BRITISH MEDICAL JOURNAL
2 OCTOBER 1976
811
CORRESPONDENCE Posts in clinical rheumatology A J Richards, MRCP; T E Hothersall, FRCPED; D H Bossingham, MRCP .......... 811 Abuse and intoxication potential of nicotine chewing gum J Hartelius, BA, and Lita Tibbling, MD ...... 812 Normal distributions R G Faber, FRCS, and others; C G Rand, FRCP(C) .........
.......................
812
Admission of old people to hospital R Tepper, FRCP; A G M Campbell, FRCPED. .812 Family planning for the mentally handicapped D A Spencer, MRCPSYCH ................ 813 Lung cancer and smoking: is there proof? A J Fox, PHD ..... ..................... 813 Emergency medical care R Erskine, MRCGP, and others ............ 813 Abortion and maternal deaths Ann Cartwright, PHD .................... 813 Hazards of smallpox vaccination G T Watts, FRCS ........................ 813 Marital urinary infection D Brooks, MD ....... ................... 813 The elderly in a coronary unit F F Thompson, MRCPED .................. 814 "Press that bruise" B M Tracey, FRCS ...................... 814 Computer interrogation of patients A L Jacobs, FRCP
........................ 814
Sign language? F C Rose, FRCP ........................ 814 Measurement of blood pressure M F D'Souza, MB, and L M Irwig, MB ...... 814 Out-of-hours calls in general practice D Hooker, MRCGP ......... ............. 815 Vinyl chloride: the carcinogenic risk J S Robinson, FFARCS, and others ........ 815 Hypophosphataemic osteomalacia in patients receiving haemodialysis 815 J Szucs, MD ....... Postinfluenzal depression T H Flewett, FRCPATH .................. 815 Ingrowing toenail A W Fowler, FRCS .......... ............ 815 Rational dosage of non-cumulative drugs D B James, MRCGP ...................... 816 A prognostic sign in ECT H L Thornton, FFARCS ....... ........... 816 Primum non nocere, or the pharmacological lucky dip D W Vere, FRCP ........................ 816 Breast-feeding and the BBC J A Davis, FRCP ........................ 816 Conception and congenital abnormalities after chemotherapy for leukaemia P Barkhan, FRCPATH, and P R Evans, FRCP. . 816 The myth of phenelzine acetylation Elizabeth F Marshall, PHD .............. 817 .....................
Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors. Posts in clinical rheumatology
SIR,-The report by Professor W Watson Buchanan and his colleagues on the poor quality of posts in clinical rheumatology (11 September, p 628) highlights the problems concerning this specialty in the U.K. Registrar and senior registrar posts in rheumatology and rehabilitation remain unfilled, even in teaching hospitals, and consultant posts with an emphasis on rehabilitation attract few or no applicants. The change of the name of the specialty from "rheumatology and physical medicine" to "rheumatology and rehabilitation" has led to some confusion over what rehabilitation actually is. There are no clear guide lines on the type of patient a rheumatologist should rehabilitate. Should he be involved in stroke rehabilitation, rehabilitation of the young chronic sick patient, cardiac rehabilitation, geriatric rehabilitation, and so on or should he confine himself to rehabilitating patients with any of the rheumatic diseases? The emphasis in training is on rheumatology rather than rehabilitation and I would agree with Professor Buchanan and his colleagues that there is now a clear case for separating rheumatology from rehabilitation. Proper training programmes along North American lines should be developed if we are to attract junior staff to fill these vacant posts. Until
this happens the work load, waiting lists, and staffing ratios will get steadily worse. A J RICHARDS Worthing Hospital, Worthing, Sussex
SIR,-I read with interest the article by Professor W Watson Buchanan and his colleagues (11 September, p 628). As an Edinburgh graduate I was surprised to find that I agreed entirely with the sentiments expressed by Professor Buchanan regarding the poor quality of posts in clinical rheumatology. He makes some proposals regarding conditions for consultant rheumatologists and I would add that adequate clinical facilities and supporting staff, including secretarial, should also be provided before the appointment is made. For the benefit of prospective candidates I should point out that in the forthcoming appointment in North Staffordshire (1) there will be no rehabilitation content, (2) there will be two consultants in the specialty, (3) there will be more than 20 beds available in the department, (4) there are more than adequate research and teaching facilities, and
Postoperative pain E N S Fry, FFARCS
...................... 817 Hysteria today G G Wallis, FRCPSYCH ...... ............ 817 Burning feet H H G Eastcott, FRCS .................. 817 Oxytocin and neonatal jaundice B Alderman, MRCOG, and J M Beazley,
FRCOG .......................
