things, like my little son Jack losing a tooth, ... My insight was given support by a ... Boy meets girl, boy has sweaty feet, boy goes to doctor, boy gets girl; it's the ...
Views & reviews
Personal views Small is beautiful Liam Farrell
My home village, Rostrevor, lies between the Mourne Mountains and Carlingford Lough, but it’s not an uncomfortable perch, as if the mountains don’t like us and are slowly pushing us into the sea. We get on better than that with our native soil; the Mournes are protective, and Rostrevor nestles under their armpit as snugly as a wee mouse in a cornstack. This is not entirely fanciful; the Mournes deflect the worst snows and the sea breezes ameliorate the worst frosts, and during the Great Famine Rostrevor was
An axeman writes The reception at the opening of the BMJ ’s exhibition last week of photographs of 20th century British doctors was a delightful, unpompous, and amusing occasion. I got a great deal of fun out of wandering round and trying to imagine what I would have
With Head and Heart and Hand Nick Sinclair’s photographs of 20th century British doctors are at the National Portrait Gallery, St Martin’s Lane, London WC2E OHE, for several months. The accompanying book is available from the gallery or the BMJ Bookshop, price £14.95. Proceeds to Age Concern. Stephen Lock—former editor of the BMJ Julian Tudor Hart—former general practitioner, south Wales Douglas Black—former professor of medicine, Manchester Donald Acheson—former chief medical officer Anthony Grabham—former surgeon, Kettering Donald Irvine—president, General Medical Council George Godber—former chief medical officer
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untouched by typhoid fever, although the potato blight did hit us hard. A Canadian visitor was unimpressed. “Heck,” he said, “You call those little things mountains? The Rockies are ten times the size.” “Oh, like you built them yourself, did you?” I retorted, for I like the Mournes just the way they are; accessible and not too rugged, so that you can climb them without Sherpas, drop a bottle of stout in a mountain stream, and when just cool enough share it with the skylarks and the ravens before taking out a big cigar and sending smoke rings floating gracefully down the breeze, like Gandalf and Bilbo would have done. Bigness is not a virtue; there is a defining quality to small things, like a Seurat masterpiece, where omission of even one dot can lose an eye, a smile, even a mood, and irredeemably change the nature of the whole picture. My brother is working in Tanzania, and I keep a diary which I post to him every few months. It is full of irrelevant things, like my little son Jack losing a tooth, or the local football team being relegated, or which flowers are doing well—and nothing about major events like the peace process (or lack of it).
guessed their occupation to be, if I had not known they were doctors. Stephen Lock, wind blown and weather beaten on the coast at Aldeburgh, suggested the captain of a trawler who had just made a bumper catch, and Julian Tudor Hart a happy, easy going, member of the crew, without a political thought in his head. In a modern version of Dürer’s “Melancolia” Douglas Black (famous for his humour and dry wit) presented such a picture of gloom, that my father (a fellow Scot) would have said, as he did to me if I dared to sulk, “Wha stole your jilly piece, ma wee pet lamb?” Donald Acheson, probably a judge, wanted to know why. Why what? Anything, and don’t mess with me when you answer. John Horder, the kindest, wisest, and most gentle of men, resembled a headmaster for whom lateness at assembly, or a mistake in homework, was a beatable offence. No exceptions. Anthony Grabham, a collector perhaps, was wondering if it would be a bit naff to take his teapot to the next visit of the Antiques Roadshow. Donald Irvine, clearly an actor, with his out of doorsy, square jawed, decisive appearance and faraway look, had been hired, perhaps, as the antismoking lobby’s answer to Marlboro Man. George Godber was clearly an aristocrat, famous for his rose garden. With his wrinkled neck, flabby face, and pursed lips, Irvine Loudon was finally convinced that he was not and never had
My insight was given support by a geneticist who surveyed 6000 people to find the true sources of happiness. “Find the small things that give a little high.” he advised, “a good meal, working in the garden, time with friends. Sprinkle your life with them, and they will leave you happier than the grand achievement that lasts for only a while.” I could add; the rim of froth on your upper lip after a draught of Guinness; that first smoke after good sex; the coda to Beethoven’s Ninth Symphony. But small things can be a bugger, like the lad who complained of having sweaty feet. He wasn’t exaggerating, and the room was filled with an fruity odour, almost pleasant if its origin had been unknown. This was, he surmised, stopping him getting a girlfriend. But I probed deeper, and found he was a Garth Brooks fan, and so technically undateable, be his feet as fragrant as Mary Archer’s. So as well as medical advice I loaned him some James Brown tapes and when he returned both his sweaty feet and his social life had greatly improved. Boy meets girl, boy has sweaty feet, boy goes to doctor, boy gets girl; it’s the classic Irish love story.
