1 00:00:02,370 --> 00:00:09,810 This is an interview with Grantly by Derek Hockaday at his home in Curtaining Cottington, 2 00:00:09,810 --> 00:00:15,420 and it's about his memories of the Oxford Medical School grants. 3 00:00:15,420 --> 00:00:20,440 You came in 1956, Torchwood? Oh, I think so, yes. 4 00:00:20,440 --> 00:00:25,940 Yeah. And what did you what made you come really? 5 00:00:25,940 --> 00:00:37,320 Well, the situation was that I've always wanted to be a GP. 6 00:00:37,320 --> 00:00:46,910 I mean, I don't know what made you want to go into medicine, but I remember when I first went up to be interviewed at Thomas's where I trained, 7 00:00:46,910 --> 00:00:52,830 uh, the called Bill, Bill, big bill that we certainly have not. 8 00:00:52,830 --> 00:00:58,770 But he'd been a government servant in Ghana in the Empire. 9 00:00:58,770 --> 00:01:04,170 And I said, why do you want to be a medical student? I said, I've always wanted to heal people, so don't be so stupid. 10 00:01:04,170 --> 00:01:32,670 He said, What do you mean [INAUDIBLE] keep. Tuesday was a deep sense of vacation, really, I mean, why do people want to do anything? 11 00:01:32,670 --> 00:01:47,280 It's something you from deep down you could explain anyway, in those days you could train very quickly because war was just started. 12 00:01:47,280 --> 00:01:56,940 So you're in and out of medical school and you learn by dugouts like I am now, because all the rest have gone into the services. 13 00:01:56,940 --> 00:02:03,660 And then you were then in a tank regiment or something in the final bits in the warfare 14 00:02:03,660 --> 00:02:08,130 where you learnt an awful lot about my experience because there was nobody else to do it. 15 00:02:08,130 --> 00:02:13,140 There was a search initially, initially, and then last in, last out. 16 00:02:13,140 --> 00:02:19,470 So I then went to the Middle East and was in the Sudan when the partition was going on still. 17 00:02:19,470 --> 00:02:29,070 And then down in Suez, the DMO, the age of 23, I suppose, looking after 600 bed and hospital and medical divisions. 18 00:02:29,070 --> 00:02:33,150 And so you had an enormous amount of experience and you learnt on the job. 19 00:02:33,150 --> 00:02:37,770 Yes. And you came back and the Pacers swarming with people. 20 00:02:37,770 --> 00:02:42,960 Court time expired registrars because there's no work for us and all the general practises were full. 21 00:02:42,960 --> 00:02:50,760 Mm. So then what did you do. And I learnt that Thomas is a very special thing. 22 00:02:50,760 --> 00:02:55,320 There was a guy there called John Richardson. He became Sajani. 23 00:02:55,320 --> 00:03:06,900 He was a very charming man. And his sister his wife was was, I think, silly. 24 00:03:06,900 --> 00:03:09,660 Abuzer, she was a woman. She was a mother daughter. 25 00:03:09,660 --> 00:03:15,810 So this tremendous collection of Thomases through the brothers who came down, you know, all of that and so forth. 26 00:03:15,810 --> 00:03:19,590 And I learnt from him. 27 00:03:19,590 --> 00:03:27,030 He said, if you become a consultant physician, you are actually the servant of the general practitioners. 28 00:03:27,030 --> 00:03:31,560 So the general practitioners will still be you because you are a servant to them. 29 00:03:31,560 --> 00:03:37,050 You're not the consultant telling the generations what to do that employ you to help them. 30 00:03:37,050 --> 00:03:42,600 An ethos and I think really needs to come back. Yes. And so that's how it happened. 31 00:03:42,600 --> 00:03:49,860 And then the only way you could get on was if you're going to have to go into medicine outside your apprenticeship doors. 32 00:03:49,860 --> 00:04:02,820 Because my cousin was a GP in the holidays as his assistant, and Tony DAUn House is a great friend of Richardo, actually was Thomas's. 33 00:04:02,820 --> 00:04:08,280 And he was in the thing called the medical unit, and he knew everything. 34 00:04:08,280 --> 00:04:16,320 And the only other place he could go to was Hammersmith. So I went and trained under MacMichael and Andrew. 35 00:04:16,320 --> 00:04:26,310 What Michael has done here, not the time, but unfortunately Andrew is a spitting image of his father and I just learnt so much from that man. 36 00:04:26,310 --> 00:04:39,630 And one of his his colleagues was Peter Schaffer, who'd been at University College and had trained with, you know, who I mean, Lewis Lewis. 37 00:04:39,630 --> 00:04:47,580 So he was part of the British Lewisite. Yes. And the rest of London was all stiff collar consultants who are British, actually. 38 00:04:47,580 --> 00:04:54,570 So, yes. And so there was Peter Schaffer went back to Thomas's and you had to get a 39 00:04:54,570 --> 00:05:01,740 job in your teaching hospital if you were to get on as a consultant anywhere. So he invited me back to work for him. 40 00:05:01,740 --> 00:05:09,240 And then he trained growing up under Lewis with, uh, George Pickering. 41 00:05:09,240 --> 00:05:18,000 Mm hmm. And then George Pickering had been asked to come down here and I had now become pretty expert in investigative cardiology. 42 00:05:18,000 --> 00:05:26,850 I know Michael Schaefer. So I was asked by George to come down here really as his bugle boy to set up a cardiac lab. 43 00:05:26,850 --> 00:05:30,390 When you were first assistant at Thomas's, were you there? 44 00:05:30,390 --> 00:05:35,550 No, no. I was called a time expired. Registration was the answer. 45 00:05:35,550 --> 00:05:40,230 Yeah. And so I was a I think I was called a lecturer on the Petersham. 46 00:05:40,230 --> 00:05:42,510 But Peter Schaffer, I learnt a [INAUDIBLE] of a lot from them. 47 00:05:42,510 --> 00:05:48,690 Guy One thing I learnt from him was that if you did anything new and you wrote a paper about it, 48 00:05:48,690 --> 00:05:54,270 you had to hone it down to every word meant anything to a paper that's five, five or ten pages long. 49 00:05:54,270 --> 00:05:58,290 I ended up on two sides of a piece of A4, which is just amazing. 50 00:05:58,290 --> 00:06:05,940 What good language could do is now when you came to Oxford, it was a sort of promotion. 51 00:06:05,940 --> 00:06:10,440 But were you intrigued by Pickering? I thought it was marvellous. Yes, well, it's worse than that. 52 00:06:10,440 --> 00:06:18,710 But because what happened was that he he needed a first assistant, as he called it, to come to him. 53 00:06:18,710 --> 00:06:22,510 Anybody else would have had a reader named. 54 00:06:22,510 --> 00:06:32,290 It was the same status, I thought, as a reader, but Peter Schaffer said to me, look, you must you must be very careful of tinkering with it. 55 00:06:32,290 --> 00:06:37,610 He said he's very charming. Don't think you can run him because he can always run. 56 00:06:37,610 --> 00:06:54,670 You watch this figuring asked me down to Chaffetz and Giles where I was living, and he asked Pamela as well, sensibly for the weekend. 57 00:06:54,670 --> 00:07:01,690 Yes. And so the timing and what his wife could talk and so forth. 58 00:07:01,690 --> 00:07:04,570 And she was an absolute dear friend. Yes. 59 00:07:04,570 --> 00:07:14,140 And Tom took after her son and he then said what he wanted to do and what he wanted me to do to come down and be a condition 60 00:07:14,140 --> 00:07:21,250 for him because he had to do all these other things so he could always feel secure because he wanted his his firm to be, 61 00:07:21,250 --> 00:07:27,030 although it was going to be the medical unit was going to be just like any other film so that the parks people, 62 00:07:27,030 --> 00:07:35,530 the scientists in the parks and sort of clinical school was no good because they were all GPS got pompous since the war came needed. 