Press this and it will start to record and what, the twenty third debate.
Yes. And it's Professor John Natyam and Gracie Fitzherbert Jones and Peggy Fritz.
And we are putting Norm Gardens in Oxford. So I stick with my family is going to start it becomes a reality.
We will turn it off. We have got five questions that I noticed, like drastic about the growth of medical school,
the fact that they also medical school is currently very successful. One of the elements that the old timers DCX.
And then what about women in medicine? And then what makes a good doctor?
Oh, that's right. We may or may not have be warning about it, Benevento.
Absolutely. But over several decades, you saw the medical school at Oxford grow.
Yes. And we wondered if you could tell us something about the main drivers for this growth, because it started off very small and grew a huge debate.
Floristry from very, very small origins.
All right. Because I came to Oxford October of 1966.
I think I should do the checking. The total repeat for most of us then was about.
Thirty three years, not happiness. And I cast my mind back to when I left in 1954 to go to London with the concept with great respect.
Tried to stay. It was in my head. On the whole, you didn't come here.
I missed you. A bit of your youth married someone that want to stay in Oxford or frankly,
even if you could get into a London medical school that she wanted Gafoor ask about.
But this was very much not what you did and your future advanced.
You've got to do it. And I'd say it was interesting to me that when I came, it was still supposedly something is introduced.
But I think my first medical fir included Margaret Zeray.
Oh, but is seen with black. Just let me see if I could get them all but there full of Basil Shipstead.
They were tenanted, actually. And the housetop, pretty talented. Thank you.
Who was it that ran in the end? The pregnancy, hypertensive squishier presented here.
His bedroom was my house position took root yet and I was shaken up when I got here
that I thought perhaps I'd come to Sleepy or Augusta from that give our number.
And the absolute reverse was the case. I remember the first day I came on, take Brian Crouch, who's my senior raised.
Right. I said it's customary here to do a take around. The patients who come in.
Never heard of. Nothing like that ever happened. None consulted.
Never appeared to see people who had been hit and students were put on the more of an.
And after. We did it. He told me to take one.
Was it four? And could I please. He wanted particular advice or maybe would never think I'd been doing research for two years.
Capable, measured. I realised that I wasn't going to be advising people to advise on liver failure.
I remember saying that I'm in the boss and I'll be half an hour. Give me a little time to do some work for me.
So they won't consider where the New and the Great came and there were the grand rounds.
I suddenly realised when I arrived that when you went on the ground runs, they went to there.
Were you any good? So you were a target. So there you were, the new physician.
Your opinion was often employed by Tony Mitchell and George Pickering. And they weren't sure they would be your calibre within a month or two.
They all tell a joke. I think you would consider it.
Now, Concettina were Wednesday afternoons, I think, which was an hour of telling people about your research.
And they took place every week and they were dead. But I felt like this is an intellectual hothouse.
It was quite shaking, a little section of Western society. Why not?
In contrast it on totally a contrast to Lobban, which is a sleepy old place.
But coming back to the students was what you wanted to know was I could quite see why they ought to come and.
George Pickering I talk to you about before. I think he was the architect of it all.
I'm firmly of that view because he felt passionately about putting those clinical school on the map.
And the first thing he did, which is perhaps almost relevant to, was he looked at these new physicians and surgeons.
Six of us were having a dinner celebrating in a week's time of Malcolm Gough Smith, Robert Duffy criticising me and Derek Carr.
And we all arrived. And, of course, we were appointed for nine sessions by the NHS in two sessions.
We could do what we liked. And the assumption was that we'd do private practise and GWP took a shorter dinner and said, look,
I have a passion on this medical school that there should be no difference between NHS physicians and surgeons and the academic people.
Thanks. Began to civilities as is raising. And John.
No, thanks. And I'm wrong. I'll give you some more.
No, it be lovely. Thanks.
So Pickering was passionate about finding together the NHS staff and the university sophon that been a good deal of friction.
If you look at it before, which I'm sure you know, I know what he said to me and to all the others.
I don't want to this second half term. What he said was, look to John.
He said, you can do a private practise if you like, and I showed you a good witch, but I have an offer to make to you.
If you do not do private practise, I will offer you, Campbell, to research sessions.
I will make you a lecturer in medicine in the university.
Could you sing? I'd like to be. And I will give you laboratory space from five hundred pounds a year expenses to start researching.
And all six of us and all five of us give Robert Duffy was professional.
Any. All five of us had what was then called A plus B appointment.
So that's just an it didn't. It caused us to decided.
And Derek and I were impressed me until I think Derek was forever and the other two of us translated into investee anyway.
The surgeons, of course, with much more money to make. Oh, you dog much more quickly.
Yes. That's fascinating because it's always bringing together. I've been talking with John Chambers and Owsla.
Yeah. And that was a way of bringing together Flexner with the academic side of things.
And I was that with the ethical presence and the ability to.
Because if you had good people and ameliorate them, then they wouldn't want to say you, professor.
So that was it. And we did.
And we suddenly felt that it with a sort of sense of invigoration that we were there was Tony Mitchell is absolutely marvellous.
First assistant to Pickering.
And of course, Ralph Wright and various other people with whom and so on suddenly realised that this place actually could explode.
And we all thought we were in an exploding group. I think, in fact, we were.
And in terms of it and then get away, the reputation grew.
I think the influx of a young that it that sounds arrogant, includes me, didn't do something.
But again, Pickering started liaising with his old university, Cambridge, and started to say, well, why don't you come and jump in a bit?
This had ended when I was who studies first, but whenever it was, I used to go.
God, remember it every winter around Christmas.
I drove to Cambridge and drove back and dined with them and went to Cambridge University Medical Society.
