was bad of Bill to be rude about me. Since then all has been fine with Bill O’Brian. He really should have been given an honour like Geoff Lofthouse for giving up his seat for Ed Balls. More deservedly, Roy Widdowson should have been given an honour. Peter Box will probably get one.
What was it like being a metropolitan district councillor? At first I was totally out of my depth at first. I felt on top of the job only after 9 months and 3 months before I lost the local election. I held a council surgery each week in a school in the ward and enjoyed articulating people’s worries by letter to the chief officers of the various departments. I occasionally wrote to the MP, Geoff Lofthouse about issues. I organised the odd petition. I had regular weekly meetings with the local press. I regularly got my thoughts into the Pontefract and Castleford Express and occasionally the Yorkshire Post. I dug up some dirt where I could but I did not like this activity. I spoke in council. I was on the subcommittee that had to decide on a new dustbin for everyone. We sat in a splendid committee room round a huge oak table. Half a dozen dustbins were brought in and put in front of us on the table. In order to see ones fellow committee members one had to peer round the left or right side of a dustbin. One memorable afternoon was when I went with two or three others (including David Hinchliffe, the future MP for Wakefield and chairman of the government health committee) on an inspection of the kitchens at the building that was the home of the finance department. We were all in a rather poky car when the mayor, Colin Croxall, passed us in his official limousine and wearing his mayoral robes. I remember David winding down the window, blowing a raspberry and raising two fingers as we were passed.
What did I do in the patch? The proudest achievement was to obtain fenced front gardens for a street that was open plan and where the residents were experiencing significant vandalism and taunting from youths who could easily get to their front doors and sitting room windows. What I realised after 6 months on the council was the technique for getting an idea through. This was to wangle it so the Labour Party had the impression they thought of it itself. As long as it got the press coverage all was OK. I got an increased vote in the local elections the next year but lost. Sir Jack Smart and the MP, now Lord Lofthouse, and the whole of the Labour machine campaigned and door knocked in our ward. Even though I lost I got more votes than are obtained now. I was relieved to be knocked off. After the count, one of the local Labour councillors gave a short speech. He said that he had not even received a leaflet from us. We had put in 5000 leaflets 4 weeks running and the morning of the vote got up at 5 am to deliver a few hundred “good morning” leaflets. That really got me and my fellow candidate, John Little (a relation of Gordon Brown!!) furious. We went back to our house and got rather inebriated. We realise we had thousands of un-delivered leaflets. Out we went again to find the councillor’s house and stuff the leaflets through his letterbox. Fortunately we could not find the house.
Sir Jack Smart and Lord Lofthouse have been very friendly with me ever since the mid-eighties when all this was going on. Recently Sir Jack published a book and signed a copy for me to give to Kath for Christmas. I have signed books by Harold Wilson, Edward Heath, David Owen and Roy Jenkins.
For my 50th birthday we were in London. Geoffrey Lofthouse was then deputy speaker and our MP. Kath had arranged, unbeknown to me, a trip round the houses of parliament having contacted Geoff. We were on the tube the day before the secret visitation. I suddenly had an idea! I suggested to Kath that I phoned Geoff on my mobile and fixed up listening to PMQs. Oh dear. She had to tell me. The good thing, though, was it was obvious that I really wanted to do this and that Kath had arranged a fantastic birthday present that I would really appreciate. We were showed round by Geoff’s London secretary who was fantastic. He told us all the gossip. He told us about Betty Boothroyd’s gin and tonics. He took us on to the roof where Urquart shoved someone off! He took us to the government front benched and I asked if I could sit on them. This is strictly not allowed. We went all over the place. While we were in the chamber, Geoff came in and said hello. Before we went in for the PMQs, we stood in the lobby and watched the speaker coming in. Betty Boothroyd positively strutted in, she was so proud to do that job. PMQs was great. We had been allocated seats that were for the sole use of the speaker (Betty Boothroyd). There was an ambassador sitting next to us. A really great birthday present.
So to 1996 or 7 and New Labour. I was a member of the Labour party and as such was entitled to attend and vote on the selection of our prospective parliamentary candidate. Geoff Lofthouse had stood down and got a peerage later. He was not there. The meeting was held in a room in Castleford Grammar School. I can not remember the procedure but each candidate had to make a speech and had to answer the same questions. Hilary Benn was up for it as was Yvette Cooper, then about 27 tears of age. I was sitting behind my old friend Peter Box (leader of Wakefield Metropolitan District Council) and he was definitely gunning for Hilary Benn. I remember a woman from Batley starting her speech in a heavy Yorkshire accent “ Comrades”. I was sitting next to two ex-miners. The daftest thing to me was that one of the set questions was “have you ever stood for a political party other than the Labour Party?” That was to weed out a candidate that had been in the SDP whom party HQ had put on the shortlist. Yvette Cooper made a great speech and had the two ex-miners and me eating out of her hand. I think she was only 27 years old at the time. She won and, as I have reminded her, there was dancing in the streets that night. The dancing was quite near to a pub.
I have remained a member of the Labour party and registered my objection to the Iraq war by writing to my MP and spoiling a local election ballot paper one year.
I have not been an active member. Yvette opened the new surgery and I am proud to have a photo of me and her on her website.

http://www.yvettecooper.com/outandabout01b_dw.htm

(I’ve lost over 2 stones since that photo).

I read David Owen’s recent book “The Hubris Syndrome” and posted it to him to ask if he would sign it. He wrote me a very nice note. I collect signed books. I have one by Edward Heath and another by Harold Wilson as well as Roy Jenkins, Bill Keatinge, Liz Moulton and Ron Mullroy. Kath has Bob Wilson’s book signed as well as one by Terry Wogan. On this day of writing I watched a recording of PMQs and the Andrew Marr show. I am very interested indeed in politics and would like to get involved locally. However the ward meetings are on a Wednesday night which is the Castleford Choral Society’s rehearsal evening. I have sung with them approaching 30 years and am the Patrons’ secretary. Yvette Cooper, Ed Balls and Lord Lofthouse are all generous patrons and Bill O’Brian has been to one of our concerts last year.

2007-10-22T01:15:00.000-07:00

http://pavlovdiary.blogspot.com/

2007-05-18T11:20:00.000-07:00

http://www.youtube.com/watch?v=DJvSSK4t5os

Interesting?

2007-05-14T11:08:00.000-07:00

http://aolpictures.aol.co.uk/galleries/rsloan7798/

2007-04-14T10:09:00.000-07:00

Experience as a patient – 4
In March 2007 I experienced a weekend of a very painful parotid swelling. I made an appointment with my GP but I had thoroughly researched which consultant I wanted to see. I wanted to be seen privately (we are in BUPA) at our local private hospital by an expert in salivary glands. I found out that a consultant oro-maxillary surgeon did private work at that hospital and my GP wrote a referral letter. I went to the hospital to book my appointment. The appointment was the day before we had planned to go to Italy. The swelling settled quickly so I did not mind waiting the couple of weeks for the appointment. I was sitting in the waiting room watching a Rolls Royce pulling up at the front door when my consultant came out of his room and returned 5 minutes later and called me in. He examined me and recommended I had a sialogram by a consultant radiologist who is an expert on salivary glands. He explained that the reason he had popped out before he saw me was to book an operating theatre for that afternoon as he wanted to sort it out before we left on holiday! What a contrast between private and NHS care. I was ashamed to an extent. It turned out that there was no need for any operation.
The sialogram was to be undertaken after our holiday in a very old local hospital. I walked what seemed to be a mile along corridors and old walkways connecting decrepit buildings (A new hospital has been approved for this site and work will start soon). When I was called, I entered a room which had a state of the art image intensifier. This room and its equipment was NHS but my sialogram was a private one. The consultant radiologist was an expert in dental problems and salivary glands. There was a senior radiographer and two others there during my x- ray. It was a bit complicated but everything was explained to me very well and it was not at all uncomfortable. Gone are the days when an x-ray film is produced. All the pictures were on the computer and the consultant explained them to me and that all was OK. She thought it was probably a small stone. She said if I had any further problems she would sort it out and that there was no need to see the oro-maxillary surgeon again. I wrote to him to thank him and telephoned BUPA to see how the bill is to be dealt with. The whole thing cost me £100 (the excess) and BUPA £ . The BUPA premiums are about £2400 per annum and this includes a decent travel insurance for Europe. We have only made a couple of claims in the past 10 years or so amounting to about £3000 and £2000 of this was a holiday cancellation due to illness. We both feel that if we cancel the premiums this is tempting fate.