63 00:07:35,530 --> 00:07:41,200 They were no good. And everybody have got to go to London. So our job was to make the parks. 64 00:07:41,200 --> 00:07:46,570 People realise it was pretty good medicine in Oxford as well. 65 00:07:46,570 --> 00:07:52,980 And then I came back and I just was a bit I just didn't I didn't feel comfortable with the guy. 66 00:07:52,980 --> 00:07:57,220 Hmm. And Pamela said to me, what on earth are you doing? 67 00:07:57,220 --> 00:08:06,850 She said, your time expired. Senior registrar, you're now nudging thirty or whatever it was, and you've got no long term prospects. 68 00:08:06,850 --> 00:08:14,710 You can't get into general practise. You're too highly qualified. And and and you turn a man down like that because you're not quite sure about it. 69 00:08:14,710 --> 00:08:21,190 You're just mad. So she took the job, right. 70 00:08:21,190 --> 00:08:25,270 So then I came and when I got here, lo and behold, 71 00:08:25,270 --> 00:08:30,790 I was slightly right because he hadn't told me that he'd gone to had his bets by asking somebody else to be the first assistant. 72 00:08:30,790 --> 00:08:35,200 Well, there were two of us were Bill Cranston. No. Joni Mitchell. 73 00:08:35,200 --> 00:08:35,560 No, 74 00:08:35,560 --> 00:08:48,340 it was it was Brown Bronte Stuart who started the whole business of liquid understanding is this marvellous guy and a South Africa and a lovely wife. 75 00:08:48,340 --> 00:08:53,740 And we were tremendous friends straight away because George had a gift of picking people. 76 00:08:53,740 --> 00:08:59,320 Yes, I think he did. And he really did. And so he was great in many ways. 77 00:08:59,320 --> 00:09:01,840 But you have to watch the quality of force. 78 00:09:01,840 --> 00:09:08,020 And when you came to Oxford, how did you find Oxford compared with Thomas's and what were you sort of feeling? 79 00:09:08,020 --> 00:09:12,520 Terrifying things. You were bad. No, I was terrified. 80 00:09:12,520 --> 00:09:21,400 Yeah, you were terrified. But what did you think of the practise of what was going on, the nursing, etc., in Oxford compared to Thomas's? 81 00:09:21,400 --> 00:09:26,560 I thought it was I thought a slipshod frankly, it's no truer. 82 00:09:26,560 --> 00:09:32,470 There wasn't that Tomatis. I had a I don't know if it's still the same. 83 00:09:32,470 --> 00:09:39,020 I doubt if it is actually had this situation where the the nursing school, 84 00:09:39,020 --> 00:09:45,940 the Florence Nightingale School of Nursing, was more important than the medical staff and the consultants. 85 00:09:45,940 --> 00:09:49,810 They were all people in Harlow Street and so forth. It was a voluntary hospital. 86 00:09:49,810 --> 00:09:54,510 They came in and gave the time as well, the hospitals and the senior staff. 87 00:09:54,510 --> 00:10:00,760 Brasilia's worked with them. But you were really apprenticed to the nurses and so forth. 88 00:10:00,760 --> 00:10:04,720 And in fact, when you went on the wards, there was a clinical student. 89 00:10:04,720 --> 00:10:12,250 You spent your first week to a fortnight working with the nurses to learn how to behave yourself. 90 00:10:12,250 --> 00:10:15,400 Right. And I don't think that's a bad practise at all, actually. 91 00:10:15,400 --> 00:10:35,560 I think to walk into the clinical school and then spend your part of your assignments would be just working as a nurse assistant with a coat on the. 92 00:10:35,560 --> 00:10:39,810 Learn how to, you know. But so that's how it started. 93 00:10:39,810 --> 00:10:43,860 And so it was and it varied enormously. Yes. 94 00:10:43,860 --> 00:10:48,570 And then you bring up good discipline. 95 00:10:48,570 --> 00:10:53,460 You were building up cardiology, but how much general medicine were you doing? 96 00:10:53,460 --> 00:10:54,180 Oh, a lot. 97 00:10:54,180 --> 00:11:03,480 I mean, I was a cute general physician, so rather than being a cardiologist, I didn't know a clinical cardiologist, the clinical cardiologist. 98 00:11:03,480 --> 00:11:07,720 I've been investigating experimental cardiologists with Michael. 99 00:11:07,720 --> 00:11:16,530 If you ask the patient if you could run catheters all over their body that, you know, you had to have their permission. 100 00:11:16,530 --> 00:11:21,540 But in fact, they were assisting you, finding out how the normal body went wrong. 101 00:11:21,540 --> 00:11:28,500 Mm hmm. So making a clinical diagnosis of heart disease, particularly paediatric heart disease, is a nightmare. 102 00:11:28,500 --> 00:11:32,470 And I just say to people like Victoria, small fish, I've never learnt on the job. 103 00:11:32,470 --> 00:11:36,060 I am learning all the time. But she still was a great help. 104 00:11:36,060 --> 00:11:44,370 Yes, because there's nobody else to go to, actually. So you would be doing angiograms for angiograms and total heart angiograms? 105 00:11:44,370 --> 00:11:53,550 Yes, yes. Yes. And was there anything special with the pressure we made our own catheter, the pressure gauges on things because you had no ultrasound? 106 00:11:53,550 --> 00:12:03,000 No, no. I mean, what what what went on to do a subsequent generations was to do parallel studies using 107 00:12:03,000 --> 00:12:06,960 non-invasive techniques so you could make do these things without those techniques. 108 00:12:06,960 --> 00:12:11,410 That's the great joy of modern advances in non-invasive cardiology. 109 00:12:11,410 --> 00:12:24,200 Yes. And what sort of you had a university contract or in any case, I was paid well, didn't worry. 110 00:12:24,200 --> 00:12:30,660 And they said, no, it wasn't proper for me to ask. No. What I did know is that I wasn't a university, so I had no more. 111 00:12:30,660 --> 00:12:38,430 Right. It was George Pickering and his department, his first assistant, then the man, The Apprentice boiler house. 112 00:12:38,430 --> 00:12:44,940 But in my state, it's in practise. How much time did you have for research? 113 00:12:44,940 --> 00:12:52,530 Well, how do I find nowadays research is spelt. 114 00:12:52,530 --> 00:12:59,220 It's called research is the whole of medicine is search research. 115 00:12:59,220 --> 00:13:08,370 So, in fact, what was required was to have a way that we could make formal diagnoses which are sufficiently 116 00:13:08,370 --> 00:13:14,790 accurate without cutting the person open to know if they needed open heart surgeries, 117 00:13:14,790 --> 00:13:18,180 which was developing then in London and so forth. 118 00:13:18,180 --> 00:13:26,010 And the idea was that it had to develop in Oxford to run getting all the patients going up there because it was not you know, we needed more centres. 119 00:13:26,010 --> 00:13:35,070 So the whole business was right on the edge of of finding out everything when when the chest was opened by a cardiologist, 120 00:13:35,070 --> 00:13:40,830 he didn't codecs and he didn't read it in those days. Know what are going to find anyway. 121 00:13:40,830 --> 00:13:46,020 So you had to ask permission. Permission, please. May I cut you open to find out if I can do anything? 122 00:13:46,020 --> 00:13:53,130 Is there was an enormous requirement of trust between the patients and the doctor and the surgeon in particular. 123 00:13:53,130 --> 00:13:56,950 So roughly, when did you begin to work with this? 124 00:13:56,950 --> 00:14:03,660 McGrath Right from the beginning, yeah. So that must have been your research topic, really. 125 00:14:03,660 --> 00:14:07,500 One did that as a hobby. Yes. Night. Yeah, right. 126 00:14:07,500 --> 00:14:15,600 But you didn't do it in working hours. I mean, do you feel that your working hours were totally taken up with clinical care, 127 00:14:15,600 --> 00:14:20,040 including the investigative cardiology and a certain amount of negotiation? 