Well, one or two London Deans. And here, Chalmers, you might know in Middlesex who was running Cambridge at that time, too.
In fact, the new Cambridge School. And tell me why they should come here.
And I did that for five years. I think they came in flats.
Of course, I can remember at the height of it all. When you could.
I'm sure I'm not wrong in saying that you could you turn down 50 percent of the people who wanted to come here.
You looked I mean, Cambridge flooded, really flooded.
Oxford, flooded London medical schools, Andrews, particularly in Scotland.
Those who had an integrated B or C could come.
And you sat in a settlement committee and suddenly realised that you were taking top class people and turning down one and two.
And you were one of them. I think it was a refugee Camp David.
What do you want of the anti refugees? I think became a flood, actually.
And he and I could remember the regions of Cambridge.
And Theo Chalmers is that Keith Peters and me are charming. You invited me here.
I say they were fed up with the black orthodoxy of the past, all their best graduates.
They're the only ones that stayed with them were the ones who couldn't get a visa.
That was that's actually true in. And so it was Pickering who put the kettle on.
It was Pickering who started it as Pickering who said, you got an opportunity.
And Pickering who said, I want to NHS consultant's to do research and teach as much as the university.
And I want the university to do as much teaching as pinnacle work.
And I don't want it to be I don't want this medical school quite different from anywhere else.
He achieved it in my view, and he was supported by Paul Beeston very much.
But I do think and people attribute attributes of victory to Richard.
I wouldn't. I think it's all it all happened before he came.
And what was the role of Nuffield spending faction? Because that was.
Must have been an extraordinary moment when Nuffield puts a lot of money in to people, in particular the professors.
You mean the nineteenth? Was it forty six or Newton that are the creation of.
That's something I don't know terribly much about. I'm an idiot. I know the legends and I'm sure you do.
No you didn't. Professor of Anaesthetics. Then we, we had the gas man and all.
And yes, there's a there's a big history which I'm sure you can get hold of of of the
argument the university had it didn't want to it didn't want a clinical score.
And as it ran it itself, it didn't want any NHS input.
And if it if if we're going to have a university medical school within all the appointees must be university.
We can't have fifty x ray people from the NHS. Lots of arrogance from preclinical logic because they were very arrogant.
I'm diverging a little bit because that's I mean, it seems to me the argument once it had taken off, people started flooding in.
I mean, if I suppose the Advent Wetherall course made a huge difference in 1974 when Peter
Morris a year later and put some dents because everybody wanted to come here,
then I don't think David Weatherill would have come here as it was two years before.
And I'm sure he wouldn't even ask him, but I think he wouldn't.
So, you know, it's some it then took off and of course, because one had this extraordinary group of students.
I mean, if you want, it goes I think when I was DCX, it was 50 a year.
Thus ensuring that medical school remains small. Because the one thing that we all saw wasn't Pickering.
So what if this place is good to survive as something really unique?
It's got to stay small. It has to be a personal relationship between the teachers and the students.
That has to be a tutorial systems and this and once it got bigger, it wasn't.
And it had lost. It had lost. And details that were written by John Potter.
Yes. All right. You're agreeing with what I'm saying.
Yes. To my second point, which is that the Oxford Medical School, as you know, is currently ranked first in the U.K.,
both in terms of its research income as a bio sciences unit and also more directly by its students graduates.
They have a questionnaire. The key elements in its success, as you mentioned, this is, in your view, its size.
And I would agree with that, of course. What do you think of the other key elements? Is it.
I suppose this is this process of having very good people who also have a mixture of self generation X and yourself generate.
If you get people will look at them.
You look at the Adrian Hills and the John Mills. Well, I can't list of all, but just wherever you go.
Yes. You'll find that Oxford graduates from this clinical school were populating the rest of the university and read the rest of the country.
Students and going on onto the president's world class. I mean, if you look at it, I haven't got chapter and verse.
I mean, there's almost nobody who left. I didn't go with distinction and make their mark outside.
Once that happens, because that's where people want to go.
Usually when I feel passionately diverging a bit about the need to support in the House and the and all the other stuff that goes on,
that I hope passionately that the university might be turning to make a mistake,
putting all its eggs in the research basket because it's got a lot of eggs is research.
Bacik is huge and well-respected. But I sort of had a sort of feeling that it might be at the expense of the teaching just beginning to be.
And this would be a great mistake because New Zealand phrase, your clinical students are the seed corn of of of the people to come.
Therefore, you want the best students in the country.
If you don't have the best students in the country, you will ultimately have the best clinical school.
And I have an example for that. If you look back in the 1930s, there were three or four fellows of the Royal Society at University College London,
and you was on the place that people went to intellectually and frankly, what do they call it?
By about the 1970s? It was a dump. It had no intellectual.
They did is professor of medicine was a disaster area. It's got productivity was no good.
It started I don't know, it just went on to call it Manchester United when the football championships.
Bloody difficult to stay there. Yeah. And also, maybe no one is going to have to struggle hard to stay there.
Absolutely. I suppose also say UCL being a large I don't know how it is comparatively without other London medical schools in terms of size,
but all along as well, I should say big. I'm not no one person can.
No, I'm not in any way. And frankly, I think it's too big here.
But I'm glad to say so. I said yes.
Other key elements in the success say that would be the key people coming.
The people interchange between Oxford, Cambridge, which you've mentioned, and the way I tell you what,
I think the essential thing was something very different, perhaps not in London.
When I came here,
I found it very refreshing that any student was allowed to have an opinion equal to my own that do worship of the consultant was absolutely absent.
It was then in London. You didn't argue with the boss, even if you knew you'd be.