2007-03-02T11:29:00.000-08:00

Hero Number 3 (1)

This is going to be a lengthy contribution as it describes my experiences and feelings about postgraduate general practice education which has been the love of my life as a GP.

Dr Jamie Bahrami introduced me to the enriching world of Postgraduate General Practice Education. He is the only one of my three heroes to have worked as a GP. His practice was in Bradford where he was the Vocational Trainee Scheme’s Course organiser until he took up the post of Deputy Director of Postgraduate General Practice at the Yorkshire Deanery. At the present time, Bradford’s postgraduate general practice education is second to none. This is in large part due to the influence of Jamie Bahrami. He became the Director on the retirement of Dr John Sinson. He used to make a regular contribution to what is now called the Journal of Primary Care Education in the form of a diary. He was very skilled at teasing people. Once when we were emerging from a meeting he said to me “You had better be careful what you say or it will end up in my diary”. I replied “we can all write a bloody diary” – very rude of me, actually, but then I was never the most tactful of people. Well – here is my “diary”!!!

In the early 1980’s I was undertaking the very arduous task of getting the practice up to the standards that would ensure it was approved as a training practice. This involved all the medical records being summarised, having teaching aids, a library and my attending a course to ensure I had the necessary teaching skills. In the early days of Vocational Training it was very easy to become a trainer and now there are several courses one has to attend and be assessed as well as an interview.
One now has to have the MRCGP and I sat and passed that examination in 1984. The written papers were in Leeds and Jamie was an invigilator – waking up and down keeping an eye on things etc. My interview was with Dr Sinson. Jamie did a preliminary inspection of the practice and I was not quite up to scratch. I improved a few things and then got through the inspection easily. My partner, Dr John Lee was a great help \with summarising the notes and my wife, Kath, who was the Practice Manager for 15 years, was also a great support.

Before embarking on the journey of training I had a long talk with the then Course Organiser, Jeffrey Ellis. The meeting took place in our kitchen and I remember he smoked most of a packet of my cigarettes that afternoon. I promised him my loyalty and he was always a great supporter of my career in postgraduate general practice education.

The course prospective trainers had to attend was called The “O” Course. It was held at a Teacher Training College at Ripon and was a 3 night residential course. This course had a reputation of being harrowing in that one was being continuously assessed by those running it. The main man teaching on that course was Martin Rogers. He frightened us all to death. He was an educationalist but I thought he was a doctor for the first day. A few years late I found out that our housekeeper, Maureen, had a sister-in-law that was Martin’s next-door-neighbour. After he told me that he was always charming with me! On that course with me were two colleagues – Geof Slater (a GP in Wakefield) and Douglas Diggle (South Elmsal). During one session of our training Martin Rogers explored at what point we called a patient by their Christian name. Douglas ummed and ahed about this saying that it was very difficult. Martin said to Douglas, “you’re not married” and moved on. Douglas was shocked. He was not married but was divorced. He was the only person on that course not to be married. We teased him a lot about this. Douglas hated the course and did not proceed to become a trainer, which is a shame. He would have made an excellent trainer. Douglas told me to keep at it as one could only alter things if one was on the inside.
All of us on that course knew we were being assessed even at coffee and meal breaks. One evening Geof and I escaped to have a pint or two in the student bar. After a while there Geof pointed out to me that the barman might be a course organiser who was assessing us!
One had to untertake two other things in order to become a trainer. One was to attend some trainers’ workshops held monthly in the evening at the local postgraduate centre. The other was an interview.
When I attended the half day release for the first time none of the trainers acknowledged my existence. I did not really know any of them but it would have been nice if someone had welcomed me and said hello. I never understood why they behaved like that. As time went on, all was OK. When I became a course organiser this had an effect on me that I made great efforts to make new trainers welcome.
The interview was somewhat daunting as there were at least 8 on the interviewing panel, including Jamie. This was the first of 4 interviews I had for various jobs in Postgraduate General Practice Education.
You will read later that I ended up running part of the “O” course and chairing several of the interview panels for the appointment of GP Registrars, Course Organisers and GP Tutors.
So I was a trainer. I was due to have my first\ full time trainee (now called GP Registrar) about 6 months after my appointment. However, I received a phone call to inform me that one of the trainers had become ill and I was asked if I could take over his trainee. The trainer was David Wilkinson whom I see every week now (2006) as he is a member and chairman of the Castleford Choral Society. We rehearse every Wednesday evening. The trainee was Isabel and I was absolutely petrified waiting for her to start. One can only learn so much about vocational training by going on courses and attending workshops. In the end the only way to progress is to work with a trainee. At my first meeting with Isabel, she somewhat shocked me by informing me that she was not sure she really wanted to be a GP. However, as the three month of training progressed, I realised she was potentially a great GP and all went well.
One memory I have of her was when I took her to a meeting called by the Local Medical Committee. Isobel was a quiet and thinking person. This was a committee of GPs elected from colleagues from geographical patches and was supposed to represent us all. It was an important meeting and well attended – it must have been about pay and money! The chairman of the LMC was Dr Richard Smith and he wore a monocle. (I used to call him the “monocled mutineer”). He was a great protector of GPs and would take no nonsense from “management” – health authorities etc. At this meeting, Richard Smith was making a case for something or other. Suddenly, Isabel shouted out “rubbish!” in front of 100 GPs. I was really proud of her.
At that time she was married to her first husband who worked for the Inland Revenue. My medical partner, John Lee, was shocked about this and asked me not to discuss partnership money matters in front of her. I could not understand his fears as we were not doing anything to fiddle the tax. He always whispered financial matters if Isabel was in the building. Isabel was with me for only 3 months (the ususal length of attachment is 6 months).
Many years later we advertised for a locum to cover a period of maternity leave of one of my partners. One of the applicants was Isabel. My wife and I thought we had won the pools as she was so good. The maternity leave Isabel was covering was that of my partner, Anne Godridge.
My second trainee and first one to be full time (6 months ) with me was Dr Anne Whitehouse (now Goderidge). She had a great personality and sense of humour and I realised very early that she would make a brilliant GP. She had a bedside manner second to none. There was a consultant at Pontefract General Infirmary called Jean Wharton for whom Anne had worked as part of her training. Jean told me that Anne was the best Senior House Officer she had ever had as her communication skills were so good. Jean told me that Anne would plonk herself on the patient’s bed and simply chat away to him or her. Anne obviously loved it at the practice because after completing her training, she approached me and John Lee to take her on as a partner. We were not quite ready for this but working in one of the most deprived wards in the Wakefield District was not easy. We did a deal with her and she started on a part time basis.
I have intimated earlier that I ended up in quite senior positions in the Postgraduate General Practice Education Network. This was because of Jamie Bahrami’s encouragement.

When I was vice-chairman of the Postgraduate General Practice Committee I occasionally had to stand in for the Chairman when he was away. The Chairman had to not only chair the main committee meetings but also interviewing panels. These panels interviewed prospective trainers, course organisers and GP Tutors. The panels were not as daunting as when I was interviewed for a trainer’s appointment. They consisted of the chairman, director (Jamie), a course organiser and trainer. I had the somewhat surreal experience of chairing the panel that interviewed Anne Godridge for the post of trainer. I remember that Jamie was in an impish mood that afternoon and I had to tell him to behave himself in the middle of Anne’s interview. She was appointed and was well deserved of this appointment. She is a great trainer and loves the job. The practice, where she is now senior partner, has two of her ex GP Registrars as partners and two of my exes are partners. This gives me a very warm feeling.

