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Drugs: then and now

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Talking to patients: changes over time
Harold Lambert Physician
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Talking to patients about things. I mean, like you, I've done a huge amount of it and I'm sure I've done a lot of it completely wrong. I mean one thing I know I did wrong, I tended to over-explain. I was so keen on the patient understanding where we were at, that I think I said too much detail really. I'm sure a lot of them went away and said when they got home, 'Yeah, he seemed all right but I don't know what the hell he was talking about'. I mean no long words just you know.

[Q] But you were very unusual, weren't you, in doing that, Harold?

I don't think so.

[Q] That's my... my feeling that actually a lot of people didn't do very much explaining at all so that actually most people were just told what to do and, and left in the dark.

Yes. I think that's partly the people, that's true, and partly the, the climate of the times. It was a much more authoritarian climate and the doctor knew best and some people I found incredibly difficult to talk were ex-servicemen, you know, hair slicked down, standing at attention in bed, 'Yes sir, no sir'. 'Yeah, well, this is the situation, Mr Brown, and we're going to cut your head off tomorrow'. 'Just as you say doctor'. I mean that was the sort of sight. It was impossible to get them to come across and say what they felt about it. So it was both sides of the equation I think, but it's a very interesting thing and we're talking about this at a very junior level but I think actually these are nuggets which are incredibly important.

[Q] But you must have seen that change in patients as well as in doctors.

Yeah.. that's right. Yeah, I think so, very much in recent years with... and of course with the web it's changed entirely. I mean that business about notes with the doctor, patients in my generation always felt very shy of this, bringing up bits of paper. I used to say, 'Do this, you'll forget and bring up some notes', and when I was ill some years ago they came and had chats with me, very nice, my colleagues, you know, and when they went away I thought: oh no, what I've really got is this and I forgot to mention that! And so I think it's very important for patients to have notes about what they want to say to you.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: patients, mistakes, over-explain, detail, change, doctors, notes

Duration: 2 minutes, 5 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008