He was hopeless. You didn't know here from the first moment.
Consultants, I think, did treat students as their intellectual equals and wanted their opinion and gave it.
I mean, that sort of thing that I would do and I'm sure others did with somebody asked me,
I didn't something I didn't know I wouldn't bluff a way out of it, which might have happened.
You'd say to the student, well, that's a damned if I can question.
I have no idea what the answer is, but perhaps you could look it up and tell me when we next make it.
In other words, the students were treated as as part of the team looking after the patient and whose opinion was equal.
And you ended with the boss because.
So what, you were the boss and you and what your way, provided you have persuaded your team that this was the right thing to do.
That was very refreshing. I mean, it may be cover pleasure, but then if it is, I think the idea that that seniors earn the respect of the students,
particularly if the students are particularly high calibre. Probably still is something that's particularly prominent at Oxford.
I count how prominent it is at Cambridge because I've never done thing where I don't have it.
That's very interesting that the whole thing was a team effort.
It must have been quite a strain to keep together the top clinical practise and also to move forwards in research area and to have research students.
So is how did you juggle that one? Because that's quite a difficult.
I mean, how do one keep up with clinical medicine? Well, I yes, I think that this is actually slightly diverting self a different subject, but.
If you if you wish to be a consultant, physician or surgeon in a teaching hospital in the U.K., in my time, you had to have a research record.
You had to have a track record of publication. You had to show some.
Some activity in the research field, and though I think many of us were not ready but suited to that.
And I remember as a young chap wondering there was so much to learn in clinical medicine and applied.
What did I really want to do? It's spend two years in the lab doing work that I really wasn't as good as as as people who primarily did it.
And I thought you ought to do research if you wanted or were interested in it rather than the compulsory thing.
And all of our time you had before you got here to do your BDA, been to America.
If you had not been to America, the state of the English medical schools research, you couldn't do any research.
I mean, I couldn't do anything that he use Middlesex, even the John Novara.
So I went and spent a year at Columbia. We've done our own research in Reading and Angiotensin and hypotension.
I don't regret it. It was good. But I sometimes look back and think, well, I could have spent those two years being a bit of a day to day physician.
And would I have been any less good at teaching students? I simply don't know.
But the gospel of the Great Professors, Pickering particularly,
was that there was a thing called the Medical Research Society, which did exist century when I was ultimately chairman of it.
But it made every month, I think, in London where the young gave a paper for ten minutes.
Papers should be spoken and not read in the front row of the audience for all the professors of medicine in the U.K. looking out for.
I'll have him. So it was a cattle market. Is Egypt a fishing trip?
Well, you when you went there and hoped that you know how you could if you went out and enjoyed your paper, my boy.
I want. What are you thinking of going. Want to go. And.
And that was it. So we all had my generation.
I mean, if you look at a slight well, you'll find out when you're talking. We had all come back to the United States.
In fact, I got appointed here when I was still in New York and then came back six months after the others had finished.
And no sooner I've been, as I say, oh, your interesting work in New York to talk about it on the Concilio.
And then you've got no plus B in your lab. Suddenly you've got people wanting to you were driven piggy by the.
By the people who wanted to do deals with you. My first was Perry Leary, who later became professor of medicine in South Africa.
My second was Martin Gregory. Whose story is it? It was David Warren.
There was Gwinn Thomas in it. And suddenly you had always two or three DeSales students attached to you.
And they were very bright.
Say I'm the first in the first century that if my published work, a lot of the engineers, a lot of the technical talent came from the chapel.
I suppose it is. If you look at Peter Radcliffe now, if our Essene professor, he was in that group,
I had a wonderful time when I had he and Jonathan Turley reign as a career.
And when you look at them, as you can see, well, it was a powerhouse and you could say, well, how did I keep up?
I don't know. And I know they were all but equal. But Peter Radcliffe started.
With me, for instance, saying what I do. I've gone to a Cambridge and the.
I'd like it to be Renald vaguely, and I'd got interested in that kind of I said Peter Hamby thought, why God put a little cohesion on the kidney.
Well, like I said, national, you know, there are ways of looking at oxygen levels in the kidney and the different.
We get interested in that well within a year. He left me well behind and was going into the molecular biology of ocean.
Sensing in general is now a world authority on it. But he did start with that.
Mr. Very often. My job was to simply what of the question?
Light the blue touch paper and then then the talent of the other subset.
And I did not do that again. Did you did also have to look after them?
In a sense, I would imagine. Oh, that's it. That you had to have that sort of getting them stale.
Yes. Well, they all felt they weren't adequate.
Well, Dr. Peter, particularly you wanted to apply for a job in geriatric mentioned in Chelmsford Wednesday,
which leads me onto your times as director of clinical studies. You did.
You decided to start institute. I read No. Two loops above.
And they were very influential because I think that you took this idea.
There's this this this passion of yours for being individually known to students.
Yes. And you built that even maybe to that to the clinical school.
But what are your key memories at those times as directly paid for?
That is what what is it what are the things that will stay in your mind? Well, and I knew when it was in the womb.
And I suppose you have to say what is director of Cadenzas Studies, therefore?
And people would have different views. My feeling very much about it was to to try to get the best clinical students you could,
but mostly to be there to represent them against the university, if you like.
Oh, yes. Now there are directors of clinical studies who are disciplinarians or who are people
who will select the curriculum or want to see the student who failed to turn up.
That's something I never took that I had to do that bit on the whole in a way that was far too benign,
I'm afraid, and let murder take place occasionally.
But but on the whole, I regarded myself as this in the position of the students trend in both times.