Being a trainer kept me up to date better than if I had not been one. Each week there were one to one tutorials with me and the GP Registrar as well as sometimes joint surgeries. The learning needs of the GPR were assessed at the start and addressed in various ways including tutorials. The GPR attended a half day release teaching session each week and learned with his or her fellow GP Registrars. The trainers sometimes led these training sessions and the content of the half day release was managed by the course organiser. When I started I dreaded leading these sessions but now I do them to help out and find them easy – experience, I suppose. When Jeffery Ellis, the course organiser, asked me to run a half day release on Audit my heart sank. I thought this was a really dry subject. I looked it up in detail and enjoyed the learning experience for me in preparing the teaching session. Jeffery was very much on the ball and had all trainees (now called GP registrars) undertaking one audit during their training time.

What happened after that was that I developed a serious interest in audit. I undertook an audit of patient satisfaction with the out of hours emergency service and repeated the cycle another twice. Most people only do the first bit of the audit. I was appointed by the Health Authority a member of the Medical Audit and Advisory Committee (MAAG). When I went to my first meeting of this, the then chairman of the Local Medical Committee (LMC), the late Dr Richard Smith (who was also the chairman of the MAAG) turned his back on me and I was referred to as the “health authority member” as though I was some sort of scab. The LMC generally reacts in a negative way to changes that involve more work for GPs and audit was one such example. In the end all was OK and Richard Smith became a most friendly colleague and a patron of the Castleford Choral Society (he and his wife Veronica had a great love of music and I am the Patrons’ Secretary). I used to undertake teaching sessions on audit in general practices. I realised that to undertake the extra work involved in audit someone in a General Practice would have to devote some time to it. I put in for a grant from the Health Authority for the salary of an Audit Administrator and got funding for 15 months and I think about 5 hours a week. We advertised for the post and Kath (my wife and then practice manager) interviewed the couple of candidates. The successful applicant was Richard Levitt, a patient, lay preacher with a degree in classics from Oxford University. What a fantastic luxury for a GP to have a person that would read up the background papers for the audit and then undertake the work. He did some high quality work and it was a shame when the grant ran out. In later years when I worked at the Deanery I was involved in managing the project and audit element for Summative Assessment of GP Registrars. Now at the Wakefield District PCT I chair the Clinical Effectiveness and Audit Group but really I have simply been the chairman of meetings with my colleague Elaine Horder undertaking the real work. The reason I believe so fervently in the value of audit is that it’s objective is to improve patient care. How can we do that if one does not look at where one is, introduce changes and look at it again, which is what audit basically is. In 2006 the Quality Outcome Framework scheme is basically a massive audit tool with indicators, targets, standards and criteria, the measurements being undertaken annually and the financial rewards for improving patient care huge. So here ends a digression into the world of audit.

I learned such a lot from the GP registrars and I hope they learned from me. I had 2 Spanish, one German and an Iraqi registrar.

Paco Fernandez was one of the Spanish GP Registrars and was big trouble. He seemed to attract trouble. On one occasion a patient hit him. An important part of the training was to look at videos of consultations with an objective of improving consultation skills. Paco showed me one of his which took place on a hot summer’s day. He asked a female patient to go behind the screen round the couch and undress. She went behind the screen and then Paco proceeded to take his jumper off ( he was hot). It looked on the video that he was getting undressed and was about to join her behind the screen! I could write a couple of thousand words about Paco. He is a truly good person and eventually gave up General Practice in the UK and is now a Franciscan Friar in Bolivia. He emailed me from there a few years ago and posed the philosophical point thet he fel that one could not be a really good doctor unless one was a good person. I totally agree and I read A C Grayling’s book “What is good” after that correspondence.

I could write about each GP registrar I have had and I hope if any of them reads this he or she will not be upset if they have not had a mention.

Patricia, the other Spanish GP registrar, had a completely different personality from Paco. Calm, good English and no problems. I was once with him when we were doing an evening emergency out of hours session and we had a visit request to a hotel in Ossett to a business man with migraine. We arrived at reception and the receptionist started the process for booking us a room for the night!

Jutta Prekov was a fantastic GP Registrar. She is German, as was my mother. She had the traits of a German – thoroughness, somewhat of a perfectionist, consciencious and a different but good sense of humour. In her CV under “hobbies” was the Argentinian Tango. She and her now husband Sven were on Yorkshire Television demonstrating and they used to teach this sexy dance. I never saw them dance but they did so at one of the Practice’s Christmas parties that I could not attend. She passed the MRCGP first time and I thought that was a fantastic achievement for someone where English was not her first language. A few years later I tried to head hunt her as a partner but she stayed in the excellent Bradford scheme.

After I had been a trainer for 10 years the Practice happened to be celebrating achieving the Investor in People award. A party was being held in Castleford Civic Centre. Absolutely unbeknown to me, Kath had invited ex trainees/GP registrars of mine. They had all to be hidden until the appropriate time. They came from all over the country. The photograph was taken that night.

From left to right starting at the back –Alan Kerry, Simon Acey, Norman Dawes, Simon Anderson Second row - Christine Dumitrescu, Isabel McCormick, Paco Fernandez, me, Carolyn Hall. Front row – Collette Coleman, Anne Godridge, Andrew Sykes.
I have shown this photograph at many teaching sessions I have been involved with.
There is a special relationship between trainer and GP registrar because of the one to one nature of GP Training. I am very pleased that two of my ex GP reguistrars are now partners in Tieve Tara Medical Centre – Anne Godridge and my last GPR, Deborah Hewitt – both absolutely fantastic GPs, of course! Andrew Sykes is now chairman of our Local Medical Committee and Carolyn an PEC member of the Wakefield District PCT. Anne runs the drug rehabilitation scheme for the PCT.

After a while as a trainer I was persuaded by a fellow trainer, the late Jean Lewis, to apply for the post of Continuing Medical Education (CME) tutor for Pontefract. Jean was the second course organiser working with Jeffrey Ellis. Course Organisers managed the education of doctors training to become GPs. CME tutors provided education and support for established General Practitioners. I applied and was very nervous waiting to be interviewed by the panel (which of course included Jamie Bahrami). There was one other colleague waiting to be interviewed and when he observed my anxiety pointed out that I was the only applicant and that they were desperate. I felt a bit more relaxed after that and got the job!

The great thing about Jamie is that he let you get on with itand motivated you to take innovative ideas forward. My job as CME Tutor was to provide educational events for the 100 or so GPs in the patch – Pontefract, Castleford, Normanton, S Elmsall and Kirby, Hemworth as well as Knottingley and Featherstone. What are the educational needs of that group of GPs? Huge and varied. I held the occasional focus group and had the benefit of a questionnaire that Jean Lewis had sent out.

In the end I took my guidance by looking at my needs and discussions that took place at CME Tutor’s Seminars held 3 or 4 times year. All the CME tutors from Yorkshire were expected to attend these seminars. They were greatly creative and this creativity was facilitated by the input of the director, Jamie, deputies such as Brian Ormston and Philip Nolan and other fantastic educationalists such as Paul Robinson and Alison Evans. The seminars were held in a marvellous venue in Ripon – a teacher training college with residential facilities, great food and a superb wine cellar. As `a trainer one was expected to attend a seminar there every 2 years. I also became a tutor on the Summer School on the ethics subschool and this was held in Ripon. I will describe life at Ripon later but it was a privilege to go there and be with such colleagues.

So what did I do as a CME tutor? I think I was innovative and tried to make the education interesting. However, there were bog standard stuff to put on. I had to approve/accredit educational events suggested by pharmaceutical companies, consultants, general practices etc. This was not innovative stuff at all but was pretty important as it constituted what is now called “maintenance of knowledge and skills”. There were events about cholesterol, menopause, gastroenterology, resuscitation etc. It was good to approve an educational event suggested by a new consultant so that GPs could meet him or her. There were lunchtime lectures at the Pontefract Postgraduate Centre. There were lots of evening events. Many of these events were paid for and sponsored by Pharmaceutical Companies.

I was a CME tutor for about 8 years and it was a great experience. I often say that “I have CME Tutor’s blood coursing through my veins”. I will describe some of the innovative and exciting educational events I set up and I must say this work was greatly appreciated by Jamie Bahrami who motivated me to continue this sort of stuff. I must say that most of my CME tutor colleagues in Yorkshire were innovators and encouraged to be such by Jamie. I got some of my ideas from these colleagues. At CME tutors seminars we were encouraged to present to one another our achievements.