Liam Farrell, general practitioner, Crossmaglen, County Armagh
been the spitting image of Gary Cooper; a bitter blow reinforced when a friend of his, Christopher Martyn, looked at the photograph and said to the man beside him: “That seems a familiar face, but I can’t decide whether it is an axeman or an intellectual.” There are five women doctors in the exhibition. Intelligence, kindness, understanding, and absolute integrity shines out of the portraits of every one of them. They look
Douglas Black
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Donald Irvine
like doctors, and the kind of doctors you would want to consult if you were ill or just anxious. Nick Sinclair, the photographer, does not, thank God, take flattering photographs, and it was comic to find how many subjects (or their spouses) were less than happy with their portraits. What a vain lot we are when presented with the reality of Burn’s “giftie”—“to see ourselves as others see us.” But Nick is a superb photographer, up there in the class of Ansel Adams and Dorothea Lange. The National Portrait Gallery shows many wonderful photographs, but few better then Nick’s. Never mind who they are, or if you know them. Go and see the exhibition—or buy the book, or both—and look at the portraits for what they are: wonderful examples of photography as fine art.
Irvine Loudon
Irvine Loudon, former general practitioner, Wantage
Medicine and the media Last week Dr Patrick Ngosa, a Zambian obstetrician and gynaecologist who had been working in British hospitals for the past six years, was struck off the medical register. The case has provoked huge press interest, initially because of the decision not to name the doctor involved. When the news first broke there were outraged headlines such as “Let’s name the diseased docs,” in the News of the World and “Fury over AIDS doc ‘cover-up’ ” in the Daily Mirror condemning the decision. Nicola Davies, QC for Dr Ngosa, accused the press of a “witch hunt.” She argued that the doctor was also a patient and deserved to have his medical condition kept confidential. In disgust the Sun retorted: “What right does this man have to privacy? The public has a right to know every fact about him.” Guidelines from the General Medical Council state clearly that in this situation Dr Ngosa did deserve the same right to confidentiality afforded to all patients, but only so long as he acted responsibly. When Dr Ngosa failed to act responsibly he immediately lost this right. Simon Barber, head of external relations at the GMC, believes that the council’s decision to hold an open hearing, therefore allowing Dr Ngosa’s identity to be made public, should have reassured the public that the proper procedures were in place for the medical profession to police itself. He was wrong—the media were not satisfied. Anne Robinson writing in the Sun two 910
ZEFA
Trust me—I’m a doctor
Negligible hazards?
days after the hearing said: “In truth there is not a single reason to suppose these days that doctors can be trusted any more than you can trust British Gas, double glazing salesmen, or the man in the pub.” Calling for the compulsory testing of all doctors at high risk, the News of the World said that “doctors from Third World countries, where AIDS is endemic, should face special screening.” This kind of simplistic argument ignores the fact that the risk of transmission is negligible, and that embarking on a huge testing campaign would cost millions of pounds. Added to which a negative test could become positive, and tests would need repeating every three months. The authorities told all those who were possibly at risk from Dr Ngosa. Many people believe that the wider population should also have a better understanding of the risks involved. The Daily Mail argued that “the most efficient way of reaching people is through newspaper publicity.” Critics claim that the popular press oversimplifies issues and is poorly
researched. Most journalists have to work within severe time and space constraints and must write entertaining stories that sell newspapers. Therefore sympathisers argue that they should not be expected to provide a comprehensive and detailed analysis of all the relevant aspects of a case. If that is accepted then perhaps the medical profession needs to take a more proactive role in informing the media and providing accurate information when a story first breaks. Perhaps this approach would reduce the kind of sensationalist reporting surrounding cases like Dr Ngosa’s. However we get our facts, we all have to make a judgment about the likelihood of getting an infection like HIV from a doctor. Our perception of any potential risk is determined by our personal experience of the hazard, our ability to control it, and how nasty its effects will be. Although we may have an opinion about the potential risk, we may not be able to decide what is regarded as safe. The BMA Guide to Living with Risk argues that a situation could be regarded as safe and the associated hazards negligible if reasonably informed and experienced people disregard the risk. The public is aware of the possibility that apparently objective scientific statements can be coloured by self interest. This case illustrates that the media are deeply suspicious of the medical profession, and despite many recent attempts to make doctors more accountable to the public, doctors are rapidly losing credibility as experts and arbiters of risk assessment (see p 847).
Naomi Craft, freelance journalist and general practitioner
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