I did it and I don't regret that. And I don't know. Compared with the other people who've done it, whether whether it was the same or different,
how their property took it a little bit to an extent, I certainly felt that I wanted to know them all.
And as you probably know, I mean,
I used to get into the medical school at about a quarter to eight and and have a cup of coffee and between eight and nine.
Any student could drop in. But of course, between October and Christmas, I managed to see them all and kept in touch.
Course, maybe people will call this dinner unnecessary, but I.
Because with the school's small school, it was very good. But the other thing was, was to find out what was happening to them.
And on that aspect of being D.c.'s that I remember being influential in, if I dare I say it, is that people would come to me saying, where do I go?
What career am I going to take? Which medical school am I going to?
What's going to be my what's going to be my aim and object?
And that I found very interesting. But I said I then built up an enormous he Azel with people all over the country.
I had only to tell Georgia about it in Newcastle that I had a student who
better take him on the house and did the same for the golden the golden root.
That left us with the top students. I would simply ring up the Brompton ICU at St.
Thomas is the renal unit at guys. People really want to get their feet wet in in in clinical medicine.
Stoke-On-Trent, believe it or not, clinical school would form. We want to.
So Newcastle and various other schools.
But those were the main ones in which I simply got on the telephone and rang up and said, well, your next your next house physician is X.
And they were. Yes. Such was that. Such was the calibre of the people we sent them.
They didn't even bother. I didn't bother with interviewing or query none.
They said, well, great. And for many years, students went through the branch and two guys who Thomases.
And and it was a steady stream of them. You'll find if you look at the distinguished ones now, you find that subtract.
They took the Senate. But that was a personal thing. Yes, I was cut now and I was able to ring people up and say, I've got somebody exceptional here.
You also had, of course, the ones who would are going to be in difficulty.
I can remember the girl committed suicide. I won't name her, but and others who weren't getting through who you had to somehow got into other things.
So I never got bothered what was in the curriculum.
There's an illustration of what the D.c.'s could do to my tribe and how I saw the job to be it.
And that sort of creativity on behalf of the students is giving them permission to do those like evil off,
off, off the wall, things that it doesn't have to do.
Another example, it doesn't matter. They had a chat with a young musician of the year and he wanted to go from his French horn.
Yeah. And he made a deal that he would come back and finish the clinical course, even if he decided that he would become a professional player.
And he came back saying, I've had a wonderful year, but I'm going to be a doctor. I'm not.
Well, that's right. And I wonder how many universities, how many middle schools or even an Oxford now.
Well, that would happen. You can tell me.
But just one other example was Emily Harris, MP, Evan Harris MP arrived and said that could take three months of thought,
not to general practise at all because he wanted to stand as a liberal concert, the city of Oxford.
He had political future. And he was only doing mentioned with a view to qualifying, knowing something about it,
that joining the Liberal Party and at last having somebody in the House of Commons who knew something about mentioned.
I gave him three months. Well, yes.
And so fighting the corner of of the students with the university in terms of funding froze the House into.
I know, but there was that there was the bird club.
Yes, there was the time that the Bird Club joined and the university said, by all means come because there were no bloody good.
And gradually, John Bell and other people found them to be good. And suddenly, as they were coming head of the river before he knew where it was.
And then there was a meeting that our UBC went head to boat to all the colleges and Oxford and announced it as the house was unfair.
It would be syndicated from a well because it got all sorts of places in them, all of them.
And things said they must be thrown off the river. They had to fight that one went over to Vincent's and talked to people.
And we won that one to do with Tom CANDU.
Hudson was extremely helpful in that matter. Absolutely.
You know, if you read. Yes. Yes.
So there were no that was one thought and then my first era these years, most of which I think were valid.
So that's another illustration that I saw.
The DEA says the bloke who who made sure that this that this was a place that people wanted to dump to be students, you know.
Excellent. So tell us your views on women in medicine.
You were always. I remember in my time there were either two Indian housemen, one of whom always, always was a woman.
And then for Indian housemen, the reason we were women was one time the entire junior staff on the Indian women.
Beatrice Sommer's was the senior registrar there on the beach.
She was in Cambridge. Yes. Well, she went. Yes. I mean, we had a time when it was really quite a joke.
But I don't think it had anything to do with anything other than talent, actually.
You may have said that whether all letting him have a soft dye for the girls. So this must be true.
Do you think they were good doctors do? I do.
I mean, I think going right back, Peggy, and you'll notice that when you're picking medical students at new college at the age of 18,
the young woman with a bit of Polish and a bit of charm and the pimply, acne ridden, almost unable to speak, shy, try tarring chap.
What did you do? I mean, you used to say to a beat, it said, look,
we're going to have to give the chaps 50 percent more and the girls happy percent and it would never elect another man.
So I don't know. I mean, it's done. My view about women in medicine starts, of course, with that.
My mother was a physician. My wife is a physician, my daughter's physician.
So I have no prejudice against women in medicine to them.
But I think if you look at the day they are girls at school should do attend lessons and work champs,
go and play rugby and and come to their come to their peak later.
Yes. If so, I'm not surprised that the girls get on it and they shine and everything else.
People ask me why they aren't all not any medicine, why they aren't on governing bodies of city companies,
why they aren't all in politics where they aren't. Or Professor of medicine. Am I also this is twofold.
I think one is I think they do peak earlier than men and the men really don't get down to it, too.
We have to do a bit later. But I think the other thing is the same old story of what a woman wants to do.
Yes. And you remember Peggy being one of the things so much when he was saying, well,
I'm coming back to being DC s now because it's somewhere about March of each year, students would come in saying, what am I going to do?
Which has structure at Blackall and what sort of medicine do I want to do?
