Letters to the Editor
Local knowledge may be inaccurate, to do so-but reads oddly in a journal CONSULTING TIME
references are often inadequate, and of a learned profession, flanked as it
attendance at courses does not tell was by The New Sex Therapy and Sir,
selectors anything about ability. You Manual of Medical Therapeutics There is a current mood that general
cannot tell a man he is turned down (December Journal, p.761). practitioners should improve their
because you have heard on the One can commiserate with your standards. 'Self-audit' is the vogue.
grapevine that he is not clinically sound: reviewer's sense of hopeless impotence And the Ombudsman lurks in the
he would appeal against the decision, in the face of the big battalions, but background to consider the grievances
and rightly so. For this reason we there must be more appropriate places of a more critical and enlightened
supplement examining the clinical for him to parade his compassion. public.
records with the only objective yardstick Having read the review I am little wiser All this is very fine but may I make a
for measuring clinical ability in general about the quality of the book; on the plea for the obverse side of this new
practice that is available-the MRCGP other hand I feel I know a lot about his coin? The plea is for more time to
examination. All examinations have moral indignation. His language would interview and examine my patients.
their limitations, and of course the not have disgraced one of our more I have worked in general practice in
MRCGP is not perfect, but if Dr Oakley outspoken political broadsheets. Are we Canada and New Zealand. In both
has a better objective method of now to expect reviews couched in countries patients were given 15-minute
assessing clinical competence in general similarly intemperate terms apostro- appointments and there was a 'fee-for-
practice we will be glad to hear from phising Fascist hyenas and the running service' payment. This meant that the
him. dogs of British imperialism? more that you did to help your patient,
We have never claimed that passing Under 'your enlightened editorship an the more you were remunerated. The
the examination makes someone a impressively wide range of topics have reverse applies in general practice in the
better trainer: it is merely a basic step. been aired in the Journal's columns, for UK at present.
Of course we take into account all the we are a liberal as well as a learned Could not the College make a start by
other points Dr Oakley lists and we are profession; and you give your reviewers advocating extra fees for extra services
in full agreement with him that a great deal of latitude, as I have reason to our patients, such as ECG
character, experience, personality, and to know. But in this case, Sir, one can examination, long interviews, speculum
so on are of great importance. Nor are only wonder whether you took leave of examination, suturing of cuts and
we concerned in the slightest whether your editorial senses. If ever there was a removal of cysts, taking of swabs and
trainers belong to the College, or pay case for asserting the editorial mailed blood samples? This alone Would do a
their subscriptions, and we have no fist under the velvet glove, this was it. great deal to raise our standards.
intention of asking them. It would be interesting to have the
Teaching general practice is largely to J. S. NORELL views and suggestions of other general
do with clinical medicine. It is a great Dean of Studies practitioners, especially those who work
pity that in the necessary development Royal College of General Practitioners in busy practices and with fairly full
of training a number of doctors seem 14 Princes Gate lists.
threatened by any attempt to have their London SW7 1PU.
performance measured. Dr Oakley talks H. M. S. NOBLE
about an insult to colleagues in general The above letter refers to Dr J. Miles' Overton House
practice. We suggest the insult is to our review of The Light in the West and was 46 The Broadway
colleagues the trainees, in that we are shown to Dr Miles, who replies as Sheerness
not prepared to set our sights high follows: Kent ME12 1TR.
enough. In the final analysis, as Dr
Oakley says, each region or area must Sir,
make its own decisions. Prospective If the Soviet Union's invasion of AN INDEPENDENT
trainees can choose whether to apply to Hungary in 1956 was not tyrannical, DISCIPLINE
the Oxford region or to Kent. brutal, and ruthless, then these words
PHILIP HANDFIELD JONES have lost all meaning. The claws were Sir,
out all right: ask any Hungarian who I have read and re-read the first
Chairman paragraph of your editorial on
General Practice Sub-Committee survived this painful period-if you can
find one at liberty to speak. And as a "Clinical work in general practice"
JOHN HASLER matter of cold fact, my first (December Journal, p.707) and feel I
paragraph-to which such fierce ex- must stand up for general practice as an
Regional Organizerfor General independent discipline not only in mine
Practice Training ception was taken-was a digest from
the book. but my father's generations, if not
Old Radcliffe Observatory earlier still.
The Medical School I was aware when I wrote this that the
43 Woodstock Road views therein might make me unpopular My father was a general practitioner
in certain quarters, and this prospect in Kensington throughout my childhood
Oxford. but he later became specially interested
sent me into paroxysms of indifference.