128 00:14:20,040 --> 00:14:32,010 You see, the real problem was that when you can retire, they couldn't find a replacement of that kind to come. 129 00:14:32,010 --> 00:14:40,500 And they also had a situation where they were beginning to realise that they had to clean up and the cardiology or part time GP surgeons, 130 00:14:40,500 --> 00:14:45,330 really very good ones and so forth. 131 00:14:45,330 --> 00:14:52,710 And they wanted to put that on the map in the same way academic surgeries as a new profession. 132 00:14:52,710 --> 00:14:57,270 And they couldn't find anybody and nobody would come on ultimately. 133 00:14:57,270 --> 00:15:03,390 And they also really would back somebody would get on some cardiac surgery. 134 00:15:03,390 --> 00:15:10,260 And so they asked Philip Anderson, who was a very, very successful general thoracic surgeon up in Leeds, 135 00:15:10,260 --> 00:15:16,940 to come, and he said, yes, he'd come and start open heart surgery, but he'd never done anything. 136 00:15:16,940 --> 00:15:28,230 Right. So what do you think he did? He took the job and then went off to Briber Hammon's in Cambridge to learn how to operate on dogs. 137 00:15:28,230 --> 00:15:34,860 Yes, I think could two years and his first assistant called Alf Gunning came down and started doing. 138 00:15:34,860 --> 00:15:40,860 A chaotic, simple cardiac surgery like Michael Stenness, mitral stenosis and stuff. 139 00:15:40,860 --> 00:15:49,980 Well, it was our previous experience where he'd worked as a junior up in Leeds for Filiba very much under his role. 140 00:15:49,980 --> 00:15:56,190 Now, Gunning, you know perfectly well who he was because F was one of these strange people who had trained. 141 00:15:56,190 --> 00:16:01,350 He was a South African as bright as a button. A very, very good surgeon. 142 00:16:01,350 --> 00:16:08,730 And he had trained as a general surgeon and then become an EMT surgeon, if you please. 143 00:16:08,730 --> 00:16:17,310 And then quite a number of his generation and I got a nominal dysphagia at this age when I get excited, I can't remember anybody's name. 144 00:16:17,310 --> 00:16:22,450 But there were three of them. There was Afghan who was one of them. 145 00:16:22,450 --> 00:16:32,130 The other one was the chap who operated on the first transplant surgeon who I mean, Chris Epona in South Africa, Chris Bowen. 146 00:16:32,130 --> 00:16:39,510 And I got to know because he came over quite often because my brother was a super chap, but Chris Barnard was something slightly different than his. 147 00:16:39,510 --> 00:16:50,520 And then there was a man called who went to London, who is the other great chap who funded him, who they were all contemporaries together. 148 00:16:50,520 --> 00:16:59,070 And so Alf came down as his job and then he did the cardiac surgery like mitral cynicism. 149 00:16:59,070 --> 00:17:07,020 And there was the beginning of cooling people down there to invent from wholesaler's so we could cool people down and open them up. 150 00:17:07,020 --> 00:17:14,550 And so it was supposed to fix that kind of thing. But Philip Anderson was an individualist. 151 00:17:14,550 --> 00:17:17,070 He didn't want to work with anybody except himself. 152 00:17:17,070 --> 00:17:22,260 So he demanded from the universe that he wouldn't come unless they built his own operating theatres. 153 00:17:22,260 --> 00:17:26,820 And they gave me and made his own cardiac lab so he could do the investigations himself. 154 00:17:26,820 --> 00:17:31,770 And he brought youngsters down and got any experience of that kind of thing at all. 155 00:17:31,770 --> 00:17:35,160 And Pickering hadn't got the plant for me to start it. 156 00:17:35,160 --> 00:17:43,440 So I had to ingratiate myself somehow or another to work in for businesses when there were no I had no authority over. 157 00:17:43,440 --> 00:17:45,990 It was very difficult indeed. 158 00:17:45,990 --> 00:17:51,900 So the only thing you could do is to get to know the people in the lab so well that they came to you rather than him, actually. 159 00:17:51,900 --> 00:17:53,370 Yes. Yes. 160 00:17:53,370 --> 00:18:02,190 And then things got to a stage where it really was very difficult because everything, you know, you couldn't do the job properly and they couldn't. 161 00:18:02,190 --> 00:18:05,550 So I built up a waiting list of four or five hundred cases, 162 00:18:05,550 --> 00:18:11,100 patients who needed cardiac catheterisation and couldn't get them and then went to the border guard. 163 00:18:11,100 --> 00:18:16,140 I never got on the board of governors. I was much too difficult to help anyone who didn't want me there. 164 00:18:16,140 --> 00:18:21,780 So I went to the board of Governors and I had to close the waiting list down because it was not morally right. 165 00:18:21,780 --> 00:18:24,990 Is all these patients who go to London is. 166 00:18:24,990 --> 00:18:34,230 And by that time they couldn't cranio subvention to the university has been cut down to triennial and then down to annual. 167 00:18:34,230 --> 00:18:38,370 And Lord Franks had just been appointed as the chairman of the Board of Governors. 168 00:18:38,370 --> 00:18:42,960 Marvellous man. Yes, upright, tall, upright man in body and in mind. 169 00:18:42,960 --> 00:18:46,710 And so and this happened. 170 00:18:46,710 --> 00:18:54,240 And so the way Franks came and said, look, you said there's a whole lot of money unspent from previous years. 171 00:18:54,240 --> 00:19:03,720 Could you have another cardiac department? So I said, yes, there's a courtyard between the X-ray department and not next door. 172 00:19:03,720 --> 00:19:08,050 I'll fill in the courtyard and we'll build the lab and have our own cardiogram. 173 00:19:08,050 --> 00:19:12,150 Right. And so the money was there. We did it. 174 00:19:12,150 --> 00:19:16,920 I started. That's about sixty three. Sixty four. I would have to look it up. 175 00:19:16,920 --> 00:19:22,620 Yeah, sure, sure. It was when Frank had been there for about a year. 176 00:19:22,620 --> 00:19:26,130 Yes. And who were the technicians really helping you. 177 00:19:26,130 --> 00:19:30,720 They were dreadful. They were all people who had no Tenere. 178 00:19:30,720 --> 00:19:36,000 They were, they were undisciplined. They're not trained. 179 00:19:36,000 --> 00:19:38,370 And it was an absolute nightmare. 180 00:19:38,370 --> 00:19:54,600 But and it was helped a lot in a funny way, coincidentally, by Alf Gunning doing most of the major surgery because filibusterer was quite, very good. 181 00:19:54,600 --> 00:19:57,900 But he was also very political, very busy. 182 00:19:57,900 --> 00:20:08,070 And he had a dining club, pretty bederson all the big surgeons around the world and Liley High and DeBakey and all these sort of things turned up. 183 00:20:08,070 --> 00:20:12,930 And there was a gallery above the operating theatre and another Department of surgery. 184 00:20:12,930 --> 00:20:20,900 And Alf Gunning teamed up with a chap called a. 185 00:20:20,900 --> 00:21:46,130 In Barraclough, who has worked in the engineering department, and his father was a technical chap, and there they were making artificial nails, but. 186 00:21:46,130 --> 00:21:52,960 And before that, the sister, junior sister in the operating theatre said, I'm not working here anymore, OK? 187 00:21:52,960 --> 00:21:57,380 Once in my contract. So then I had a sister was so good. 188 00:21:57,380 --> 00:22:02,100 Now central to London to train as a technician. And she ran the technician. Right. 189 00:22:02,100 --> 00:22:10,280 Right. So that's how it was done. Yeah, it was. So, you know, that's how the place worked. 