And it's simple sort of a characterisation, but a surprising number of people who had a double first at Cambridge and a little of this,
every other president of the union female who would come and say the following to me.
They'd say I was I was bright at school in Science City, pushed me to science.
And then there's a initial private side. You better do medicine. And when I was found to be really quite good at that, they said, well,
if you really want to do medicine the top place, you go to Cambridge and the preclinical school.
And then they told me at Cambridge that if I was ready, very bright, the right place to do clinical mentioned was Oxford.
And here I am. You can think of all the people I'm talking about. And I loved it.
It's a hobby. It's something I'm used to. But actually, I want to marry and have children.
And I do not wish to be a professor of medicine at Hammersmith.
I know I could be, but I want to be. And can you advise me? I remember my own daughter saying, shall I do haematology or rheumatology?
Because it seemed to be the ones that I am least likely to be born out of bed at night when I can about you and people.
I mean the concept that women actually want to run things.
Yes, there are odd ones that Sheila showed up, for God's sake, get.
Yeah. So it's a particular sort of so I might wish that there is a small proportion who really want to be a Margaret Thatcher.
But the vast majority that they want to do a good job, they look them broadly educated.
They're fascinated by medicine as an intellectual pursuit. But they're not ambitious to have a better department than somebody else.
The show is today the rose, and that debt is very obvious.
Two sessions that it made, maybe 10 years is. And the mother who.
Did medicine between diet consultant between 1929 and 1947 without any payment at all?
You did. I mean, before the days of the health service,
you were known we didn't say mom did five five sessions a week at the world free at five sessions
a week looking after children and no money at all that I would put up with that as a background.
And I still think it's true. I think people who try to push it any other way are pushing against a motor
that won't move and maybe making women guilty if they're guessing to do that.
Oh, absolutely. Yeah.
Yeah, I you know, I only I went to that come to the same point of view as well, that it may be that women don't choose to go into those roles.
And I think they will be given increasingly superhuman that some of those.
I think we're asking too much of people who lead huge enterprises.
Medical research. I think your point that the ones who who don't want to push it start feeling guilty.
It's also true that. But also, passengers are terror by having a wife who isn't mentioned in my time.
The concept, when do medicos married?
The wife had an equal career. It wasn't to be thought of.
I mean, Elaine and I got married when she didn't SAHM and said Crick's want to be an obstetrician within a year.
We got a child and she was doing part time general practise with Jillian.
Slight. I meant what Jillian did.
I think it was sort of my keeping even, you know, pregnancy advisory service or law school or medical office or something when you could look.
Did Hockaday, on the other hand, did pursue a career. But got held back?
I mean,
one of the cities at Oxford had was to find that there were wives who could be made use of and one get to leave because their husband for them.
So they didn't promote them and didn't give them the recognition they needed.
So that said, what did he want to say? Ask about women in general.
I think God, women and men to know their. I think they are.
I don't know whether they do provide more.
I mean, my chief worry about medicine now is my shorthand and what I think the NHS does, which is they treat disease, not people.
That is my shorthand. Yes. And I believe people should be taught.
And I think women are more likely to treat people who are less fascinated by the Meccano set of their
latest gadgets that we have of the women who are still wanting to sit the other side of a patient.
And it is, I think, well, who still value that as an element in the profession.
Yes, I have. That brings me on to my last question, which is that you have a long career as a distinguished clinician.
So what do you think makes a good doctor? Well, I think it's very difficult.
There are lots of things you can write down. A good doctor has to have had a very, very, very broad and intense experience, which he no longer has.
I believe that the code to which we grew up was into many people's minds at this dreadful era.
But by the time I was consultant, I had seen almost anything it was possible to see.
And I would see some difficulty and I'd say, I've seen that before with something else.
I can remember that case that I saw with. I turned him on.
I remember that case that I saw with Dick Bayliss, know where it was.
And so there nothing that primary need is real deep in depth, out of bed at night.
Follow it right through this clinical experience. That he's a cynic known and the current business of working hours.
And this is, I think, nothing short of a disaster, in my view.
It comes piecemeal rather than joined up. Well, yeah, you can't.
It's the piece that that's one aspect. Peggy, the other is the total lack of experience.
If. If, if. When I was on the House and Middlesex, I had six hours out of the hospital in the first year, there was a barber in the hospital.
There was a bank in the hospital. If your patient was ill, they might have been up three nights in the way it was you who got cold again.
Now, people say that was dangerous and you killed them. I don't believe we did, actually.
But there's nothing you learnt doing it that way.
You learn not only clinical medicine, the outcome and recognition of things,
but you also learn how to talk to people and how to be personal with people.
All this rubbish, the way he put it to of communication skills, you do that.
It will need that. You learnt it the hard way by sitting and communicating endlessly.
I have a vivid recollection of my first sales job, a 26 year old girl with lactating cosson and with a breast.
It was going to go like a forest for her and be did. She wasn't sent home.
She wasn't sent to save our house. She remained was the responsibility of the team to look after it to their dying day.
And I would go and spend half or three quarters of an hour with her every morning and every evening.
Now, what did I learn about how to handle people who were dying?
Much better than having an actor. A list of things, how you hold hands and how you make eye contact, all that rubbish.
I mean, put it that way. I feel actually passionate about this.
You can't put the clock back.
But I think what made great commissions, the first thing you need is experience and personal responsibility and not handing it over to somebody else.
And spending every hour of the day seeing people.
But even when you do that, there were some people who had what I think is a clinical gift of what it is.
There was an obituary of a chap the other day who had this. Some people just have an instinct.
Of course, in my time,
you had to make decisions on totally inadequate evidence a lot of the time these days with MRI scanners and C.T. scanners and doohickeys of diagnosis.