I organised a large debate at Pontefract. The first had the motion which was something like “that this house believes that fundholding is the best development of the NHS since its inception”. It was packed. We hired Pontefract town hall. The event was sponsored by 6 or more pharmaceutical companies. We videoed the debate and the video is in Pontefract Postgraduate Centre library. The motion was defeated.

The second large event, again held in Pontefract town hall, was a lecture from the ex Bishop of Durham, Bishop Jenkins, on “Spiritual Care”. It was riveting and he was challenging. I was sat next to him and his notes for the talk fascinated me. They were one big doodle. I realised later that they were a form of mind mapping.
Another event took place as the 1997 General Election was approaching. I held an event on the lines of the BBC’s “Questiontime”. I invited each of the 4 prospective parliamentary candidates (Labour, Conservative, LibDem, UKIP) standing for the Pontefract and Castleford Constituency. Each was allowed to bring one other person as a guest. All, apart from Yvette Cooper (Labour) brought their agent. At the back of the lecture hall in the postgraduate centre was a bloke wearing a flat cap. He was Yvette’s guest and was, I think, a retire miner from Knottingley. The questions were all about health policies. It was a good evening.
I held several education events for GPs and another discipline – pharmacists, the clergy and vets. The evening with the vets was memorable to me. It started with a 10 minute talk from the Hospice doctor about how she was against euthanasia. There was a perception from the GPs that the vets put animals down if they coughed once. One vet had specialised in bereavement counselling. Another gave a short talk on medical conditions humans could get from animals.

The events described above are an illustration of how we GP tutors were encouraged to be creative and we shared our ides at the seminars at Ripon.
What about Ripon. Please see Hero Number 3 (2).