190 00:22:10,280 --> 00:22:15,050 I mean, it was very hard, but it was small enough to do this when you don't know when it's systematised, 191 00:22:15,050 --> 00:22:19,040 you have intrigue and a massive scale with a place as big as it is now. 192 00:22:19,040 --> 00:22:25,030 Heaven help the place. So how are you getting on with this work? 193 00:22:25,030 --> 00:22:39,400 Well, I had a big grant for that. Yes. And the reason for that was that when I was at, uh, before I was it. 194 00:22:39,400 --> 00:22:48,280 When I was in Hammersmith, oh, no, I know when I first came back to Thomas's, you couldn't do it, and that was in 1953. 195 00:22:48,280 --> 00:22:52,030 Jaspers can't remember what happened on the dates. 196 00:22:52,030 --> 00:22:59,980 You couldn't do anything in Britain in academic medicine without working in your teaching hospital and 197 00:22:59,980 --> 00:23:06,760 getting your knees brown in real research in the United States long before Europe was got anything with it. 198 00:23:06,760 --> 00:23:11,440 And so you had to have been to America to get ready. 199 00:23:11,440 --> 00:23:17,560 And in my I had the wit to see that you must go for something in cardiology that nobody else could go into. 200 00:23:17,560 --> 00:23:26,290 The person who'd done that to perfection in another field has been what's it got to back today? 201 00:23:26,290 --> 00:23:31,060 What subject? Tropical medicine started in World War. 202 00:23:31,060 --> 00:23:39,100 He picked something that nobody else would lose interest in and has gone on forever because nobody's in that in that penumbra area. 203 00:23:39,100 --> 00:23:41,800 Yeah. And so I thought, well, 204 00:23:41,800 --> 00:23:50,740 there are a whole lot of people who especially physicians who are just physicians making diagnoses of chest disease when it's heart disease, 205 00:23:50,740 --> 00:24:00,560 particularly with fluid on the lungs and so forth, and cardiologists making diagnoses of cardiac disease when it's lung disease. 206 00:24:00,560 --> 00:24:08,170 So I'm going to specialise in micro circulation of the lung. And Schafer did all I could to help him do that. 207 00:24:08,170 --> 00:24:16,570 And so you went in and you found that there was something very strange in the lung circulation because the pulmonary artery pressure, 208 00:24:16,570 --> 00:24:19,240 if it gets above 20 centimetres of water, 209 00:24:19,240 --> 00:24:28,150 the whole thing leaks because the capillaries so thin that there's something not doing, keeping it down, regulating it. 210 00:24:28,150 --> 00:24:36,700 And so you have to then look at the physics and read enough about physics to know about compliance and all that sort of stuff. 211 00:24:36,700 --> 00:24:44,650 You had to do something to find out what the transmission line was doing in those physical terms. 212 00:24:44,650 --> 00:24:51,750 So you have to have a way of measuring the you could measure the signal output, the fly, 213 00:24:51,750 --> 00:24:56,480 but because by this time making little catheters, it was the pressure gauges on the air. 214 00:24:56,480 --> 00:25:04,120 So you could tell the pressure in the pulmonary artery. But Valve and you had to get and you could measure the flow with the fluid that you got on the 215 00:25:04,120 --> 00:25:12,760 that these cases we made in the department more so with the help of the engineering school here. 216 00:25:12,760 --> 00:25:23,320 So, uh, um, I, I learnt that before that. 217 00:25:23,320 --> 00:25:28,270 Pickering, um, about Schaffer's. 218 00:25:28,270 --> 00:25:33,730 Well, if you want to go and look at this long so you better go to work with this man called Julius Cobbora. 219 00:25:33,730 --> 00:25:39,350 Unfilial everybody. If you went to work for Julius Gomera, you, you, you learnt everything. 220 00:25:39,350 --> 00:25:43,640 Yes. He was a pharmacologist. So it wasn't only about four or five years old. 221 00:25:43,640 --> 00:25:50,830 That was, I suppose, at the time. And he looked about a hundred. And so if you worked for Julius, it was tremendous. 222 00:25:50,830 --> 00:25:55,690 And so I went to do this Komarow for six months, I think it was. 223 00:25:55,690 --> 00:26:00,670 And he employed us English people because he paid us so little. We worked all the time. 224 00:26:00,670 --> 00:26:07,600 And, uh, there there was a man called Arthur Dubois who worked with Ron Otis and Fynn from Rochester. 225 00:26:07,600 --> 00:26:13,930 And Arthur Dubois was Rennie Dubois, his son, the metabolic person. 226 00:26:13,930 --> 00:26:19,300 You know, what about him? And Arthur was an incredible guy, very quiet. 227 00:26:19,300 --> 00:26:30,520 And he asked me what I was doing. And I said, I have this idea that there's something preventing them leaking, keeping the pressure down. 228 00:26:30,520 --> 00:26:39,430 And I've come to learn about this here. And he said, well, we have to look at the ten quick that he was a professor. 229 00:26:39,430 --> 00:26:49,300 And he said, uh, Krog used to use a spirometer for measuring cardiac output with nitrous oxide. 230 00:26:49,300 --> 00:26:55,170 And I've got a system, a graph here for studying the mechanics of the lung, which do discoverability. 231 00:26:55,170 --> 00:27:01,150 Fire came from Richardson, the great big thing, like a steel box for going down into a submarine, 232 00:27:01,150 --> 00:27:05,290 you know, jump in the box and here's a bag of nitrous oxide. 233 00:27:05,290 --> 00:27:10,690 And, uh, and we'll measure the pressure in the box and see what happens. 234 00:27:10,690 --> 00:27:24,670 And he put NCG on me, uh, and, uh, that very afternoon, I took a nitrous oxide and EKG to see when the heart was the ventricle was pumping, 235 00:27:24,670 --> 00:27:31,120 uh, you know, and lo and behold, there was a trace in the box, a lot of pressure. 236 00:27:31,120 --> 00:27:37,360 And it lost in a funny sort of way. It looked like when you plotted it that it had a wave pattern to it. 237 00:27:37,360 --> 00:27:46,820 So it. Blood flow in the capillaries right in one day is, you know, that doesn't happen very often. 238 00:27:46,820 --> 00:27:52,670 How was it how easy was it to get a book built in Oxford Pickering? 239 00:27:52,670 --> 00:28:02,520 Well, the first. But then when a when a train passed in Philadelphia, the box resonated with a much bigger signal. 240 00:28:02,520 --> 00:28:06,060 So you had to get rid of all the noise. So brilliant. 241 00:28:06,060 --> 00:28:10,580 And I said, well, why don't we put a fourth wall down the middle. Yes. 242 00:28:10,580 --> 00:28:17,630 And we'll put a differential manometer in the box measuring the side without a person in. 243 00:28:17,630 --> 00:28:23,300 And we'll and we'll use a subtraction. So he was just a wonderful technician, this guy. 244 00:28:23,300 --> 00:28:32,150 So he tried it all out. And then I came back to Oxford. And Camilo's a wonderful creature because we used to go in at night into it. 245 00:28:32,150 --> 00:28:36,140 So I made a box. I knew it had to be rigid, so I made a box. 246 00:28:36,140 --> 00:28:42,800 It would fit on top of the catheter table, which was really but of course, the teeth of the table was fat sided. 247 00:28:42,800 --> 00:28:47,300 So it's just like one side of that box in Philadelphia. 248 00:28:47,300 --> 00:28:58,770 And so, George, George Pickering's labs, we all had our own level way down the corridor is still there and the pump for the off. 249 00:28:58,770 --> 00:29:10,790 And I had a lab on first one on the left and he came in and it had a concrete was designed for animal work, so it had a concrete terrazzo floor. 250 00:29:10,790 --> 00:29:22,580 So I decided and then Frank started with a man who was working for Bordelon and done that, Jemmy Savile. 