Q J Med 2014; 107:167–168 doi:10.1093/qjmed/hct215 Advance Access Publication 29 October 2013
Commentary My medical practice: mentors and perspectives M. EASTWOOD From the Department of Medicine, University of Edinburgh, Western General Hospital Edinburgh, Edinburgh, UK Address correspondence to M. Eastwood, 10 Cross Street, East Riding Yorkshire, Beverley HU17 9AX, UK. email: [email protected]
hospitals. He was President of the Royal College of Physicians of Edinburgh. I was his clinical assistant and first Chairman of the Collegiate Members Committee of the Edinburgh College during his Presidency. I grew deeply to admire this compassionate and urbane man. He was medically well educated, courteous, gentle, wise, kind and companionable as well as drawing upon a wealth of knowledge. When our family wanted to move from Newington (acceptable area) to Portobello (questionable), he popped down to view the house before giving this his blessing. All my working life I had a mental panel of five people, drawn from all periods of my life, to whom I referred difficult questions. I would pose the question and possible resolution and their nod or head shake would give the answer. He is a member of this panel. Why was he my strong influence? Because his style suited my personality and approach to medicine. At school I struggled with having a divergent mind in a convergent minded world, with its need to respect rather than to challenge the immutable orthodoxies. My parents taught me ‘be true to thyself and fear no one’. I am essentially a dreamer, a lifelong student who likes to have time on my own each day, away from a convergent and often brilliant minded hospital world. Wonderful clinicians who would draw from fixed, unquestioned menus of medical knowledge. These two different approaches were not necessarily dealt with flexibly or with understanding. I was always aware of the trust given by patients, ordinary folk held in the thrall of illness. The men that I met whilst growing up and whilst earning money labouring made me aware of the worries
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://qjmed.oxfordjournals.org/ by guest on November 14, 2015
I was only the second of my family to go to university. Almost from infancy my mother would describe me as ‘my son, the doctor to be’. My brother and I went as choral scholars to Southwell Minster choir school, perfect Anthony Trollope country.1 Sport, especially long distance running and science proved to be my lifelong interests, leading to Edinburgh University and the exciting life of medicine. A bonus in our first term was to meet my future wife Jenny, companion, friend, Consultant Psychiatrist and mother of our four children. Together we joined a medical community who still meet regularly as friends and to help and support each other. After graduating I studied biochemistry, before training as a physician in the Royal Infirmary of Edinburgh. I was appointed as Consultant Gastroenterologist at the Western General Hospital, Edinburgh in 1969. The appointment was a mix of academia and clinical practice. The prime project was to study the physiology and role of dietary fibre in the aetiology, prevention and treatment of a long list of diseases. A big, even improbable task.2 So what was my perception of a model Physician? I was fortunate to work for such first rate chiefs in the Royal Infirmary of Edinburgh, Ranald Murray-Lyon and Professor Ronald Girdwood. However, the ideal for me was Sir John Halliday Croom (1909– 86), a medical aristocrat, the third generation of Edinburgh clinicians, educated at Glenalmond, Cambridge and Edinburgh. A superb clinician and clinical teacher, who was also a golfer, fisherman and horse racing enthusiast. He was through and through a Royal Infirmary consultant, yet he would care for diabetic patients in peripheral district general
168
M. Eastwood The introduction of intervention procedures, fibre optics, stenting, assisted feeding etc. has radically changed the activities of physicians. I really enjoyed these procedures. When treatment fails, the doctor is faced with that most uncomfortable state of mind, uncertainty. The prime objective is quality of life after treatment and how this person may be in seven years’ time. Some doctors regard conditions of unknown aetiology as psychosomatic; the mind causing ‘misbehaviour in an organ, a form of weakness and by implication, get a grip on yourself’. But what if these conditions were organic and the mind secondarily involved? The dismay seen as the causation. Duodenal ulceration was seen in part as a psychosomatic condition, not a common or garden infection. Medicine slavishly followed the ‘no acid, no ulcer’ mantra, yet the Helicobacter was there waiting to be seen under the microscope, medium power. The practice of a physician has changed out of all recognition during the 53 years since I graduated. My hope is that kindness and compassion remain the essence of our evolving, constructively evaluated practice, help often and wonder more. Altruism, order and progress. For me, I follow Sydenham’s quote.5 ‘Whether it is better to serve men or be praised by them, I prefer the former’. It does not matter who gets the praise so long as it is achieved.