2006-10-02T01:08:00.000-07:00

Number 2 hero

My second hero is Professor W R Keatinge (Bill). At the time of writing he is in his seventies and working part time at University College Hospital.
After I had nearly completed my pre-registration house jobs at the London Hospital, I wanted to kill some time until I started my career as a GP. This was because my first wife was younger than I and was at that time a medical student and wanted to catch me up so we would be at the same stage of our careers in medicine.
I decided I would like to do some research and heard that there was a post as Lecturer in Physiology coming up.This was in 1970. I put in an application. Shortly after that I was admitted as an emergency to the Fielden wing of the London Hospital with a nasty flare up of a pilonidal sinus that had to be operated on. Bill Keatinge was the reader in physiology at The London Hospital Medical College at the time and it was he who interviewed me. Amongst other things, he asked me if I wanted to be a “perpetual student”. I interpreted this as an enquiry into my possibly not wanting to undertake responsible work. Of course, I love learning and am now a great believer in life long learning. I think I did not want to leave the world of enquiry and research. It was an interview with a difference. I was in bed and in my pyjamas. He offered me the job which was to start at the end of my house jobs.
The job involved a pay cut from that of a house officer and this was the first of two occasions I had dropped my pay for the sake of my career.
I started to get anxious about the job as I had not read any physiology for a few years and things can change rapidly with new discoveries. I knew I would have to lecture to students, facilitate tutorials and run practical classes. At the same time I had no idea what area I would research and who would be my supervisor.
On the first day of that job I arrived at about 8.30 am and there was no one in the department. I can’t recall whether I had a room to go to. I realised as time went on that academic freedom meant not only a contract for life but the freedom to come and go at whatever time one wished. One could work at home, in the lab or in the library of the Royal Society of Medicine. One could start at 6 am or work all evening. This struck me as great but was against the work ethic I was brought up in. There were a mixture of people in that department, some with medical degrees and some without. I had the impression that those with medical degrees tended to work 9 to 5 regularly and more if necessary. Those without medical degrees worked just as hard and were just as fruitful but had a different approach to time, I felt. I am sure if any of them read this they might argue vehemently against my impression.
The head of department was Professor Kenneth Cross who was researching an aspect of physiology related to cot deaths. Occasionally he would stand at the entrance of the department. Any one who arrived after 9 am he asked to hold out their hand which he would then hit without saying anything. He had a medical degree.
I was given my own room and Bill Keatinge told me that I had 3 months to look at what was going on in the department and then decide with whom I would like to work and supervise my research. What an amazing luxury. I took this very seriously and there was some fascinating research going on, mainly on animals. One or two people told me that Bill Keatinge was a difficult person but I felt that there was a bit of competition going on to get me to help with certain people’s research work.
In the end I asked Bill Keatinge if he would supervise me undertaking some research in hypothermia. Bill was famous at that time and was one of the leading experts in the world in human cold water physiology. He had published a book entitled “Survival in Cold Water”. I think that because I had worked as a student with Professor J Z Young meant that I felt it would be an honour to be supervised by Bill. If he would be a hard task master that would only be good for me. Bill was working on the physiology of smooth muscle at that time and this involved working with pigs’ arteries. This involved Geoffrey Graham, a PhD student working with Bill, calling in at the slaughter house first thing in the morning on the way to work. The arteries were transported in a special container that kept them very cold.
I was not at all keen on doing any animal research and something to do with human temperature regulation would suit me down to the ground.. There was a room next to my laboratory that had air cooling and heating devices such that its environmental temperature could be altered and maintained steady.
Bill’s PhD student before me that worked on temperature regulation was Jim Haight. He worked on the effects of alcohol on thermoregulation in man. I read his thesis. One thing in Jim’s thesis that amused me was that he noted that the brandy in the containers carried by St Bernard dogs had a higher content of sugar in it than other brandies. Blood sugar levels tend to fall in hypothermia. I read Bill Keatinge’s book and started reading a variety of papers. Throughout this process Bill was my guide, mentor and supervisor. Unlike me, he is a very good writer and improved my writing no end by his editing. The work we did was truly joint and I was allowed to go down avenues of research that cropped up either from readings I made or ideas we had. Geoffrey Graham had the greatest respect for Bill and Geof helped me no end. Bill was Geoff’s tutor at Oxford University. Geoff had qualified in medicine and did his house jobs with great difficulty because of a significant disability affecting his mobility and necessitating his wearing callipers.
The people in the department were fascinating and each one was always willing to advise and help me. I can not mention them all and I hope I do not upset anyone by their omission from this blog. Ron Spiers was a dental physiologist and helped my look up references on salivary temperature. David Wingate was a gastroenterologist and took over the lab next door to me from Dr Barrowman, also a gastro-physiologist. Fred Smales was a dental physiologist in another lab next door to mine. He had an obsession for a while in writing a computer programme for a game he had invented. Andrew Wade was a vet by background. Towards the end of my period of time working in the department I shared my lab with Hilary Sellick who researched on something to do with respiration in newly born mice. She joined the department after a period of illness and was very kind to me with advice regarding my approach to writing the discussion of my PhD thesis. She married Andrew Wade and I went to their wedding. Her parents were very wealthy from owning a successful laundry business. The reception was at their house and I pulled up in my car to what I thought was the house. It was the lodge! I think they have left now and own a farm.
Mike Hathorn had left South Africa for political reasons and was a superb teacher. He was working on the effects of lack of oxygen on iron absorption and distribution in rats. I met him a couple\ of years ago at a dinner Bill invited us all to in the Royal Society of Medicine in London. Claire Torrie came after me and was another PhD student of Bill’s. She was awarded her PhD at the same ceremony as I.
Kenneth Cross I have already mentioned. He was married to a consultant paediatrician and his niece was a formidable nursing sister in the accident and emergency department (then called the Receiving Room). He researched in what was called the neonatal group with Drs Bolton and Goodwin. The now head of department is Mike Armstrong-James who was a senior lecturer when I worked there. He is a neurophysiologist. One summer vacation he build himself some sort of computer. We were each allowed to spend up to £10 on bits and pieces. He used this facility to buy components for this computer. One had to get the signature of the head of department for this spending. In the summer holidays, if the head of department was away the next most senior academic could sign these spending requests. Mike often ended up as head of department and could sign his own requests. Even I ended up as head of department for a week. Everyone was away! Most of the colleagues mentioned above became professors. I became a GP but now I am Professor Pavlov!!
I will get into serious trouble if Tony Barnet ever reads this. I have done a real upstairs/downstairs act and mentioned the academics first and before the technicians. The technicians I remember well were Geoff Watling (chief technician), Adran Jacobs (Bill’s technician) and Tony Barnet (senior technician, electronics). None of the researchers could have done their work without these and the other technicians. The teaching experiments and demonstrations were set up and maintained by the technicians.
Tony Barnet realised the power of the technicians and kept what he called a “black book”. If any academic was rude or demanding with him, down this would go in the black book and implement delaying tactics with ordering components or undertaking work. The fact he discussed the black book with me might have been evidence of good rapport with me compared with my colleagues, or he may have used this technique with all of us. I have to state, at this point, that Tony Barnet was my backbone for my research and that we worked really well with one another. My research, as you will read later, was a mixture of developing an electronic instrument, and experiments on humans undergoing cooling. Tony was an equal partner with me (and Bill was the overall director) in developing the Zero Gradient Aural Thermometer.
I don’t think I was ever in Tony’s black book. He once had a bit of electronics I needed flown over from the USA on Concord as he had told them it was urgent.
My research was essentially in two bits and was somewhat difficult to put together in a thesis but Bill was a great adviser when it came to writing up. I got interested in the accuracy and reliability of sublingual temperature as an estimate of deep body (core) temperature. This led me down a research alleyway where I proved that saliva increased in flow and was cooler in cold air. When I write “I” this should be “we” as although I did the experiments and thought up some of the areas to investigate, Bill was in on everything. Looking at sublingual temperature involved comparing it with rectal and oesophageal temperature. I had to work on volunteers mainly from the student population both medical and nurses. Inserting an oesophageal probe by the nose and positioning it behind the heart was difficult and uncomfortable at first. Many potential volunteers could not continue as the procedure induced wretching. One of the volunteers was a nurse called Averil. (I bet you think I am going to say that I ended up marrying her!!). Averil was one of the people who could not tolerate the oesophageal probe. She later married my wife’s half nephew (who became a pathologist) and we have seen them regularly over the years. Another volunteer was Bill himself. I was really nervous with him and I knew he was uncomfortable with the probe in place because one of his eyes was watering. However he did not complain which is typical of him. I could easily swallow the probe and did loads of pilot experiments on myself.
This work led us to think about developing a thermometer that would take the temperature of the ear canal and be unaffected by the head being in a cold atmosphere. Tony Barnet was a vital part of this project and the first prototype was on racks as tall as me and on wheels. The crux was to cover the ear with a heat pad, the temperature of the inner surface being maintained at the same temperature as that recorded from the ear canal. We called this thermometer the Zero Gradient Aural Thermometer. Loads of experiments were undertaken to establish its reliability. We decided to approach a private company and ask if it could make a neat one of these. I discussed this with one of the senior directors of Muirhead Ltd. Discussions too place in the Physiology department which included Bill. To our surprise, the company not only wanted to make a portable device but also wanted to manufacture and sell it. It eventually went on to the market and sold a few. I think one was bought by NASA. The royalties went to The London Hospital Medical College.
Bill and I published most of our work in reputable journals and there was a presentation and then a demonstration at the Physiological Society. I was a nervous wreck with the demonstration. This involved Adrian exercising his legs in a deep tank of warm water with the aural thermometer recording. Setting this up was a major task. I nearly ran for it when I spotted the Nobel prize-winner Andrew Huxley coming towards us. He asked a question and seemed happy with the answer. If one put work before the Physiological Society in this way the members voted on your work at the end of the day.
Our publications and the demonstration was Bill’s method of ensuring I obtained my PhD as the work had already been peer reviewed. I am really grateful to him for that approach.
One of the main experiments took months to plan and involved taking measurements from 28 children swimming in an indoor pool that was coolish after a bank holiday weekend. There were about 23 observers and some of the children swam breathing in to a Douglas bag which was held by an observer suspended above the head of the swimmer. One of the observers was Lt. Commander Frank Golden with whom Bill had done some work in the Navy a few years previously. In about 2003 I recorded a programme from the TV which showed the effect of a very cold environment on the presenter of the programme monitored from outside the cold chamber by Frank Golden. I thought the bloke was going to die!
I left the department to be a GP in Cheltenham and it was there I wrote my PhD up. The time arrived when I had to have my PhD viva and this was with Bill and the external examiner was Professor W I Cranston, professor of medicine at one of the London teaching hospitals. I was a nervous wreck as I knew that if the viva did not go well I could be turned down or even worse be set a whole day’s practical examination. The night before the viva I had noticed one of my graphs was not quite right. One hour before the viva was due to start Bill saw how nervous I was and sent me out to have a walk in Whitechapel. Of course the viva went OK and Prof Cranston was charming. When I pointed out the graph that was not quite right he advised me to photocopy it, alter it and glue the new graph over the old one in my bound thesis. This I did and when Prof Cranston shook my hand to say goodbye, I nearly stuck to him as there was some glue on my hand.
I continued to work in Cheltenham until I was divorced 3 years later. I decided that I wanted to go back to Physiology and discussed this with Bill and the then head of department, Professor Kenneth Cross. An advert was put in the BMJ for a lecturer in physiology. I applied and the interview was with the Dean, Sir John Ellis and Bill. I had been interviewed by Dr Ellis when I applied to be a clinical student at The London. This was an odd thing to do as I had a place in University College Hospital and I was requesting a transfer. At that first interview, the dean asked me, amongst other questions, whether I was going out with a nurse at the London. He thought that was the reason I might want to change teaching hospitals. I was not. At the second interview, he asked what I would do if after he had set up a department of general practice, would I move over from the physiology department. I answered in the negative, of course.
I was offered the job and started but the things went very wrong and I really let Bill down. After one week in that job as lecturer I realised I had made a mistake. I did not go to work and told Bill on the phone. That episode of my employment history is omitted from my CV. Bill has been the perfect gentleman about it all and never said an ill word to me. Indeed he has always praised the work we did together. I think I was under considerable mental strain after the divorce but had the great support of my wife Kathleen. We had been married only a month or two when all this happened.
I became a GP in Castleford in 1978 and retired from that job in December 2005.
About 4 years ago Kath and I were in London and invited Bill for lunch. I had booked a table down the net but we were the only people in there. Bill gave us a nice bottle of wine and told us about his adventures in Russia when he visited the coldest place on earth to do some research. He has learned Russian and reads Russian literature. He certainly is a highly and broadly educated man and I am sure this contributes greatly to his approach to research and teaching.
About 7 years ago Geoff Graham and I decided to invite all Bill’s past co- survived. Two or three years ago, Bill returned the compliment and invited those people and more to a dinner at the RSM. He paid for the lot. It was again a lovely evening and illustrated what a gentleman Bill is.At one point his entry in Who’s Who was the one after his father’s, Sir Edgar Keatinge. Bill’s first wife sadly died but in his Christmas card 2005 he informed us that he had remarried and I hope he will be very happy and to see him again soon.

We did not get a Christmas card for the first time in 2008. I discovered he died of prostate cancer in April 2008. there was an obituary in The Times: http://www.timesonline.co.uk/tol/comment/obituaries/article3889176.ece

2006-08-16T12:13:00.000-07:00

Number one hero

There are many definitions of a hero and mine includes someone I highly respect, whose opinions I trust, who is honest and true and whose mentorship has had a deep and lasting effect on my personal and professional development.