251 00:29:22,580 --> 00:29:27,740 Chaplin got so badly he he'd worked with Bob Dylan. 252 00:29:27,740 --> 00:29:35,270 And Frank Stark was a brilliant inventor, is a very charming man to work with, such as Never Got Anything Done. 253 00:29:35,270 --> 00:29:42,110 But he was the guy that helped the developing oxygen breathing equipment for Hillary and people. 254 00:29:42,110 --> 00:29:46,400 Uh, and the unit had shut down when Bob Dylan retired. 255 00:29:46,400 --> 00:29:51,230 And so Pickering had made a home for Frank Stott. 256 00:29:51,230 --> 00:29:54,090 And so, Frank, start with an emergency employee on this business. 257 00:29:54,090 --> 00:30:04,760 And he came in and he designed the hoisting equipment and so forth, and a new way of measuring the instantaneous pressure flow, which was so clever. 258 00:30:04,760 --> 00:30:17,060 It was unbelievable that we had to do it on the floor because it was rigid and thick concrete, the feminised to come in with Frank at night. 259 00:30:17,060 --> 00:30:23,730 And she'd be a subject insider on the book. And then a man called. 260 00:30:23,730 --> 00:30:28,420 Oh, Lord. David, David, David, David. 261 00:30:28,420 --> 00:30:42,190 From from it'll come from the network is very great now we all tiny, we all knew each other internationally, like, you know, people do still sense. 262 00:30:42,190 --> 00:30:45,700 And he invited me to to Buffalo. And I got very fond of him. 263 00:30:45,700 --> 00:30:52,480 And he came over here and he was the kind of guy that was such an experimentalist. 264 00:30:52,480 --> 00:30:56,170 He used to get his colleague to do kestrels on him. 265 00:30:56,170 --> 00:31:07,000 So he had a catheter, a cardiac catheter done at night on the floor so we could measure pressure and flow at the same time. 266 00:31:07,000 --> 00:31:14,890 And then we had the situation of not wanting to try and do it, and disease of people with pulmonary hypertension, all the rest of it. 267 00:31:14,890 --> 00:31:21,280 And we had patients who came in who needed heart disease investigations. 268 00:31:21,280 --> 00:31:25,390 And we talked to them and said, look, 269 00:31:25,390 --> 00:31:33,760 there are things that we could do that would help us enormously at the expense of prolonging a catheterisation for some time longer, 270 00:31:33,760 --> 00:31:35,680 perhaps half an hour longer. 271 00:31:35,680 --> 00:31:42,490 And it means coming down the corridor and coming into my lab and going on the floor and having these measurements and going back again. 272 00:31:42,490 --> 00:31:53,710 And I said there is risk because it's not necessary. And it's an astonishing that people you got to know them so well. 273 00:31:53,710 --> 00:31:57,700 They said, cut my head off. You like Doctor, you know, I trust you. 274 00:31:57,700 --> 00:31:59,230 And so within. 275 00:31:59,230 --> 00:32:06,350 So what I used to do is then get a colleague, Jeff Brown, criminal, turned up by this time to go with them and say, look, this is really in it is. 276 00:32:06,350 --> 00:32:10,630 And then finally give him a piece of paper to sign. Yes. And they still did it. 277 00:32:10,630 --> 00:32:14,950 So there were one or two studies done like that on the floor. Mm hmm. 278 00:32:14,950 --> 00:32:23,740 So he then got one or two measurements, which were quite enough then to say this is why it was working if you didn't need to do anymore. 279 00:32:23,740 --> 00:32:33,670 And out of that came a strange thing, because as we got more and more expert and things got tougher and I mean by tougher, 280 00:32:33,670 --> 00:32:41,440 the diseases got less and less available because we were studying diseases as perturbations of normal physiology. 281 00:32:41,440 --> 00:32:46,070 I understand. Yes. But as the diseases got better treated are disappearing. 282 00:32:46,070 --> 00:32:50,300 Yes. So we couldn't go on with finding out the pathophysiology because they weren't there. 283 00:32:50,300 --> 00:32:54,190 And we had to do experiments on animals is to look at that. 284 00:32:54,190 --> 00:33:00,310 And I found that much more difficult because animals don't have a choice of saying, I don't want that done. 285 00:33:00,310 --> 00:33:05,170 Yes, I do this. I do. There's another moral dilemma for you. 286 00:33:05,170 --> 00:33:06,790 So. Well, this was going on. I mean, 287 00:33:06,790 --> 00:33:19,510 the other big change as it happened probably before Brown came was the cocain malum retard and the whole firm system in medicine was shaken up. 288 00:33:19,510 --> 00:33:24,130 Where did that fit in? That would have happened while you were building up the graph of. 289 00:33:24,130 --> 00:33:30,100 Well, it did it it it was it didn't hurt at the same time. 290 00:33:30,100 --> 00:33:46,360 They did virtually. Yeah. Within months. Well, the point was that Judge Pickering was very good at getting people and that is where oh lord. 291 00:33:46,360 --> 00:33:50,690 I got this Faizabad today. Tony Mitchell. No, no, no. 292 00:33:50,690 --> 00:33:59,650 I'm letting them do is so. So John Ledingham came down as a second physician on John Pickering's farm were. 293 00:33:59,650 --> 00:34:04,420 No, I think he came as a second on a new firm within the first year. 294 00:34:04,420 --> 00:34:09,580 Well, he came down, yes. But let's say he came down having been recruited by George Ray. 295 00:34:09,580 --> 00:34:13,660 Yeah, absolutely. And that's where that was one of the replacements came. 296 00:34:13,660 --> 00:34:18,040 Yeah. Yeah. And I can't remember who the other one was because before that, 297 00:34:18,040 --> 00:34:26,080 presumably you'd been working on the end er on the Regis professor's firm doing your job hunt. 298 00:34:26,080 --> 00:34:35,200 Yes. And how much on take medicine were you doing that before you got the firm with Joan. 299 00:34:35,200 --> 00:34:39,580 Oh I think we were on take. Well there were four physicians we don't take every fourth day. 300 00:34:39,580 --> 00:34:43,630 Yes that's right, yes. I mean you are the main Ontake. Oh George. 301 00:34:43,630 --> 00:34:46,120 Yes. Yeah, that's what I thought. Yes. 302 00:34:46,120 --> 00:34:57,580 And just enormously I mean that the time in the army with the Sunnis and in in the Sudan and and initially with all sorts of diseases, 303 00:34:57,580 --> 00:35:05,770 I mean, we not even seen one of the few people in the world have a smallpox epidemic, for instance. 304 00:35:05,770 --> 00:35:12,850 I mean, you had an enormous, expensive medicine of all kinds, but you'd be into digital dating with bill grants and interdimensional. 305 00:35:12,850 --> 00:35:18,100 They were just on the phone. Right. Okay. So they were under me, in a sense. 306 00:35:18,100 --> 00:35:28,850 Yes. And then you started up on one of five firms with John Ledingham because I was with John and so John and I. 307 00:35:28,850 --> 00:35:41,600 And John was a wonderful person because he was good at coming to work, he very you know, he knew how to talk to people nicely and he and I. 308 00:35:41,600 --> 00:35:47,690 So he got much better at the community. And we thought so like we didn't have to ask each other. 309 00:35:47,690 --> 00:35:55,850 Like, we knew we trusted each other completely. And so I could keep out of the lab. 310 00:35:55,850 --> 00:36:01,310 And one thing and another, if you're going to do any research on John, was not a research work. 311 00:36:01,310 --> 00:36:06,200 He was a clinical research worker. But he could do that at the bedside in a sentence, you understand? 312 00:36:06,200 --> 00:36:09,200 Yes, I do. So then it could be a full time doctor. Ready. 