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Interest in medical education


Putting together the reductionist and the imaginative in medicine
Harold Lambert Physician
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[Q] How do you think we should bring back, bring together the reductionist side of things and the more imaginative side of things? Is that, is that...

Yeah. I suppose I'm a bit depressive about this. I don't actually think you can do it all that well. It's mainly... you know thyself, as it says in Delphi. I mean you, you have to know that both elements are important and I do think of it as a sort of... parallel but separate process. You...  the scientific side, the reductionist side, is very clear to me. I mean, I don't know if it's clear individually, but it's clear what you're supposed to be doing and want to do, and it does seem to me, in its nature, pretty Popperian. You're setting up hypotheses, which you are successively trying to demolish. You know, I mentioned these early books. I remember in Arthur Eddington, Nature of the Physical World, I read when I was about 14 or 15 or something, and he's talking about science and he says it's like a chap doing a jigsaw puzzle. You come in one day and say, 'Ooh, that's a nice bit of blue sky there,' and the chap says, 'Yes, it's lovely, isn't it? Really lovely blue sky', and you come in a week later and you say, 'Oh, what's happened to that sky?' he says, 'Oh it was sea, there was a boat on it'. And I think that's exactly what we do in medicine all the time and I... I, actually I feel as a conscious thing that as you're sort of walking along the corridor trying to think what's going on, you're trying to consciously balance those probabilities and in recent years, with far more investigations... there's... I was talking about the noise in the system, and I know I very often, quite often with a difficult problem, I'm not pretending all medical problems are difficult, but I'm talking about the difficult ones I actually mentally quite often, having seen the patient, had to mentally stand back and say: now look, there's all these things about his blood this, and his chest that and his this the other, and the other and this germ blood culture and I sort of think to myself: how do I actually see this problem? Now, you could say that is integrationist, but I think it's really just trying to put the reductionist thing in a kind of context. But, no, I actually don't see them very much together, the two halves. No. I see them going along properly at the same time.

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: scientific side, reductionist, hypotheses, imaginative

Duration: 2 minutes, 27 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008