I must start with my father. He left school at 14 and became an office boy in a local firm making surgical needles. Redditch, where we were living is/was renowned for needles of all sorts as well as fishing tackle and springs. Anyway he climbed the greasy pole and became office manager and left and set up his own company.
As a boy he had joined St John’s Ambulance brigade and got more involved with this when as a key worker he was not called up during the war. With his exposure to ambulance work and the making of different needles for the full range of surgical operations he had always wanted to train as a doctor but coming from a poor family there was no chance of it. I was clearly influenced by his experiences and with some difficulty was accepted into the Welsh National School of Medicine in Cardiff in 1966.
As a student things were pretty hectic with few free periods and once on the wards we spent lots of time hanging around in the evenings to see as much as we could. It was then you learnt how to suture and do a lot of the procedures you would need later on. Yes the patients were practiced on! There was a saying “see one, do one, teach one” it was during such an evening session that I had the chance to assist at my first operation. About 10pm a surgeon came into casualty saying that he needed two assistants for a renal transplant later that night. It was about 3am by the time we were all gowned up and hanging onto a retractor terrified we might do something wrong. The amazing thing was that the new kidney was inserted under the skin in the groin rather than the abdomen – a real learning experience.
Another very memorable time was when I had to clerk (take a history) from a Mr Bell who was an octogenarian but when aged only 3 had been operated on by Lord Lister who introduced antiseptics. It really shrank the history of modern medicine into a lifetime. Another such occasion was when our professor of bacteriology told us that he had once been tasked with transporting the “world” supply of antibiotics in his brief case.
The first baby I delivered as a student arrived on a very hot and humid evening (no air con then) the day man landed on the moon. It was a boy and no prizes for guessing what they called him!
My first paid post after 5 years training was very fortuitous. I saw an advertisement in the British Medical Journal for 3 jobs in Southampton. I was invited for an interview to find that 2 of the positions were to work for professors. One was Prof Donald Acheson who, unknown to me, was a founder member of the Faculty of Community Medicine of the Royal College of Physicians as well as being the first Dean of the new embryonic Southampton medical school. During the inquisition I mentioned for some reason that I was interested in community medicine and amazingly he hired me. He subsequently became the national Chief Medical Officer and went on to work for WHO.
The system of training then was 2 years pre-clinical, 3 years clinical, and a year split between house jobs in a medical and surgical speciality. You were then fully registered and could set up as a GP straight away but the concept of vocational training was being developed. This involved another 2 years in various jobs in hospital and a year as a trainee. If you were lucky you then were accepted into a practice where you wanted to settle and after about 3 years of working up to parity you became a full profit sharing partner. Very few GPs were then salaried or part time or indeed female.
After Southampton, where I met my wife, I had 3 jobs in Cardiff and a stint in Wrexham before returning to Cardiff for a trainee year. So why did I choose general practice? I had spent a year in children’s medicine and thought that was my future but in Wales, at least, there was huge competition for consultancies in paediatrics and even then very little support with lifelong rotas of one in two, or worse, of evening and night work after a full day’s work. Together with that there were difficult exams to navigate and I had just got married and we had our first daughter. General practice seemed an altogether better option and I have never regretted it.
In 1976 when I started in Basingstoke as a GP a book had just been published titled “Six minutes for the Patient” This was revolutionary as very few doctors spent more than 5 minutes on a consultation and much of that was trying to find your way round the old brown, hand written, Lloyd George records. Those records had been first conceived by the Germans and were employed by the then British government.
Our practice was coping with the rapid influx of patients from London; my personal list growing from 0 to 3500 in about 18 months. In addition, our consultation time was about double the national average initially as quite a few had no local extended family so all problems came to our door. In those days, of course, we did all our own on call on a I in 5 rota. When on duty we would be on for the evening and night following a full day and followed by another full day. We were also covering our maternity patients about half of our pregnant ladies delivering under our care. It always surprised me how many went into labour in the middle of the night! We had no mobile phones so out of hours calls came to us from our partners at home via a bleep. We then had to find a phone and re-plan our route around the patch. The change to the out of hours service with the Hantsdoc co-op came just in time as most of us were on our knees. My low point was probably when I was called out of bed five times after midnight.
Things had to change, and the changes have been massive, largely enabled by the advent of computers as in so many areas of activity. We were able to build on our use of A4 paper records with enhanced coding and that in turn allowed us to tailor our provision of services to improve care. The NHS payment system also made data collection imperative. For a few years we were legally obliged to record everything on paper and the computer which was a big time waster. We became a bit paranoid about the millennium bug which we successfully avoided only to be caught out on the following 29th February.
All of the above has unfortunately meant that patients have less continuity of care seeing their own family practitioner only rarely as ancillary staff take on more of the traditional roles forced by increasing work load. It is a very different job to one I started with.
A postscript – since retirement and more time spent the other side of the desk I have become increasingly aware of how difficult it is to know when to seek help. If I feel that way with my experience then I am sure that others feel it more so. It is a constant dilemma as to how society can best use the service responsibly. Educating the public about when to present and when self- care is more appropriate is an area that requires more consideration but it is better to call unnecessarily than to not call when you need to.
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