313 00:36:09,200 --> 00:36:16,940 But I was I was I was the new generation of people that had to be a clinician and a scientist and 314 00:36:16,940 --> 00:36:22,370 not so subspecialties in clinical work that you only know a tiny bit of the body you used to do, 315 00:36:22,370 --> 00:36:25,910 which is what's gone wrong now. It's gone completely too far. 316 00:36:25,910 --> 00:36:34,640 But then John was not so fond of, but involved very heavily with the renal dialysis business within a few months. 317 00:36:34,640 --> 00:36:41,720 But he was a clinician because there was Desmond Oliver and he was the boss there. 318 00:36:41,720 --> 00:36:50,150 I mean, John had no say in how the dialysis was done. The Desmond wrote, there was a lot of no nonsense there. 319 00:36:50,150 --> 00:36:54,020 Yes. Then it was accepted. Yes. 320 00:36:54,020 --> 00:37:02,990 As a supplier of patients, that is the relationship is now don't get this wrong. 321 00:37:02,990 --> 00:37:08,120 But the places where graft didn't yield what you hoped it would yield. 322 00:37:08,120 --> 00:37:20,090 Absolutely. In terms of knowing, I mean, I still have enormous confidence in differential diagnosis of what's now being looked at with perplexity. 323 00:37:20,090 --> 00:37:28,470 There's all sorts of disease research being done and molecular genetics being thought about when it's nothing to do with it. 324 00:37:28,470 --> 00:37:41,000 Yes, I mean, the management of cardiopulmonary lung disease is still incredibly badly done because it's been so subspecialists. 325 00:37:41,000 --> 00:37:47,060 It's worse than it ever was when there was general cardiologists and general physicians. 326 00:37:47,060 --> 00:37:52,460 Do you understand me? So why isn't there a body seismograph in every hospital, as it were necessary? 327 00:37:52,460 --> 00:37:56,390 Because you can do so much with non-invasive method. Right. Okay. 328 00:37:56,390 --> 00:38:03,890 Because we then got to a stage where we're with the new methods coming along, you could do with ultrasound and stuff, most extraordinary things. 329 00:38:03,890 --> 00:38:11,250 You can work out the pressure fluid dynamics very well. But there was the ultrasound that really took over. 330 00:38:11,250 --> 00:38:22,220 What? Yes, everything that we did, we had to be done as to turn taxonomy into applied physiology to be sure about it, 331 00:38:22,220 --> 00:38:29,490 and then somehow correlate that with with more and more sophisticated non invasive methods. 332 00:38:29,490 --> 00:38:35,480 Yeah, yeah. And you only use the invasive methods. Now, flow methods is not used any more. 333 00:38:35,480 --> 00:38:48,020 Now the pressure, but sometimes I do understand is and now within NMR stuff is getting even more sophisticated. 334 00:38:48,020 --> 00:38:55,220 So Bozman and Bhishma Rajagopalan worked with you and a Frith first Firth. 335 00:38:55,220 --> 00:39:01,550 Colin Firth. Yes. And, uh, and what's in there? 336 00:39:01,550 --> 00:39:11,870 Bernie Gurche, who went to the Mayo Clinic in South Africa, and he's now chief editor of the European Heart Journal. 337 00:39:11,870 --> 00:39:16,460 Good. Because Biche is still in Oxford, of course, and ambitious and extraordinary. 338 00:39:16,460 --> 00:39:18,470 Man, I have very fond opinion. 339 00:39:18,470 --> 00:39:29,870 Uh, he was, um, he wasn't me, really, in the fact that he's one of the the most superb general diagnostic technicians I know. 340 00:39:29,870 --> 00:39:41,420 And he's an enormously creative scientist. I mean, the stuff he did on with, um, NMR is magnificent. 341 00:39:41,420 --> 00:39:50,310 Well, but he was one of the he was one of these people that could never. 342 00:39:50,310 --> 00:39:56,100 Uh, somehow couldn't imposes authority. 343 00:39:56,100 --> 00:40:25,460 Mm hmm. And I think the reason for that is that she's a very devout Brahmin man and he has an enormous sense of humility and deep humility is. 344 00:40:25,460 --> 00:40:29,690 This was being led a dance when he was making a lot of the creative decisions down 345 00:40:29,690 --> 00:40:38,270 there and I went to saw David Weatherall because he needed a new first assistant, 346 00:40:38,270 --> 00:40:49,610 Mérida, because John had gone missing. And so the visuals approached. 347 00:40:49,610 --> 00:40:53,810 But David very sensibly didn't make him a main reader. 348 00:40:53,810 --> 00:41:01,790 He made him a first assistant to do the work of a mind reader and organising the clinical teaching and stuff, you know, 349 00:41:01,790 --> 00:41:08,210 and which made an absolute mess of it because you had a nurse or he couldn't get people to toe the line, right? 350 00:41:08,210 --> 00:41:11,540 Yeah. And this has gone on like that. 351 00:41:11,540 --> 00:41:20,210 And he's been made use of all his life. And yet he's the one who missed an enormous creativity. 352 00:41:20,210 --> 00:41:31,850 That man. I'm very fond of him. Then how happy were you about the evolution of your general medical duties, the firm duties with John Ledingham? 353 00:41:31,850 --> 00:41:40,460 I mean. Well, they were beautiful. Yeah, I know. But the general sort of hospital set up and the Ontake arrangements and all that sort of thing. 354 00:41:40,460 --> 00:41:44,300 Well, it was sufficiently intimate that it didn't work immensely. 355 00:41:44,300 --> 00:41:49,250 Well, I mean, when we went up the hill, John and David, 356 00:41:49,250 --> 00:41:57,480 whether or not there was a situation that there was really very tight senior continuity every day and night. 357 00:41:57,480 --> 00:42:08,120 There was no business of working time directive and going or, you know, for a half day week and you decide to go to go sailing that weekend. 358 00:42:08,120 --> 00:42:11,930 But then gradually patients tended to be scattered around the hospital. 359 00:42:11,930 --> 00:42:22,700 And that's a real problem then, was that the the the the disaster was never a transfer because you went up the hill and the business 360 00:42:22,700 --> 00:42:32,810 of opening the to the contractive coincided with more and more stringent imposition of budget. 361 00:42:32,810 --> 00:42:43,490 That meant we were now not just a district general hospital had evolved out of the war looking after local areas specialities. 362 00:42:43,490 --> 00:42:55,130 We were now an area speciality for an increasingly urban population, but we were now that then a regional speciality, subregional speciality. 363 00:42:55,130 --> 00:42:59,420 Then we became a regional speciality there and became a national speciality in that. 364 00:42:59,420 --> 00:43:04,340 But in every discipline you can think of and an international speciality, 365 00:43:04,340 --> 00:43:09,350 Midway's and we had the same number of beds as we needed for our local population. 366 00:43:09,350 --> 00:43:16,160 Yes, that was the problem. Yes. And so we then in a situation where we were hunting around and going to any bed you could find. 367 00:43:16,160 --> 00:43:23,750 And so there were five or six firms so-called going into the same ward and the nursing sisters being driven, frantic. 368 00:43:23,750 --> 00:43:30,500 In fact, they couldn't these doctors coming in all the time. If they went round to the doctor all the time, they had never done the nursing. 369 00:43:30,500 --> 00:43:36,310 And so the result was there was a them and us growing up with the nurses and doctors and got on with their end 370 00:43:36,310 --> 00:43:46,460 and and corporate understanding and management suffered by default through sheer overtaxation to understand. 371 00:43:46,460 --> 00:43:51,710 I do. Yes. And I think that's a very good and it's one of the real problems about Oxford. 