References 1. Trollope A. The Warden. 1855. 2. Eastwood MA. The physiological effect of dietary fiber: an update. Annu Rev Nutr 1992; 12:19–35. 3. Davidson S. The Principles and Practice of Medicine. 9th edn. Edinburgh: Livingstone, 1968. 4. Tennyson A. In: Memoriam A.A.H. 1849.
Our little systems have their day; they have their day and cease to be.4
5. Sydenham in the Quiet Art, A Doctor’s Anthology, compiled by Dr Robert Coope. Edinburgh: E&S Livingstone, 1958.
Downloaded from http://qjmed.oxfordjournals.org/ by guest on November 14, 2015
inflicted by poverty, whether financial, social or emotional. In clinics the sight of patients scrubbed, in their best clothes never failed to affect me. After our little farm failed, during the last year at school, my father became mortally ill. Two hospitals told us that he could not be seen for a year. Privately yes on presenting a £5 note, which somewhat influenced my views on private medicine. I often did ward rounds on my own, just chatting to patients of death, pain, loss and being in a strange environment. Whatever we had to offer had to be with understanding, confidence and kindness. It is important to be a clinician on the wards and scientist in the laboratory. Patients become patients by design or accident. Cigarette smokers and heavy drinkers of alcohol are aware of the risks which they chose to ignore. I have a recollection that one in three individuals who smoke heavily develop cancer of the lung, which means that two out of three do not. Is it worth the risk? Others harried by life’s events are weakened in body and resolve. They deserve our sympathy and dedicated care in this grand gamble. The majority is the truly unfortunate who develop acute, chronic or fatal conditions for no apparent reason. Throughout the years, a mainstay of a physician’s care has been provided by nurses. Nursing is formalized compassion especially when bed rest might be all that physicians could offer. Throughout my consultant life I enjoyed working closely with the nursing team, despite the risk of being reminded of the modus operandi by a special talk from sister. A good secretary who is a friend is mandatory. Many treatments are merely ameliorating and slowly pass out of fashion, ignis fatuus or the willo’-the wisp of certainty. Davidson’s text book of medicine from the 1950s and 1960s is so very different from current practice.3
Commentary My medical practice: mentors and perspectives M. EASTWOOD From the Department of Medicine, University of Edinburgh, Western General Hospital Edinburgh, Edinburgh, UK Address correspondence to M. Eastwood, 10 Cross Street, East Riding Yorkshire, Beverley HU17 9AX, UK. email: [email protected]
hospitals. He was President of the Royal College of Physicians of Edinburgh. I was his clinical assistant and first Chairman of the Collegiate Members Committee of the Edinburgh College during his Presidency. I grew deeply to admire this compassionate and urbane man. He was medically well educated, courteous, gentle, wise, kind and companionable as well as drawing upon a wealth of knowledge. When our family wanted to move from Newington (acceptable area) to Portobello (questionable), he popped down to view the house before giving this his blessing. All my working life I had a mental panel of five people, drawn from all periods of my life, to whom I referred difficult questions. I would pose the question and possible resolution and their nod or head shake would give the answer. He is a member of this panel. Why was he my strong influence? Because his style suited my personality and approach to medicine. At school I struggled with having a divergent mind in a convergent minded world, with its need to respect rather than to challenge the immutable orthodoxies. My parents taught me ‘be true to thyself and fear no one’. I am essentially a dreamer, a lifelong student who likes to have time on my own each day, away from a convergent and often brilliant minded hospital world. Wonderful clinicians who would draw from fixed, unquestioned menus of medical knowledge. These two different approaches were not necessarily dealt with flexibly or with understanding. I was always aware of the trust given by patients, ordinary folk held in the thrall of illness. The men that I met whilst growing up and whilst earning money labouring made me aware of the worries
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://qjmed.oxfordjournals.org/ by guest on November 14, 2015