The technical skills, of course, are disappearing and probably unnecessary.
But some people had I don't know what it what it was a kind of feeling of which way to jump it.
Like a musician with musical ability. Yes.
And you could find other people who I can think of my kid, many of my contemporaries who read the journals and knew every bit of research.
And we're not top class conditions, they hadn't they hadn't got this ability to act.
They would have perhaps Piggy, who shall we? I can never take a case.
A girl comes in with a big pulmonary embolism. Should she have a pulmonary embolism to me or should you hold tight?
She might be killed by the bambrick to me. She might die.
The good condition somehow instinctively makes the right decision.
The chap or lady who knows just as much medicine or more haber's doesn't make a decision.
We know of colleagues who were indecisive at the bedside.
You can't be pleased you couldn't be there. It might be something to do with this strategy.
Knowing what worst case scenario is, how it might pan through in terms of experience, either entirely just funny instinct.
And I don't know where that comes from. There are people who could build on conditions.
I can't tell you what that is. But the other thing I think, though, that makes a great condition.
I'm telling you that the future is awful because it doesn't. All the things I liked don't exist anymore.
When I was ascending the medical thing, you didn't decide you wanted to pursue a career in cardiology or something else.
What you did was. You worked for X, you worked for a man with a reputation and a charisma and his special, you may be different from one.
By the time you're qualified. I mean, I spent so it would be said much about me, but I'm not alone in my era.
I got emotionally entranced by my second house job in neurology with Michael Kremer.
Valentine. Hello. The son of The King's Speech. Logue.
Yes. And. You know, these people inspired me, so I ended up doing two years in Iraq, McCain, and then I got to see.
An adviser, he as well. Well, before you go to Queen's Square as a house officer, you better do a bit more, general.
So you end up as a registrar to don there. Our own topic is endocrinology, metabolic diseases.
He says, John Nephrologist, he offered people you better than to do it. Remote object.
And then I've just done my dick a bit research with him,
and I find the senior registrar with the various queen's position, the X D of Hammersmith is available.
He's clearly in the best condition under my bed. Got went for him.
So that if I was any good physical medicine, I base it on being followed in the footsteps of Michael Cremer, John Novarro and Dick Bennett.
To that sort of role model. Take all away, actually, real role [INAUDIBLE] doesn't exist anymore.
You don't have farms. And I think Rosie was essential because you learn from them how to behave, how to think, how food by osmosis.
And again, the musical analogy that if you haven't if you're if you're with somebody who has the ability,
but also the technique, I think you if you have innate ability, then you learn that, as it were,
the technique of how a very broad range, not just the technical things, but also the people, things like that,
you you pick those up and unbuild on them, whereas without them, you have to build the whole thing yourself from scratch.
And I suppose that students do rotate too much more quickly now.
So they don't and they don't get the ability to work with a particular person.
So I know they're allocated much more than that, I suppose. Well, I think it is inevitable, but an ending.
The cop turned the cop magnet, Nancy, off.
So what I'm saying also, of course, you have to learn what not to do from people whose behaviour as your chief you don't like.
And there is an illustration that the great athlete as the Evan Bedford Library in the commission positions,
great cardiologist, was on his firm as a medical student.
And we used to when he'd done a walk round, the student had to go round and prepare the weeping patients who he'd handled that badly.
And I could recall when you went to Bedfords Outpatient Clinic, the new patient to come in, he didn't make eye contact, didn't look up.
He was cute to write the letters and he would say rather Russia. Well, what brought you here then?
Or something go in that room and get undressed.
Come back, cheque. Come back. On occasion, they had the temerity to say, go to Bedford.
Can you tell me if there's anything wrong? And he had two answers.
One is a busy man. All right. Your doctor. The other was you wasted my time or suffering from your particular health.
And I sort of as a clinical student, I thought at least I have not had. I mean, that was an extreme.
How not to behave. But there were people who treated patients abominably.
And you're right from that, too, I think. And if those you worked with, would you single out one or two who were particularly inspirational?
The Michael Cremer, funnily enough, then you would have lost his job.
Yes. My Premal. He had an ability.
Oh, of course. He's a marvellous condition. And knowledgeable. He tell you why you would want to work with him?
N.K. decided that his house physician was the person around whom.
But he revolved his registrars and his senior registrars and research fellows.
On what grounds remain quiet? Yes.
He asked my opinion. He said, well, now the his thing. Just tell us about this patient and tell us what you think.
And I could remember Patty Fullerton. You wouldn't know. Patty became professor of neurology and later might be good office to grab your attention.
And Patty went to a make or two. And I overlapped with her with Grima.
She was his house physician first. And she made an absolute pig's ear of telling what the physical signs were of a patient.
She had either forgotten or she'd been unable appropriately. I postnatal.
Kremer then initiated the physical signs that she said were there by cooking them.
And then it's like a Tea Party. Never do that to me again. Well, if you work for a condition like that, it will also force.
Well, here I can remember and legends about my Klima.
There was an BBC Radio three chat with Avenal was GSF and Funny or Orangy, and nobody could come and he'd look back and she said,
John, at four o'clock, Sir Francis Walsh, abuse age is going to come and see this patient to give his opinion.
And at six o'clock, Sir Charles Simons is going to come and we should be both at both attendance and
then ring me up and tell me which is the better neurologist not to do what for,
man? That is you. And you watch him clinical skills.
You watch him handling people and ethnic gore, this practise of hysterical illness, people with hysterical and word headache, hysterical.
I can't move my limbs. I've got a problem. I'm dizzy, Doctor.
I know. And he. I can't go into any.