Over the past 40 years I have worked with three people who I regard as heroes. Interestingly, only one of these was a fellow General Practitioner and he is Dr Jamie Bahrami, the now retired Director of Postgraduate General Practice Education for Yorkshire. I worked with the second, Professor W R Keatinge, after my pre-registration house jobs. He was my Ph.D supervisor and we undertook research in the area of human temperature regulation from the Department of Physiology in The London Hospital Medical College, as it was then called. I will now turn to my third hero.
In 2000, one of our closest friends, Geoffrey Mair (who died in 2002) asked me “What were we both doing on September 23rd 1963?” I could not remember and so he reminded me. We went to our first lecture as fellow medical students at University College, London. Geof and I could remember some important points that were made in that lecture, which was pretty good after 40 years. The lecturer told us of the importance of the invention and development of the printing press for communicating scientific ideas. He also told us how Claude Bernard, a physiologist, in 1859 wrote “ la fixite du milium interieur c’est la condition de la vie libre”. (Free life depends upon the consistency of the internal environment). Maintaining a stable internal environment despite changes outside the body is now called homeostasis. Some of us were confused. The lecturer was an anatomy professor telling us about history and physiology!
The Professor of Anatomy was John Zachary “JZ” Young. I quickly realised that he was one of the leading biologists of that century and a very eminent scientist indeed. He was the first non-medical biologist to be appointed to that post. He was my first hero. That appointment was made in 1945 (the year of my birth) and I was not yet 18 when I attended that lecture. He was 56. His work in the 1920s on nerve fibre structure led to a Nobel Prize for Andrew Huxley and Alan Hodgkin. He also developed a method of re-joining peripheral nerves using a “glue”. He wrote many books and was the Reith lecturer in 1950. After the first 18 months pre-clinical work at University College, if one did fairly well in the first set of examinations (called 2nd MB), one could be invited to apply do an extra 18 months studying towards a B.Sc. in either Anatomy, Physiology, Biochemistry or Pharmacology. I decided to apply for the Anatomy B.Sc. course and was accepted. One of the attractions of that course was that during the summer holiday there was funding for us to go to Naples with JZ for 6 weeks and help with research.
You may think at this point that there could be no possible value in studying Anatomy in such depth to become a GP. You will read later how this experience had a huge effect on me as GP and a teacher of GPs.
12 of us spent 18 months working on our “Anatomy” degree. There is a trend these days to do part-time degrees whilst still at work and I think this is a great development. There is also a trend in the General Practice education world that, as one gets older and is awarded higher degrees, to drop a “mere B.Sc.” and only use the higher degrees. My B.Sc. was a most important qualification for me and I will never drop it. I am really proud of it even though it was a lower second class honours degree. My B.Sc. took me an extra 18 months of full time education!
The learning atmosphere in the department of Anatomy at University College was fabulous. There was every opportunity to question and explore. The course covered anthropology, comparative anatomy, embryology and histology.
JZ introduced us to the Oxford Tutorial system. The tutor sets you a task to write up and hand in an essay on a subject of his choice.This was handed in before the tutorial. The tutorial was one to one and I had JZ as my tutor for one term of the course. One of the tutorials involved me comparing two scientific papers. One was written by Solly Zuckerman and the other by Jacob Bronowski. Each of the papers were discussing the anatomy of an Australopithicine tooth that had been found. One author argued that this tooth was more like a human’s and the other more like an ape’s. I had to critically appraise these two papers and present my analysis to JZ. I was absolutely petrified at the prospect of a tutorial with such an eminent man on such an erudite subject. My fears were unnecessary. He treated me like an equal and like an adult. I found this absolutely fantastic and a great contrast with some of my hospital and general practice teachers. This is one of the qualities I have tried to develop when I teach and consult. I have tried to respect my students, GP Registrars, and other doctors I have helped, as equals. I hope I have also had a similar relationship with my patients however poor or deprived. This is how that B.Sc. course influenced me as a General Practitioner. I realise now that all the eminent people I have met in my life and whom I respect behave like this.
The summer arrived and 6 of us went to Naples for the fisrt half of the summer break and the other 6 for the second. We worked with a team scientists, who had arrived from all over the world, at the Stazione Zoologica. JZ had been going there for many years and was funded by the US Airforce. JZ had been working for several years on the memory system of the octopus. In the laboratory there were about 50 small tanks each connected to the nearby sea and were thus supplied with circulating natural salt water. Each tank contained one octopus and the lids were weighed down by bricks. This was because they were particularly adept at pushing the lids off, climbing out of the tank and slithering along the floor to the front door, then escaping outside.
A gang of experienced research workers from all over the world spent various lengths of time working there each summer.
Why was JZ was working on the memory system of the octopus. An octopus can only do two things – attack or retreat. They can see and feel. So, they were taught to recognise a shape or feel something rough. For example, with a shape, a triangle might be presented to the octopus and attached to the triangle there would be a small crab. The octopus attacked and ate the crab. Eventually the octopus would attack the shape without the crab being attached. JZ would then anaesthetise the octopus and remove a small part of the brain that he was studying. The octopus recovered in the tank and then it was presented with the shape again. If nothing happened the octopus’s memory system had been disturbed at a particular site in it’s brain.. If it attacked then the removed part of brain was probably not associated with memory. When JZ first started working at the Stazione there was a headline in one of the local papers which, translated, read “English Professor teaches octopuses to speak”. On one occasion a gang of us came back after a night of pasta and wine and fooled about trying on JZ’s lab coat. This was unique in that it was black. Usually laboratory scientists and hospital doctors wear white coats. I wonder why. Was it something to do with octopus ink or was this a bit of attention seeking? I took an octopus out of its tank and the tentacles of all eight legs sucked on to my forearm. It was with the greatest difficulty that I got it back in the tank. No sooner had I detached a few tentacles, one or two would re-attach themselves to my arm. It took two of us to get it off. There can’t be many GPs who have had such an experience with an octopus.
We worked Italian style with an early morning start. We had breakfast in a coffee bar and this consisted of a cake and Café con late. Lunch consisted of bread, mortadella and some fruit and this was taken at the beginning of a long siesta. The mortadella was ideal for the very hot summer days in Naples as it was fatty and there was no need for butter, which simply melted quickly. After lunch JZ would often take us to some place of interest such as Pompei or Herculanium. It amazed me that every afternoon for 6 weeks we could visit somewhere different in or around Naples. We often went swimming. These experiences gave me a life long love of Italy. We continued our work out of the heat of the sun from 4 to 8 pm and then went out on the town to eat at a tratoria and had plenty of wine and liqueurs such as grappa and ouso.
One tratoria I remember was called the “chicken run” because there were chickens running about which were used that evening for meals. Occasionally JZ would take us all out for a meal. He would drive his Austin 1800 with us all crammed inside and two trips had to be made to get us all to his favourite restaurant. There was a string quartet playing at one restaurant (a bit posher than the “chicken run”!) and when he walked in they stopped playing whatever they were playing and struck up JZ’s favourite tune. I forget what it was but I think this is fame indeed for a British scientist.
One night he asked me and my fellow student Dave Bromham to baby-sit for his daughter Kate while he and Ray went out with some of the senior researchers for a meal. They left us out all sorts of cold meats, cheese, bread and a huge bottle of chianti. When they all back at about midnight Dave and I were virtually unrousable (the chianti) but eventually heard the doorbell. Far from being in trouble, we were invited to have a nightcap with them.
Half way through the 6 weeks’ work JZ crammed some cash in our hands and Dave and I were given two days off to have a break. I felt that the whole 6 weeks was a “break” and we were not expecting this. We went to Palermo in Sicily by train and boat and slept on night on Palermo railway station to make things cheap. Dave became a consultant gynaecologist in Leeds and died several years ago at a relatively young age. Every summer, 5 of the students worked with the octopus memory experiments and one worked with squid giant axons. I was the one JZ asked to work on squid.