Clinical academic staff and new NHS consultant contract P Quilliam, FRCP ........................ 818
Splinter organisations D V Bateman, FFARCS; B D McKee, FRCR. .818 Consultant contract Barbara E M Clay, MRCS, and J P P Donnelly, FRCS ........ ................ 818 Juniors' contract dispute P Martin; N H N Mills, MFCM ............ 819 Medical manpower and hospital staffing G I B da Costa, FRCSED .................. 819 Industrial action J M Laurent, MRCGP; Jean E Lawrie, MB ..819 Bureaucratic cancer R H Barrett, MRCS ...................... 820 Points from letters Beyond Calais (C Rummelsburg); Postoperative pain (B R P Murray); Teaching of anatomy (P H Brunyate); Metabolic disease in Asians (D R Matthews); Aspirin and papaveretum tablets (J Sloggem); Finding part-time jobs (Janet F Hosegood); ...... 820
(5) as a result of the hard work put in by the consultant physicians in the past there is a very high standard of junior staff in the district. T E HOTHERSALL North Staffordshire Health District, Central Outpatients Department, Stoke-on-Trent
SIR,-The point made by Professor W Watson Buchanan and his co-authors (11 September, p 628) concerning the poor quality of posts in rheumatology is well made. He raises the apparently intractable problem of attracting staff to this Cinderella specialty. The problem is how to direct the young doctor from what he sees as the exciting or dramatic in medicine to those disciplines of great import with great opportunities like rheumatology, which is as much a specialty within medicine as cardiology, neurology, endocrinology, and so on.
Until all teaching hospitals have within their department of medicine a department of clinical rheumatology, with opportunities for students to be taught something about the subject, rheumatology will remain a Cinderella. The opportunity to do something effective for the rheumatic sufferer today is greater than exists in many other disciplines within medicine and the number of patients ("clinical material") is great. Until general physicians refer patients to rheumatologists as routinely as they order radiography or 12-line biochemical analyses
2 OCTOBER 1976
811
CORRESPONDENCE Posts in clinical rheumatology A J Richards, MRCP; T E Hothersall, FRCPED; D H Bossingham, MRCP .......... 811 Abuse and intoxication potential of nicotine chewing gum J Hartelius, BA, and Lita Tibbling, MD ...... 812 Normal distributions R G Faber, FRCS, and others; C G Rand, FRCP(C) .........
.......................
812
Admission of old people to hospital R Tepper, FRCP; A G M Campbell, FRCPED. .812 Family planning for the mentally handicapped D A Spencer, MRCPSYCH ................ 813 Lung cancer and smoking: is there proof? A J Fox, PHD ..... ..................... 813 Emergency medical care R Erskine, MRCGP, and others ............ 813 Abortion and maternal deaths Ann Cartwright, PHD .................... 813 Hazards of smallpox vaccination G T Watts, FRCS ........................ 813 Marital urinary infection D Brooks, MD ....... ................... 813 The elderly in a coronary unit F F Thompson, MRCPED .................. 814 "Press that bruise" B M Tracey, FRCS ...................... 814 Computer interrogation of patients A L Jacobs, FRCP
........................ 814
Sign language? F C Rose, FRCP ........................ 814 Measurement of blood pressure M F D'Souza, MB, and L M Irwig, MB ...... 814 Out-of-hours calls in general practice D Hooker, MRCGP ......... ............. 815 Vinyl chloride: the carcinogenic risk J S Robinson, FFARCS, and others ........ 815 Hypophosphataemic osteomalacia in patients receiving haemodialysis 815 J Szucs, MD ....... Postinfluenzal depression T H Flewett, FRCPATH .................. 815 Ingrowing toenail A W Fowler, FRCS .......... ............ 815 Rational dosage of non-cumulative drugs D B James, MRCGP ...................... 816 A prognostic sign in ECT H L Thornton, FFARCS ....... ........... 816 Primum non nocere, or the pharmacological lucky dip D W Vere, FRCP ........................ 816 Breast-feeding and the BBC J A Davis, FRCP ........................ 816 Conception and congenital abnormalities after chemotherapy for leukaemia P Barkhan, FRCPATH, and P R Evans, FRCP. . 816 The myth of phenelzine acetylation Elizabeth F Marshall, PHD .............. 817 .....................
Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors. Posts in clinical rheumatology
SIR,-The report by Professor W Watson Buchanan and his colleagues on the poor quality of posts in clinical rheumatology (11 September, p 628) highlights the problems concerning this specialty in the U.K. Registrar and senior registrar posts in rheumatology and rehabilitation remain unfilled, even in teaching hospitals, and consultant posts with an emphasis on rehabilitation attract few or no applicants. The change of the name of the specialty from "rheumatology and physical medicine" to "rheumatology and rehabilitation" has led to some confusion over what rehabilitation actually is. There are no clear guide lines on the type of patient a rheumatologist should rehabilitate. Should he be involved in stroke rehabilitation, rehabilitation of the young chronic sick patient, cardiac rehabilitation, geriatric rehabilitation, and so on or should he confine himself to rehabilitating patients with any of the rheumatic diseases? The emphasis in training is on rheumatology rather than rehabilitation and I would agree with Professor Buchanan and his colleagues that there is now a clear case for separating rheumatology from rehabilitation. Proper training programmes along North American lines should be developed if we are to attract junior staff to fill these vacant posts. Until
this happens the work load, waiting lists, and staffing ratios will get steadily worse. A J RICHARDS Worthing Hospital, Worthing, Sussex
SIR,-I read with interest the article by Professor W Watson Buchanan and his colleagues (11 September, p 628). As an Edinburgh graduate I was surprised to find that I agreed entirely with the sentiments expressed by Professor Buchanan regarding the poor quality of posts in clinical rheumatology. He makes some proposals regarding conditions for consultant rheumatologists and I would add that adequate clinical facilities and supporting staff, including secretarial, should also be provided before the appointment is made. For the benefit of prospective candidates I should point out that in the forthcoming appointment in North Staffordshire (1) there will be no rehabilitation content, (2) there will be two consultants in the specialty, (3) there will be more than 20 beds available in the department, (4) there are more than adequate research and teaching facilities, and
Postoperative pain E N S Fry, FFARCS
...................... 817 Hysteria today G G Wallis, FRCPSYCH ...... ............ 817 Burning feet H H G Eastcott, FRCS .................. 817 Oxytocin and neonatal jaundice B Alderman, MRCOG, and J M Beazley,
FRCOG .......................
Clinical academic staff and new NHS consultant contract P Quilliam, FRCP ........................ 818
Splinter organisations D V Bateman, FFARCS; B D McKee, FRCR. .818 Consultant contract Barbara E M Clay, MRCS, and J P P Donnelly, FRCS ........ ................ 818 Juniors' contract dispute P Martin; N H N Mills, MFCM ............ 819 Medical manpower and hospital staffing G I B da Costa, FRCSED .................. 819 Industrial action J M Laurent, MRCGP; Jean E Lawrie, MB ..819 Bureaucratic cancer R H Barrett, MRCS ...................... 820 Points from letters Beyond Calais (C Rummelsburg); Postoperative pain (B R P Murray); Teaching of anatomy (P H Brunyate); Metabolic disease in Asians (D R Matthews); Aspirin and papaveretum tablets (J Sloggem); Finding part-time jobs (Janet F Hosegood); ...... 820
(5) as a result of the hard work put in by the consultant physicians in the past there is a very high standard of junior staff in the district. T E HOTHERSALL North Staffordshire Health District, Central Outpatients Department, Stoke-on-Trent
SIR,-The point made by Professor W Watson Buchanan and his co-authors (11 September, p 628) concerning the poor quality of posts in rheumatology is well made. He raises the apparently intractable problem of attracting staff to this Cinderella specialty. The problem is how to direct the young doctor from what he sees as the exciting or dramatic in medicine to those disciplines of great import with great opportunities like rheumatology, which is as much a specialty within medicine as cardiology, neurology, endocrinology, and so on.
Until all teaching hospitals have within their department of medicine a department of clinical rheumatology, with opportunities for students to be taught something about the subject, rheumatology will remain a Cinderella. The opportunity to do something effective for the rheumatic sufferer today is greater than exists in many other disciplines within medicine and the number of patients ("clinical material") is great. Until general physicians refer patients to rheumatologists as routinely as they order radiography or 12-line biochemical analyses