But he actually handle these people in a way that I read.
I said is a dimension of medicine. So be far beyond science that there is a strategy for managing that just as much as managing pain.
Yeah, but I put this Sydney in the Gazette, but I medicine.
But my father, who was an Aberdonian. Medical graduate saying to me when I went to university, he said,
you you're going to be another these people who get all the work done by somebody else and travel
around the world giving papers on what your unions have done and not getting up at night.
They are losing. I wish you hadn't done it, my boy.
But when you reach my age, which is 70 plus, he said, you will realise that to have found a new disease found a new gene for something.
A. Even discovered the structure of DNA didn't say that or have made a diagnosis jeopardies, Mr.
Vanity, all is vanity. When you reach my age, you will realise that if you go and see a patient who is either undiagnosed or untreatable.
And sit with them for half an hour. Get back there better. That's for my mind.
What venture about? It still is for me. And I regret that it's I think gone probably will be interesting to reflect on that.
I mean, it hasn't been on this weather to date in it better than anybody.
We've always said that Silwad. Mm hmm.
But there are others I can think of a word. Thank you.
It's great that there is a micro sense. Easy and my like to act now.
And I've got to tell you on spring break, it's it's a it's a pretty personal philosophy,
but that's all part and parcel, I think, of the home for all the guests over a very long period of time.
I think it all. I think it all streams. It all rubs yourself. Yes.
Have you gotten this memorable patient? Oh, absolutely.
Yes. Do I know you may see what it was. It was a mutt Mesmer.
With high fever, rapid pulse rate, intractable diarrhoea.
A tremor. And video. And here's what I think about medicine is as it was, and they couldn't sorted out who she was.
She was thought to have some metabolic disturbance. Sarcosuchus just came up.
It wasn't right. And there was a strange condition in which you some mitochondrial disease or something or another.
Anyway, we went to the small print and nobody knew and she put it out her ear and eventually
it got to his old friend at Hammersmith and sent the lady over to Hammersmith,
where by chance they did him. I don't know why they did a better balance, but they did give what she made and what came out.
I found a lot of magnesium in her stool and she did come back and the ward sister found that her bath salts rose
something or other bath salts continued sodium magnesium sulphate with which she had been poisoning herself.
I can think of those sorts of patients. Never mind that the patient of Sheila Canada that I shared with her here,
who had an anaemia, persistent depression, positive alchol, blood's in the stool.
Never did do it until she stopped being a good condition, devised a method putting into a sideboard and finding it with a syringe and needle.
She could take out having 50 vials of blood and swallow it.
These are often these are sort of cases that live in my mind because they are beyond see.
He's getting an MRI and molecular biology. They are actually letting deciding what?
What people do, and I think in some way this is sort of genetic.
I'm being very you know, when I look at the silver plate that my mother was given on Rapscallion for the World Free.
It has some words which I wish they'd written about me, which was to a great teacher of medicine and a teacher of the ways of human beings.
So I did. Of course, there are other uses in Moscow. What Susie's saying, oh, she's in the bath salts.
I've heard that before. Well, no, you weren't. I think she probably unique.
Yeah. But selfies on people, people who who who were epileptic, you would say another one.
Do I remember that they all the ones I read or remember are in this category with the girl that came in when I was a registrar.
Middlesex. Who announced that she had a very severe headache?
The tape of the last week, she couldn't see things to the right, to the left, and that she suddenly become terribly thirsty.
And gave a chemical history. Of course, a pituitary tumour of some size and grey.
And so you ring the boss and say, I've got her. And he says, you better do a caracara garrotted.
And she goes, Oh, you did then. And then the radiologist said, this woman's got holes in her head from previous neurology at that moment.
Kreamer brings me back and says, John, I've been thinking I know it's 3:00 in the morning.
Has she got red hair and is she around? I said, yes. She said, we have heard the National Assembly last week.
She's a classical Munchhausen and she likes having garrotted edges.
And I remember going to see her and say, well, we were in Queen's Square last week with Dr. Kreamer.
Funny. Oh, Doctor. She said, I'll go.
Say these have vivid memory or something together with that sort of great triumphs of first drops from done in this country in Oxford,
which is all it was unwell. It was me and Tom Patterson and Joe Smith.
Yeah. Yeah. I do. Yeah, but you see, that reflects that I'm not caring about terribly clever science.
It's human nature. I I'm a little bit leading to a conundrum.
I think that detective story side of medicine is Cassity. When a detective story about Baylis and I'm getting off now.
But when I had to write Bates's victory, I had to look into him.
I thought for what made him a great clinician. And he was in India.
In the war, there's an outbreak of diarrhoea and vomiting off of infective nature that nobody could track down.
And he, Captain Baylis, was sent out to do this by the brigadier.
And he observed after a little bit that it didn't affect the how the ranks or the Sarge Smiths.
It was confined to the officer. And it was confined to the end, to the nursing officer's mess.
And then what else? And they'd be a good tradition, went round and asked them what they had to drink before dinner.
And some are happier. Some had escaped. And some had to.
Gin, gin and tonic. And they found that the gin and tonic ones were the ones.
Then find out whether gin and tonic was made.
Later, Lake in India found that only a picture of the gin and tonic factory was a source of water in which of a couple of dead cats.
That's clinical medicine, man.
They wanted to test as I studied medicine and so on.
And when do you decide to study medicine? Really?
I fought very hard against it as men found having not only two parents, father and mother in medicine,
but an uncle, an obstetrician, another uncle in general practise, and a great aunt who had been a midwife.
On the other hand, my mother's family were distinguished journalistic family.
Her father be in Egypt, The Observer, her step brother was deputy editor of the Times.