JZ won a scholarship from Oxford University in 1928 to study in Naples. He became fascinated by the behaviour and nervous system of octopuses and squid. When he returned to Oxford he studied the nerves of earthworms with John Eccles and Ragnar Granit. They generated nerve impulses along large diameter fibres of about 300 micrometers. JZ Young wrote a chapter in 1975 in “The Neurosciences: paths of discovery” and I particularly like one passage which discusses how scientists work.
“I did the dissection, Eccles the recording, whilst Granit sat in a deck chair. We were not quite sure of his function. Perhaps he was deciding what logical methods we were to use, though I doubt whether scientists really proceed in the way that philosophers of science seem to suppose. It is a banal truism that all scientific workers operate with some hypotheses, but this alone does not adequately describe the motivation or process of their activities. Eccles, Granit and I were certainly not doing the work on earthworms to try and disprove the hypothesis that nerve fibres conduct. We were groping our way, trying to find new material for study. Disparagers can say that this is not science, but we three seem to have been moderately successful scientists”.
JZ thought that others missed the discovery of the giant axons in squid because they were too large. It was in 1934 when he discovered giant axons of about 500 micrometers diameter in the mantle cavity of the squid and in 1936 stimulated the axon with a crystal of sodium citrate and recorded the discharge from the fibre.
There was a theoretical mathematical model developed by Hodgkin and Huxley that the conduction velocity of a nerve fibre (axon) is proportional to the square root of the diameter of that nerve. JZ was trying to prove that formula was true and each summer two of the 12 students in Naples measured conduction velocities of giant axons and also recorded the diameter, which varied.
Every morning a fisherman would bring in one or two freshly-cought squid and put them in a tank of sea water. I had to fish one of these out and “kill” it by cutting its head off. The tentacles remained attached to the head and the latter continued to move about on the floor while I got on with my dissection. Speed was of the essence. I had to dissect out a giant axon from the body using a scalpel and a microscope and do this under saline to keep it functional. This was a delicate operation and a minimum length of axon was required in order to complete the experiment. After dissecting out, each end of the axon had to have a length of cotton tied to it. It was then carried by me, in a dish of saline, along to the other end of the building where the measuring equipment was. The nerve was put in a special container so that an electrical impulse could be sent down it and picked up at the other end. The readings were made using an oscilloscope and the diameter of the nerve measured using another gadget. JZ showed me how to do all this on the first day and got a perfect reading. I got no reading at my first attempt. I got no reading at my second attempt. I could do my experiment only once in the morning and once in the evening as time had to be spent setting up and calibrating the instruments. Three weeks went by and I got no results. JZ said this was not a worry and that “it would come”. It did and I got readings twice a day for the rest of the stay. The results were plotted on a graph that had been started 6 years previously and it looked to me as though the relationship between diameter of axon and conduction velocity had been established. However, JZ wanted to do another couple or more years work on it. All this taught me about being patient when it comes to scientific research and not to expect an answer in weeks. It may take years to prove or disprove something. The other 5 mostly worked on “training” the octopusses to recognise shapes both visually or by feel.
JZ had a theory that there was a nerve connecting two parts of the octopus and he asked one of my fellow students, Brian, to work on visualising this nerve using a dye. Again, Brian spent day after day searching and eventually found it. This was my first experience of a scientific discovery and the excitement it generated.
JZ asked me to drive his car (an Austin 1800 Estate) back to England with some of my fellow students and some of the equipment. I liked driving and again he gave us what seemed like loads of cash to get us back home. I can’t remember where we stayed on the way up Europe but we arrived at the British customs in Dover at about 2 am. We were asked if we had anything to declare. I replied that we had an automatic octupus feeding device. I thought we would all have a laugh at this but the customs officer made us unload the whole car to get to this device which he examined carefully before allowing us to go on.
The B.Sc. Anatomy course was 18 months long and the trip to Naples was in the first summer holiday after the first term. There were three terms to go.
Most people assumed that a course on Anatomy involves simply studying the anatomy of modern man in more detail. The course covered anthropology, histology and comparative embryology, for example.
There were 12 of us on the course at University College and 30 in all in the University of London. To be offered a place on a B.Sc course, one had to get through an interview. One was only offered an interview if one had done well in the second MB examination, which was undertaken after 18 months.. As I mentioned above, there were other B.Sc courses offered. These were in Physiology, Biochemistry and Pharmacology. Of the 120 or so medical students that undertook the 2nd MB examination at University College about 25 of us went on to spend an extra 18 months undertaking one of these courses. It was a big decision whether to do this or not. The friends I had made would be going on to do their hospital training and would become doctors well over a year earlier than I. I talked it over with my parents who were supportive as usual and willing to fund my grant. I went back to my school in Wakefield and talked things over with the biology master Dr Bill Fletcher. He pointed out to me that 18 months was not a long time in a 40 year long medical career and advised me that I should not turn down opportunities that cropped up such as this one. This clinched it for me. I went for it. I have followed this advice all of my medical career which has been fascinating and enrichiched.
The 4 terms undertaking this B.Sc. was a journey on which we travelled from the creation of life to looking at the latest electron microscope pictures of cells. The course allowed time to reflect as well as exploring any avenue one wished by reading. One of us, Adrian, read both volumes of Marshall’s Physiology of Reproduction and he described to us in graphic detail such things as the weight of elephant testicles and how porcupines approached sexual intercourse. I spent some time reading about consciousness and what yawning was all about.
A lot of the course was undertaken at one’s own college or medical school but there were elements when all the Anatomy B.Sc. students from the University of London got together (30). This particularly happened when famous speakers had been invited to teach us. We had one session with Louis Leakey, the father of anthropolgy and expert in the finds at the Oduvai gorge in Tanzania. The main anthropology teacher was Dr John Napier. He came into the seminar room with two boxes. One contained 20 ashtrays which he distributed and the other a load of flints and tools. He smoked like a chimney as did a lot of us. He had worked with Leaky and I particularly remember a teaching experience he gave us on stone-age tools. He had recently spent a week at home where he and his wife only used stone-age tools for preparing food. It was extremely difficult. Just imagine what it would be like making a sandwhich! I meet two of my fellow anatomy B.Sc students at an annual reunion, Robin Harrod, Colin Teasdale and I generally agree that the anthropology we studied was the most interesting part of the course. Some of the time involved visiting the primate house at Regent’s Park zoo and observing the behaviour of the monkeys and apes. The Department of Anatomy at University College had a very good collection of models of skulls and bones of the ancestors of man. In the final examination I was presented with a dead pidgeon and had to dissect out the nerves in its arm pit (axilla) and describe how this complex of nerves (called the brachial plexus) differed anatomically from that of man. The main difference was that the nerve supplying the pectoral (chest) muscles of the pidgeon was 5 times the size of the nerve in man. Those muscles operate the wings and need to create a lot of power for flying. Thank goodness we somehow all knew that this was coming up the night before!! I think one of the lecturers told us in the pub. There was a prehistoric skull to identify in another part of the examination. The twist was if one labelled this as Autralopithecus or Homo Erectus or something, this was not good news. It was a model of the skull of the Pilkdown man which was a forgery that fooled the worlds anthropologists for many years. What a rotten thing to put in an exam!
Histology was a significant part of the course. We were taught how to make microscopically thin slices of tissue, put them on a slide, fix and stain them so as to show up differing aspects of the cells. The electron microscope was a fairly recent development and we were shown fabulous and beautiful pictures of structures in cells never see before because they were so small. I went back to the Department in 2001 and wondered up the stairs. On the walls there are still the framed colour photographs of electron micrographs.
JZ was a great influence on me. A couple of months ago i bought one of his books in a second hand bookshop in York. "The life of vertebrates" Published 1950 767 pages long. I have his book "A model of the brain" all about the octopusses. I hope to find theother text book "The life of mamals" somewhere -actually I have seen it on ebay. What a long blog this one is!!!

