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The London School of Hygiene and Tropical Medicine

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The silent centre of medicine
Harold Lambert Physician
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The business about, going on slightly from there, about the, the consult and all this new work about education and communication does puzzle me a little bit. I mean, at the end of the day, when all this is said and done, I truly believe that there's a silent centre for medicine. And by that I mean there's a doctor and a patient into a room- in a room, trying to come to terms with what's going on and for the doctor to make the diagnosis and the patient to see what he's on about and the doctor see what the patient's on about. I mean, this of course is rich, Western medicine. This wouldn't be in a Darfur refugee camp and it wouldn't be in a rural clinic in Nigeria with 250 children outside where you need Morris King's famous four-minute consultation. You know, look at the mother, is the patient breathing- you know, sort of I can't remember all the four minutes. Brilliant, brilliant, brilliant way of assessing a child's illness in four minutes and, and valid but we're talking about this kind of medicine in a country like this and I just have this sort of puzzled sense, all these studies and all these trials and all these things about communication, video tapes and, and patients doing this- and they're all sort of swirling round and round the silent centre and wondering- it's probably just being old- but wondering to what extent that all gets through to actually improve that silence centre and what goes on in it. And this is only a question, I haven't got a, an answer to it but in a way I sometimes feel a lot of the work you see, especially the qualitative research work is to do with analysing what's happening without necessarily improving what's happening. It's obviously- its long-term intention is to do that. I don't know if I've been very obscure or, or muddled about that but that's, that's what I, I ask myself and there are some things I've already said which I do think are clearly important, like teaching certain basic things about how you relate with patients and on the teaching side how you relate with students. That's for sure. It's just I don't know how much of it gets home.

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: doctor, patient, western medicine, qualitative, analysis, teaching

Duration: 2 minutes, 20 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008