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Avoiding getting too specialised

RELATED STORIES

Psychiatric and emotional factors in physical illness (Part 3)
Harold Lambert Physician
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Now I think that the general practitioners who I teach and I hope my colleagues would, would work, would mark, would work, would walk on two feet so that they, they would, they would be thinking about this psychological as well as the physical knowing only too well that, that, you know, you can't, you can't deal with one without the other. And, and when I was talking to the French doctors about this they said- oh, oh well, is that how you do it here and, and I found that very fascinating. And I'm not quite sure, I'm not crowing about English general practise or English medicine, I mean, but it just opened up to me this change that had happened in the last few years. Yes. Yes, I remember that well. I remember as a student thinking it was rather funny because we were told exactly that. I thought it seemed rather strange that most headaches weren't brain tumours, thank goodness, and is- I didn't know, I don't think I would have known, you know, expressed it in the way you have explicitly and clearly just now but I, I realised there was something a bit peculiar about the whole arrangement We're going to come back to the world to- I found my dean chuckling, he's a very humane man, he said I've just come across the expression CAT, CAT scan negative headache, he said which he thought was a very, I mean, he said just, why isn't we- He'd just actually been, he'd been called as a, as a consult to a surgical ward where a, an, an African woman was being investigated for bellyache and he sat- they'd come across nothing so they called in a physician and he sat down on her bed and said when did you get your, when did your tummy ache start. And she said- it was when my husband took my son back to Nigeria and it was the sort of think- Oh dear, oh dear, oh dear. And you think what, what sort of education are we giving people that they can't, you know, get something else other than- Yes. It's partly specialisation, isn't it. I mean you're the only generalist, aren't you because it's now getting increasingly hard in hospital context to kind of get a person who'll kind of take it all in and the gastro- I'm not saying there are not, many of them are extremely good generalists but they now cone down on one aspect and it's quite hard to- actually I remember Richard Asher I mentioned, my boss at the Central Middlesex, one of his stories was about a patient coming from an ophthalmologist because he had retinitis pigmentosa and somewhere way in the textbooks there's Laurence-Boon-Moon-Beadle syndrome, do you remember, way from the past. Yes. Yes. So that the ophthalmologist wrote on the notes this is retinitis pigmentosa, this is Laurence-Moon-Beadle syndrome, refer to a general physician for an opinion about polydactyly. And as Richard Asher said, it's surely not beyond an ophthalmologist to see whether someone's got six fingers or five fingers. It was a typical Richard Asher insight. Yes, I, and I think the danger for us is not just specialisation as a, as a, as a profession but also what we do with that specialisation because I- you know, my specialist colleagues are mostly now gazing down tubes and they're not actually, you know, they, they're not actually, you know, the patient is not very much just there, that's, they're already doing what the ophthalmologist is doing looking into an eye, looking down a tube or up a bottom or something like that. It's, or in, or into a heart, which is wonderful but actually there may be other things that you have do first. This is what they focus on, isn't it? Yes. I mean, Maggie Turner Warwick once told me that- Richard's father was a famous, I think, rectal or gastro- something surgeon and a patient came who'd seen him before and he said- he didn't remember that he'd seen him before and he was looking up his backside with a scope and he said, oh yes, I remember you perfectly!

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: general practitioners, patient experiences, specialisation

Duration: 4 minutes, 5 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008