My two aunts had been up, but somebody were reading English one and both.
One was the literary editor of The Observer and the other the other the literary editor of The Telegraph.
So I was surrounded by people and I thought, I want to be and I want to edit dimentia to God.
And I thought, hmm, I find no talent actually in imagination or writing.
So I don't know. I decided within the Army in Hong Kong that I want to do medicine because suddenly the decision was there.
You can have to do something with your life. And did I really want to do Latin?
Greek? The rest of it an indefinite schoolmaster to say in Paris.
And I thought probably I didn't learn very much. My second string from medicine would have been teaching holiday.
Yeah. Yeah, no question.
So then I decided in the Army and I'm living in a tent in Hong Kong with a little to do because the Chinese were not coming over the borders.
He thought they would. I remember buying. Grove, a news biology steads, electricity and magnetism.
And reading these textbooks and attend land on the census.
Then arrived at Oxford. I had to do prelims in the first year.
I went to a cram school behind Victoria Station for a bit.
And did that attitude botany and then all sorts of zombies for you as an undergraduate at New College, not three, and didn't qualify for this.
And you do your cooking for the Middlesex Anderson.
Yes. Yes. I didn't consider it if I went to the middle states, which actually was great.
Very strong, surgically offset the military. But, you know, I, I remember doing final in schools here, going back to Oxford.
I actually had enough of this sort of, dare I say it, intellectual arrogance of the preety,
the professors of the era when, you know, slightly felt to.
They slightly felt that you.
When selling us intellectual sailed on the river of information, you rarely were any respectable with few remaining physiology.
And I guess what? I don't want to hear anything more about symmetry conduction or the squid axon.
I wish to see the sick. Yeah. So at once arrival, little Middlesex and I had a medical firm that quite extraordinary was still alive.
Had dinner with them. There were three of us from Oxford in a total of two from Cambridge, three from Oxford and one from London.
Our first medical firm. And of the three.
I am one that Jeffrey Redden became professor of endocrinology at Middlesex.
And Ross McCarty, professor of medicine at Edinburgh.
Christian was who payment paediatrician Vic Aldan speak to. They were good partnership advantage, yes.
Well, we had fun. So I enjoyed the Middlesex Great.
Yeah. And then, of course, London, you know.
You I mean, you said what Gregory wanted to be a neurologist.
Wanted to be an endocrinologist. Answer them. I just want you to look it up.
But I think the advert in the BMJ for Hockaday site and I was wanted general physicians with an interest in cardiology.
The one, the dairy crocodile in office. General medicine, diabetes, endocrinology and metabolic disease and nephrology.
We have a pretty general. Yes. That I was here.
Europe and the other question did an. Oh, tell me anything about the house and how they get funding for the Reforge servicemen.
Can I do for you? What can I do for the medical school so there's no wind, Tapley Romanos,
the house given by him that will win Tetley scholarships for a good 10 years where three out of
students went to Hong Kong and three outcomes students gain to a new thing all through winter.
And I suppose also music with Ms. Threat opening a study and making, as is he had the whole of the upper floor of Greven House to say goodbye to and.
Revising now. Yes, indeed. Yes.
Is then anyone that that is alive or either of hers or something?
When I got connected, I think I was about. And did you see? Because, Alistair, if I have to say I mean,
Alastair was that Lachlan was the chap who when Green College was coming up and where the students are going to go there or not,
as the House had a meeting with its lecture theatre, which doll was invited to arrive to discuss what the new daughter arrived a bit early.
Well, the business was going on and you wouldn't be surprised how Buchardt behaved.
He said, Regis, I'm afraid we're busy. Would you please leave me and change my marriage?
He, of course, is now headed to the house. Yeah.
So that's why that happened. Yes. Interesting. You were saying racist in the rally is.
No, I never. I suppose I know you want to have a chap who had a hockey blue and regarded oarsmen.
It is beyond the pale, actually. I thought when I arrived at Veoh college, they had just gone head of the river.
They also won the ladies play to Penny and they had six members of the Oxford Blue Boat.
You call yourselves and they lounged about the common room either with pink
socks from Leander or with M.J. Hawks written across a bloody great red sweater.
And they ate separately. And I thought they were paying. And I was delighted with the Oxford crew sack.
I was sort, you know, people who are real athletes did something with a bowl of people who rode boats were just people who are sick of.
Come on, let's go. Now, I said they got some.
I mean, you know, we should be going. And, you know.
But you wonder about rowing. Of course, there's the high school, you know, rowing, and everybody wants him and everybody read it.
So that was. And I've never been to the river. I've never I've never watched each week.
No, not even once. No, no, not even once. I like to watch the Olympic rowing.
But if you wanted to know about the distinguished people who are around,
when I used to see people look back at what is now the warden's lodgings of greed gone and used to be my officers.
Yes, sir. And they came in and one day came in this Canadian road scholar with head on to here looking like a pop star,
then a reverse belt baseball cap on his head who turned out to be a bell.
And he came in with the following. Director, he said.
I don't wanna waste your time. Bell. I'm OK, you said, but I have something to tell you.
Oser could go head of the river if you get the right guy.
There's a bloke at Keibel who stroke the Canadian Olympic crew.
Want to come to the house, but he's sick. He fails exams.
Dull and ever have an. It's up to you to answer my question, and it's about Ron.
John Bell, who first time I met him.
No, I think good. Also, I think they are.
Peggy would know this, that and I do. But I can remember when you had applications for new college or.
No application of the clinical school in a pile done in my head.
And I. He asked a reverse.
Can't say it enough. No, but he might be helpful. I'm here to respect Sanchez.
Well, not a bit. Whether or not he is in charge.