I was only the second of my family to go to university. Almost from infancy my mother would describe me as ‘my son, the doctor to be’. My brother and I went as choral scholars to Southwell Minster choir school, perfect Anthony Trollope country.1 Sport, especially long distance running and science proved to be my lifelong interests, leading to Edinburgh University and the exciting life of medicine. A bonus in our first term was to meet my future wife Jenny, companion, friend, Consultant Psychiatrist and mother of our four children. Together we joined a medical community who still meet regularly as friends and to help and support each other. After graduating I studied biochemistry, before training as a physician in the Royal Infirmary of Edinburgh. I was appointed as Consultant Gastroenterologist at the Western General Hospital, Edinburgh in 1969. The appointment was a mix of academia and clinical practice. The prime project was to study the physiology and role of dietary fibre in the aetiology, prevention and treatment of a long list of diseases. A big, even improbable task.2 So what was my perception of a model Physician? I was fortunate to work for such first rate chiefs in the Royal Infirmary of Edinburgh, Ranald Murray-Lyon and Professor Ronald Girdwood. However, the ideal for me was Sir John Halliday Croom (1909– 86), a medical aristocrat, the third generation of Edinburgh clinicians, educated at Glenalmond, Cambridge and Edinburgh. A superb clinician and clinical teacher, who was also a golfer, fisherman and horse racing enthusiast. He was through and through a Royal Infirmary consultant, yet he would care for diabetic patients in peripheral district general
168
M. Eastwood The introduction of intervention procedures, fibre optics, stenting, assisted feeding etc. has radically changed the activities of physicians. I really enjoyed these procedures. When treatment fails, the doctor is faced with that most uncomfortable state of mind, uncertainty. The prime objective is quality of life after treatment and how this person may be in seven years’ time. Some doctors regard conditions of unknown aetiology as psychosomatic; the mind causing ‘misbehaviour in an organ, a form of weakness and by implication, get a grip on yourself’. But what if these conditions were organic and the mind secondarily involved? The dismay seen as the causation. Duodenal ulceration was seen in part as a psychosomatic condition, not a common or garden infection. Medicine slavishly followed the ‘no acid, no ulcer’ mantra, yet the Helicobacter was there waiting to be seen under the microscope, medium power. The practice of a physician has changed out of all recognition during the 53 years since I graduated. My hope is that kindness and compassion remain the essence of our evolving, constructively evaluated practice, help often and wonder more. Altruism, order and progress. For me, I follow Sydenham’s quote.5 ‘Whether it is better to serve men or be praised by them, I prefer the former’. It does not matter who gets the praise so long as it is achieved.
References 1. Trollope A. The Warden. 1855. 2. Eastwood MA. The physiological effect of dietary fiber: an update. Annu Rev Nutr 1992; 12:19–35. 3. Davidson S. The Principles and Practice of Medicine. 9th edn. Edinburgh: Livingstone, 1968. 4. Tennyson A. In: Memoriam A.A.H. 1849.
Our little systems have their day; they have their day and cease to be.4
5. Sydenham in the Quiet Art, A Doctor’s Anthology, compiled by Dr Robert Coope. Edinburgh: E&S Livingstone, 1958.
Downloaded from http://qjmed.oxfordjournals.org/ by guest on November 14, 2015
inflicted by poverty, whether financial, social or emotional. In clinics the sight of patients scrubbed, in their best clothes never failed to affect me. After our little farm failed, during the last year at school, my father became mortally ill. Two hospitals told us that he could not be seen for a year. Privately yes on presenting a £5 note, which somewhat influenced my views on private medicine. I often did ward rounds on my own, just chatting to patients of death, pain, loss and being in a strange environment. Whatever we had to offer had to be with understanding, confidence and kindness. It is important to be a clinician on the wards and scientist in the laboratory. Patients become patients by design or accident. Cigarette smokers and heavy drinkers of alcohol are aware of the risks which they chose to ignore. I have a recollection that one in three individuals who smoke heavily develop cancer of the lung, which means that two out of three do not. Is it worth the risk? Others harried by life’s events are weakened in body and resolve. They deserve our sympathy and dedicated care in this grand gamble. The majority is the truly unfortunate who develop acute, chronic or fatal conditions for no apparent reason. Throughout the years, a mainstay of a physician’s care has been provided by nurses. Nursing is formalized compassion especially when bed rest might be all that physicians could offer. Throughout my consultant life I enjoyed working closely with the nursing team, despite the risk of being reminded of the modus operandi by a special talk from sister. A good secretary who is a friend is mandatory. Many treatments are merely ameliorating and slowly pass out of fashion, ignis fatuus or the willo’-the wisp of certainty. Davidson’s text book of medicine from the 1950s and 1960s is so very different from current practice.3