As to Dr Norell's complaint that I in eyes (as James Mackenzie in hearts)
SUITABLE CASE FOR gave no clue to the book itself, I can and left general practice to practise as a
THE JOURNAL? only surmise that this despicable consultant in Wimpole Street, being at
paragraph engendered such indignation the same time on the honorary staff of
Sir, that he could read no further. I hope he the Western Ophthalmic Hospital. His
A book review containing in its very has since read the book and enjoyed it. brother was never in general practice
first sentence the words "claws", but, being on the honorary staff of two
"tyranny", "brutally'", "ruthless" JOHN MILES London hospitals, practised as a
(and these epithets were not even to do Meiklie House consultant in Harley Street. Their uncle
with the book itself) certainly makes the Glenurquhart was in general practice in Gloucester
reader sit up-perhaps it was intended Inverness. and was, I believe, treated as a con-
Journal of the Royal College of General Practitioners, March 1979 187
Letters to the Editor
sultant by fellow practitioners in the DISTRICT MANAGEMENT perhaps the College would consider
county; so perhaps in his generation it TEAMS piloting a study of the problems facing
was not "an independent discipline", members of district management teams,
but it most certainly was in my Sir, unless they would really prefer to leave
generation, and the one before, and I would like to disagree with Dr Mary such matters to the BMA?
when consultants at my teaching Chisham (June Journal, p.372) and
hospital said, as they often did, "most RICHARD MAXWELL
of you will go into general practice" defend Dr Evans (March Journal, General Practitioner Member
they meant that we would enter that p.181) who is, I believe, like myself, one Frenchay District Management Team
discipline-and, we might guess, they of the relatively few active general 267 Soundwell Road
rather hoped we should call them in practitioners who struggle, without any Kingswood
when we needed a surgeon's help or a specific training, to serve as clinical Bristol.
physician's opinion. members of district management teams.
When I began practice in Hampstead Some of us in this role have noted two LOOKING AFTER CHILDREN
in 1920 I was one of about 50 general disturbing trends: first, the increasing
practitioners in North West London difficulty clinicians have in maintaining Sir,
belonging to a medical society which an effective voice in ever more complex I read your editorial (September,
met in members' houses. How we management decisions, and secondly, Journal, p. 159) on "Looking after
should behave to our patients, to each the problems arising from using cost children" with interest. However, I
other, and to consultants was well effectiveness as the main criterion for would take issue with your assertion
understood and the society had a- distributing patient services. that general practitioners have "greater
rarely functioning-ethical committee Although I am not a member of the experience than all other doctors" on
to uphold these rules. Some of us were, College myself, I hope there would be the impact of problems at home where
some were not, members of the few College members who would try to children are concerned, and the article
National Health Insurance Service: all argue that increasing academic stan- on child psychiatry by Bailey and
were general practitioners. dards can be pursued realistically now- colleagues (October Journal, p.621)
The Collings Report (1950) described adays in politico-economic isolation. appears to support my view.
some sadly debased clinical practice and Why, for instance, is there so little As in the past, so it is today that that
the College was founded in the hope of evidence that doctors who have been neglected and often derided body of
raising standards. I hope it has suc- vocationally trained at great trouble and doctors, the clinical medical officers,
ceeded but good general practice is not expense are any better than those who deal with and have the greatest ex-
new, nor is general practice research, have undergone no training at all? perience in preventive medicine for
though the College has done much to Indeed, where is the evidence that children, their parents, and families
promote it. vocational training is cost effective? who have psychosocial and educational
Surely, sir, general practice has been I strongly believe that it becomes problems. It ill becomes a powerful
evolving as an independent discipline increasingly important for general College such as your own not to
for a century and more; what is new is practitioners to play an active part in acknowledge the debt general prac-
the organization of specialties. There academic, political, and organizational titioners and paediatricians owe to
were no paediatricians, geriatricians, or roles simultaneously. If we do not, our clinical medical officers for medical
psychiatricians when I was a boy! decisions will be taken from us by services to children.
administrators. I also belive that it is ELSIE MAY
LINDSEY W. BATTEN time that consideration was given to Specialist in Community Medicine
Retired General Practitioner providing incentives for general (Child Health)
practitioners to improve their ef- Alpha Tower
65 Oakfield Road ficiency. It should not be too hard to Suffolk Street
Selly Park devise some. Since I feel that there are Queensway
Birmingham 29. implications for all clinicians here, Birmingham B I I TP.
BOOK REVIEWS
THE MEDICAL ANNUAL the numerous growing points in operation and research are particularly
197819 medicine. The Annual bears the sub- noteworthy.
title The Year-book of Treatment but in Among points of particular interest to
Sir Ronald Badley Scott and fact it takes a broader view to embrace general practitioners is the reminder
Sir James Fraser (Eds) the management as well as treatment of that Campylobacter enteritis, Giardiasis
John Wright patients. All the sections are of high lamblia, or rotoviruses may be a cause
Bristol (1 978) standard and few general practitioners of diarrhoea, which is not a disease but
will fail to find something of interest. a symptom. The value of rubella and
378 pages. Price £11.00 Once again Professor J. D. E. Knox measles immunization is also discussed
contributes a perceptive chapter on and a review of two new drugs, labetalol
The publication of the 1978/9 edition of general practice. His comments upon and diflunisal, is included.
the Medical Annual is a reminder not routine blood pressure measurement The constant problem of cost ef-
only of the passage of time, but also of and the need for interdisciplinary co- fectiveness is drawn to our attention in
188 Journal of the Royal College of General Practitioners, March 1979