372 00:43:51,710 --> 00:43:57,680 And we now have it. And and it's got to such an extent now that the main wards for the people over 65 373 00:43:57,680 --> 00:44:02,480 are in the home that you are now sitting in because they have to get them out. 374 00:44:02,480 --> 00:44:12,770 Yes. Yes. And so there's a situation where if you go in for any thing that is that is acute, which takes time in the elderly. 375 00:44:12,770 --> 00:44:20,030 You are blocking a bed. Yeah. And so that comes back to the whole business of the relationship with general practitioners in the hospital. 376 00:44:20,030 --> 00:44:27,800 If the general practitioners are only there to to decide where the patients go for their things, when things go wrong, 377 00:44:27,800 --> 00:44:33,980 when the whole business of designing the health service and the Beveridge and they've been in the 378 00:44:33,980 --> 00:44:42,680 van was a GP's had a per capita stipend where they knew their patients intimately when they joined, 379 00:44:42,680 --> 00:44:48,530 and they are therefore then saw to it that they picked up the slightest thing that went wrong very early. 380 00:44:48,530 --> 00:44:59,570 Mm. So they didn't. So they knew that when patients did go to hospital it was dateable with and so the turnover. 381 00:44:59,570 --> 00:45:09,710 But nowadays that same nurturing and understanding of what the patient's health, deteriorating health where there is is not there. 382 00:45:09,710 --> 00:45:16,130 So the patient is then sent in to be sorted out at a time when things have gone beyond the point of return, as I understand it. 383 00:45:16,130 --> 00:45:24,990 Yes. No, indeed. That is what's happened. Yes. Yes. And it's a real problem because the main wards now for people over 65 have to be. 384 00:45:24,990 --> 00:45:35,850 In home, there's not room in the hospital or institutions, did you think the organisation of nursing nursing training was changing for the better? 385 00:45:35,850 --> 00:45:47,280 Well, that's just another political situation, because, quite frankly, the nursing training that that worked right up until someone came along, 386 00:45:47,280 --> 00:45:59,500 which was again in the era of the Thatcher era that started abusing her name because I can't remember the year but say, 60 right now. 387 00:45:59,500 --> 00:46:02,820 Two things happened there, which I think is part of one, 388 00:46:02,820 --> 00:46:09,960 was that there was a thing called the University Grants Committee, which provided for the teaching hospitals. 389 00:46:09,960 --> 00:46:17,580 It couldn't continue grant to the universities for their units, so-called in the teaching hospitals. 390 00:46:17,580 --> 00:46:28,140 All right. And these provided for the staffing for research and teaching purposes, as well as clinical leadership in the specialities, 391 00:46:28,140 --> 00:46:35,760 the growing specialities with their colleagues and calling in exchange for plant and services. 392 00:46:35,760 --> 00:46:46,050 All right. Mm hmm. So they weren't paid by the NHS, but they were paid by the university in exchange for a level for not having to pay a 393 00:46:46,050 --> 00:46:50,580 university and having to find the money for the plant and services to understand. Mm hmm. 394 00:46:50,580 --> 00:46:56,850 And then with Margaret Thatcher, she to tidy it up. 395 00:46:56,850 --> 00:47:04,080 She did it. She and money was getting tight. She said, well, the easiest thing to do is to make it the university funding committee. 396 00:47:04,080 --> 00:47:09,970 Mm hmm. So it's separated. And then at once they had no plant you. 397 00:47:09,970 --> 00:47:12,210 Yeah. And that's where the trouble started. Yes. All right. 398 00:47:12,210 --> 00:47:20,940 Now, one of those things was that they were then siphoned off and it was then university funding for teaching and research. 399 00:47:20,940 --> 00:47:27,780 And at the same time, the expertise and the nursing was now getting to the stage of being fraught. 400 00:47:27,780 --> 00:47:36,360 And at the same time, the previous health had been national health and social service was all in one so 401 00:47:36,360 --> 00:47:42,060 that the consequences of looking after the care of people was not just for nursing, 402 00:47:42,060 --> 00:47:52,760 but also for the plant and services which required occupational therapists and all these sort of people social and the accoutrements that go with it. 403 00:47:52,760 --> 00:48:01,110 Right. Yeah. And one of her colleagues, which is Keith Joseph, separated social services from national health. 404 00:48:01,110 --> 00:48:08,790 So then there was another fiefdom and then and tensions of professionalism grew. 405 00:48:08,790 --> 00:48:13,380 And then the nurses found that the doctors were behaving badly, which they were, 406 00:48:13,380 --> 00:48:26,030 and talking down to the nurses so that the the Royal College of Nursing said they should should be a university training scheme for nurses. 407 00:48:26,030 --> 00:48:32,140 Yes. And so then there was another fiefdom where the nurses had to go to university. 408 00:48:32,140 --> 00:48:39,390 And and it was in particular the problem was that the university was another university and not a non-profit. 409 00:48:39,390 --> 00:48:47,220 So there was a competition of interest. And then the royal colleges then started having been genetic colleges of Royal 410 00:48:47,220 --> 00:48:54,210 College of Surgery and all kinds of medicine and alternatives to obstetrics. 411 00:48:54,210 --> 00:48:58,830 All right. Mm. They then became subspecialists. 412 00:48:58,830 --> 00:49:11,010 You had the Royal College of P p o the Royal College of General Practise and so and the Royal College of Psychiatrists. 413 00:49:11,010 --> 00:49:17,890 Every kind of sounds better. And then all in developed fiefdoms and Chinese walls of excellence is. 414 00:49:17,890 --> 00:49:29,170 So the whole thing then became a competition of excellence, which was so rather like the fiefdom of of of unions that they are a form of union. 415 00:49:29,170 --> 00:49:35,820 Mm. Uh, in many ways the same as the BMA. 416 00:49:35,820 --> 00:49:38,010 Mm. And the teaching unions. 417 00:49:38,010 --> 00:49:46,860 And so there's enormous competition of personal interests where the patient is a product that can be defended and traded between each. 418 00:49:46,860 --> 00:49:56,070 You know, from your days in the PM, you then became one of the teaching. 419 00:49:56,070 --> 00:50:04,800 I mean one of the main firms of the NHS. You would have kept up your links with the PM after 66. 420 00:50:04,800 --> 00:50:09,280 And then did you move the graph down to the cardiac unit? 421 00:50:09,280 --> 00:50:17,820 But it still happens. What happened when when we went up to the dawn of the days of the would? 422 00:50:17,820 --> 00:50:25,170 No, no, that's fine. I understand that it went yes. So now when you're up at the Dome Reactive Work Universe attach. 423 00:50:25,170 --> 00:59:09,440 Used to have. 424 00:59:09,440 --> 00:59:22,610 Looking at your time in the Radclyffe, John Radcliffe, do you think things developed well or poorly or should they have gone down the route? 425 00:59:22,610 --> 00:59:26,450 I think it was almost inevitable from outside circumstances that things that happen 426 00:59:26,450 --> 00:59:39,950 like this and what's happened is that the the society has changed from one of noble 427 00:59:39,950 --> 00:59:47,300 endeavour amongst the caring professions and the teaching professions and the and 428 00:59:47,300 --> 00:59:57,270 the legal profession and the political professions where there's a situation that. 429 00:59:57,270 --> 01:00:11,450 Them, where they think entirely about the material goods, the particular requirements, so it's very much a utilitarian functional. 