2006-08-15T11:15:00.000-07:00

Experience as a patient 3 - x rays

I was a GP in Cheltenham for about 4 years from 1973 and patients with tuberculosis were not unheard of. I had seen a child 4 years of age with tb of his spine having contracted this from another adult patient of ours. I was dealt with as a tb contact and was asked to have a chest x ray. I was a patient of our practice (frowned upon these days) and wrote out the chest x ray form myself (also frowned upon now). One could go along to the radiology department without an appointment which I did. I handed in the form and a radiographer came to me not so much later. She spoke to me gruffly and said something like “get in there and take your shirt off”. This I did and she roughly manhandled me to the right position relative to the machinery. She actually pushed me. She took the film and told me to get dressed. After I had dressed, she said “Right. Go to your own doctor in 5 days and ask for the result”. I said “I am my own doctor” and walked out.

In about 1979, I was under considerable stress form setting up, with the fantastic help from my wife, a general practice from scratch ie no patients when we opened up (but this is another story). I was not sleeping well and drinking too much alcohol. I crashed our mini into a lamp post and was taken to the local casualty department in an ambulance. The car was a write off. This was at about 10 pm. My ankle was x rayed and I was told there was no fracture. I went home and found that the pain was so bad that I had `to go up the stairs backwards on my bottom. In the early hours of the morning ( and this action is a sign of my poor mental state) I decided to phone Mick, who was nearly a consultant orthopaedic surgeon. I told him the story and asked what I should do. He said “you need your leg xraying” and put the phone down somewhat hastily as it was about 2 am. The next day I went to another casualty department and saw a great Egyptian doctor. He discovered a fracture of my left lateral malleolus and put me in plaster of Paris. I did not complain about the first casualty department as I had done that job in the East End of London and I knew how difficult it was to interpret xrays late at night without a radiologist.

About a year ago I went to my GP (who was in another practice from my own) to talk about my hypertension tablets and management. I wasn’t looking forward to seeing him because he was new and this was my first consultation with him. He turned out to deal with me in an exemplary fashion. He asked me to have a chest x ray and I asked if it was OK to fill in the form myself with his name as the GP – this was to be helpful and save him time. He agreed and I did the form knowing the result would be sent to him.
Again, one can go for a chest x ray to the local radiology department without an appointment between certain times in the working week. I arrived at about 8.30 am and handed in the form to the receptionist. I sat in the waiting room with quite a few other patients. The receptionist (who knew I was a GP) came back to me, and, in front of all these patients asked “ Have you filled this form in yourself?”. I said “Yes, but my GP said it was alright”. She said “I’m sorry but we are going to have to fax your GP for his signature” and she went off. I was livid and felt she was accusing me of forgery. I had recently had the honour to have been elected a Fellow of the Royal College of General Practitioners and believe in its very strict ethical approach. I thought that if she says anything else to me in front of all these people I would give her some lip. She came back and told me “The fax machine is not working. We will have to wait until the consultant comes in and ask him”. I said “ Do you think I have forged an x ray form without going to see my GP? What sort of person do you think I am?” She then apologised, the consultant came in and I could have my x ray.
I was told to proceed to a cubicle and prepare myself. In that cubicle was a shirt thing. I could not work out which way round to put it on. Also in the cubicle was a notice telling patients to ask for assistance after they had been in the cubicle for 15 minutes without being called. I was called after about 5 minutes, had my x ray, got dressed again and was in a bit of a rush to get to my work place in Leeds. The radiographer was charming and when I waqs leaving said to me “Dr xxxxxxx (the consultant) will see you now”. I told her I was in a bit of a rush to get to work and asked her to apologise for not seeing him. As I was driving to Leeds, I started wondering why he wanted to see me. I ended up thinking I had lung cancer at the very least and was in a bit of a state when I got to the Deanery in Leeds University, where I was working that day. I told one of my GP colleagues my tale and he advised me to phone the consultant which I did. I asked him whay he wanted to see me and that I was worrying about my x ray. He said “ the x ray is fine. I just wanted to say hello.” Phew.
I went to see my GP a week later. The first thing he said to me when I went into his room was “Rugby Player?”. I had no idea what he was on about. I am the laziest person I know. In a department store I used to look for an escalator to go down! The x ray result had discovered two healed fractured ribs, he explained. I then remembered what could have happened. A few years ago, in the winter, I had bought 6 eggs and on the way back to the car slipped on some ice. I fell and hurt my chest. Not a single egg was broken! I did not have an x ray at the time.
Well, I have not had great experiences with x rays and I am a doctor! What patients have to put up with I can only imagine!

2006-08-14T07:17:00.000-07:00

Experience as a patient 2

I did not have much illness when I was a child but soon after starting my clinical studies I developed a pilonidal sinus which is a sweat gland that does not open to the air and becomes recurrently infected. It is usually situated in the skin near the anus at the base of the coccyx. It has been known, in the USA army as “Geep’s arse” as there is a possible association with lots of driving. I put up with these recurrent infections for 3 or more years taking antibiotics prescribed by my GP for the flare ups. Towards the end of an appointment as a House Officer in the Accident and Emergency Department of the London Hospital in the east end of London, I developed a terrific flare up and I could neither stand, sit or sleep properly. I was admitted under the care of Sir Alan Parks, an eminent bowel surgeon. One of the perks of working at the London was that medical staff could be admitted to the private wing (Fielden House). There was superb food with a choice from a different menu each day. The operation took place in the main hospital. I was given a premedication injection and had a last cigarette smoking it with my head out of the window. I was put on a trolley and wheeled up the street and into the main building. I was wearing a sort of shroud and white socks for this and greeted my friends as I passed. I had the operation and the somewhat large wound was left open to heal by what is known as granulation rather than having stitches. I had heard that sometimes one had to let this heal by lying on one’s stomach for 2 weeks with a weight attached to each buttock and hanging down each long side of the bed. Fortunately I was allowed to lie on my side without any wires sewn into me. I was in some pain the first night and asked the sister for a couple of paracetamol. She decided because the wound looked so awful that I should have an injection of pethidine. That was a really lovely injection. I can see how people get hooked. I also realise that pain can be in the eye of the beholder.
I had it really cushy in that private room. I had bottles of booze, fruit and nibbles and a television. Mr Parkes (he was knighted after my operation) complained to me that I never offered him a drink when he did his evening round. There was a thing at the London called the Rectal Club. If, as a student working with Mr Parks, one did 50 rectal examinations on patients or a sigmoidoscopy one was entitled to have a rectal club tie. I was told that since I had had an operation by Mr Parks I was entitled to a tie. I never claimed it. Mr Parks’ surgical house officer when I was in was in our year and was called Tony Matthie. He kindly put a couple of bets on horses for me so I could watch the races on the TV. When he saw me immediately after the operation, he told me it had been so interesting that a film had been made for teaching purposes. I believed him for a few seconds! Tony Matthie became the treasurer of the Royal College of General Practitioners and the Director of Postgraduate General Practice Education for the Liverpool Deanery. I met him in 2002 at the college and spoke to him. He did not recognise me and gave the impression that he had never heard of me. Such is fame!!
I had applied for a job as lecturer in physiology and one of my heroes, Dr W R Keatinge (reader and soon to become professor) interviewed me while I was in the bed in my pyjamas! I got the job and will tell you about it sometime.
In the room opposite me was a consultant physician who was having a piles operation. After operations such as that and mine one had daily salt baths. He came in to see me shortly after his operation. He said he was embarrassed to ask something of the sister as he was a consultant. He wanted to know how much salt one was supposed to put in a salt bath. I had no idea but I said I would ask. The main sister was rather ferocious but I asked her and the answer was “to taste”.
I found the whole experience fascinating and actually had a great rest after working so hard as a houseman for 11 months. I did not want to leave the ward. Indeed, when I was told I could go home one afternoon I asked if I could stay and have the evening meal as I was looking forward to the trout. I was allowed to stay and went after dinner.

2006-08-12T23:00:00.000-07:00

Experience as a patient 1.

In my opinion, it does all doctors good to be a patient occasionally. I have had some great, some amusing and some awful experiences.
I was really upset at the age of 4 when my mother told me one Sunday afternoon that I was going to hospital to have my tonsils out. The reason I was so upset was that I was about to miss “Muffin the Mule” on the television. After the operation my parents gave me two alarm clocks, one red and one blue. I have never worked out why I was given two. The surgeon was called Mr Hutton and after I got back home I asked my parents why Mr Hutton had so many sisters. I had seen him saying “Good morning, Sister” to one nurse and then “Hello, Sister” to another and different sisters nearly every day.

2006-08-11T23:09:00.000-07:00

I have always wanted to be a professor and now I am.
I have just emailed the radio 4 today program to say how good John Humphries was interviewing a goverment minister about Iraq. The minister was patronising and irritating and spouted the party line which certainly does not represent the views of me and the majority of my friends ie that the UK is at greater risk from terrorism because of our foreign policy.
I have canceled my monthly donation to the Labour Party and have emailed central office informing it that this will be until there is a new leader. The response to this has been one standard letter and two impersonal standard emails. One of the standard emails informed me that correspondence is always read carefully!
I think my peerage is now on hold! Professor Lord Pavolov of Omsk would have sounded rather good.