430 01:00:11,450 --> 01:00:32,180 Uh, humanistic, utilitarian philosophy, which doesn't have a place deep down in the quietness of the mind for the nature of the intuitive, 431 01:00:32,180 --> 01:00:42,470 which in the kind of fields that we're moving in into sounds and and natural philosophy, 432 01:00:42,470 --> 01:00:53,680 which medicine is where the condition of the nonmaterial domain of consciousness is not just something that is part of a construct of a machine, 433 01:00:53,680 --> 01:00:58,310 uh, but comes from something which is totally mysterious and worshipful. 434 01:00:58,310 --> 01:01:13,980 So there's the sense of that kind of a duty to some higher, higher principle than just material to to understand it's doing it very well. 435 01:01:13,980 --> 01:01:15,590 No, no. That is what's going on. 436 01:01:15,590 --> 01:01:22,190 And so if you look at anything that's going on, including the new arrangements of the National Health Service and the professions, 437 01:01:22,190 --> 01:01:30,890 it's all about how we can tinker with the means when we haven't defined the philosophy of what that means for you to do. 438 01:01:30,890 --> 01:01:40,560 And there is a fundamental difference between the whole way that the material world is thinking compared with what you find in something like, 439 01:01:40,560 --> 01:01:45,130 uh, and it applies to the religions as well. 440 01:01:45,130 --> 01:01:56,670 Uh. To surprise me, the defence area and the police, 441 01:01:56,670 --> 01:02:01,820 and so where are the situation where going and being more and more sophisticated about 442 01:02:01,820 --> 01:02:07,490 how you prevent something happening which ultimately leads to massive conflict? 443 01:02:07,490 --> 01:02:10,370 Yes. Yeah, no, indeed. The wrong way around. 444 01:02:10,370 --> 01:02:16,520 So we have to come back to a situation where we don't tinker with more and more clever ways of monitoring each other. 445 01:02:16,520 --> 01:02:20,390 Just imagine the current situation with the community care groups. 446 01:02:20,390 --> 01:02:28,310 We now have a thing called Monitor that's a name for you with the government is to monitor how the monitoring has been done. 447 01:02:28,310 --> 01:02:36,110 So everybody is watching everybody else. There is a sense of deep, deep mistrust. 448 01:02:36,110 --> 01:02:40,520 Yes. Yes. Uh, and the openness. 449 01:02:40,520 --> 01:02:47,510 However, you can't have openness without trust, and that is so serious. 450 01:02:47,510 --> 01:02:52,880 It has to be it has to change and it won't change from the top down. 451 01:02:52,880 --> 01:02:57,260 And it comes back to how places like great medical schools like Oxford occur. 452 01:02:57,260 --> 01:03:00,950 And I take the view ultimately, if you go around the wards now and here, 453 01:03:00,950 --> 01:03:07,310 those clinical students in there who are all problem solvers and know exactly where they're going, 454 01:03:07,310 --> 01:03:16,640 they come in and then be marched about in groups, being told what what's going on by juniors and even the seniors. 455 01:03:16,640 --> 01:03:25,580 And I've even heard senior people in the medical school who they are to lead them talking about the kids when they're in their twenties and thirties. 456 01:03:25,580 --> 01:03:32,730 Mm hmm. Mm hmm. There's an arrogance of knowing best when we should be a place of corporate learning together. 457 01:03:32,730 --> 01:03:40,340 Yes. Yeah. So I think ultimately it'll have to change from the way the newer generations coming in have the guts to do. 458 01:03:40,340 --> 01:03:45,290 What's happening by analogy in Turkey at this moment when people know what's right. 459 01:03:45,290 --> 01:03:50,150 And so the children, the kids come in and they say, this isn't how we're going to be taught. 460 01:03:50,150 --> 01:03:57,920 We are we are coming to learn to solve problems with you as your genes take a long, long time to change. 461 01:03:57,920 --> 01:04:02,030 Yes. To that, partly as an answer to what I was thinking. 462 01:04:02,030 --> 01:04:07,820 What would you do if you were the Gauleiter of health over the next five years? 463 01:04:07,820 --> 01:04:17,210 But you feel it's a much longer problem. You're one of the people that I would like to go and talk to quietly is the current Gauleiter. 464 01:04:17,210 --> 01:04:22,700 His name is What's your name? I forget some of it was Donaldson, but. 465 01:04:22,700 --> 01:04:28,200 No, no, no. I mean the politician. Oh, right. Yeah, the new one's just moved. 466 01:04:28,200 --> 01:04:31,610 I think the guy's got right out. He could have it. 467 01:04:31,610 --> 01:04:39,860 He's got it. Yes, but it ends with an eight. He going there were you know, can't understand. 468 01:04:39,860 --> 01:04:44,300 Now that chap I, that chap I just never met him. 469 01:04:44,300 --> 01:04:50,420 But I can take a look. I mean he but he can't do it from the top down. 470 01:04:50,420 --> 01:04:55,170 No, no. He's got all these fiefdoms I've talked about. We know what to do. 471 01:04:55,170 --> 01:05:00,230 You have to do with the Royal College of Physicians. And what did you think. 472 01:05:00,230 --> 01:05:05,540 Yes. You were on a committee or do I know I wasn't? 473 01:05:05,540 --> 01:05:11,290 I was, uh, I think I've never been on any committee or anything. 474 01:05:11,290 --> 01:05:16,910 And, uh, I've got to know people up there. 475 01:05:16,910 --> 01:05:28,820 Um, my view is that if the committee seemed to actually get hubristic so that ultimately they only know each other on themselves, 476 01:05:28,820 --> 01:05:32,980 I've taken the view that I will find out who the secretaries of the committees are. 477 01:05:32,980 --> 01:05:41,270 Mm mm. And the same way that I used to know intimately every every gay porter in Oxford. 478 01:05:41,270 --> 01:05:50,990 Mm hmm. So you could park your car is in the same way that I still more or less know the telephone operator. 479 01:05:50,990 --> 01:05:55,490 They know who I am when I talk to them. Yes, but but, uh. 480 01:05:55,490 --> 01:06:08,680 So you need to know the functionaries very well. Hmm. But but I have a great admiration for people who are sufficiently public, so, I mean, 481 01:06:08,680 --> 01:06:17,710 the public servants that I'd like to see in college much more are the people who are in their 60s who give up, 482 01:06:17,710 --> 01:06:24,490 who don't want to go on, but people going in to do things on the college in their 40s and so forth. 483 01:06:24,490 --> 01:06:30,530 And so to the exclusion of what they ought to be doing makes me very, very worried indeed. 484 01:06:30,530 --> 01:06:43,260 And you will find that now with electronic voting, the college is now very dangerous because it's all done electronically on the first you know, 485 01:06:43,260 --> 01:06:46,690 the people who go and the only people who are going to people who are grim grooming 486 01:06:46,690 --> 01:06:51,610 themselves for high office and then doing their work properly is a very worrying situation. 487 01:06:51,610 --> 01:06:58,300 Yes. What did you think about the administration in Oxford, Ben? 488 01:06:58,300 --> 01:07:08,770 Well, I learnt a lot about how wrong I was about it. I mean, the one thing I mean, when you're simple directive, we all rather laughed at John Barrow. 489 01:07:08,770 --> 01:07:13,720 We thought he was sycophantic one week run by his wife, actually. 490 01:07:13,720 --> 01:07:19,000 But when you came to find out what was going on in that tiny organisation, 491 01:07:19,000 --> 01:07:22,920 John Barrow was one of the most devoted civil servants has ever been in health. 492 01:07:22,920 --> 01:07:31,450 Yes. And you didn't find out until he wrote that book. And that book wouldn't have been written if we hadn't had a thing called McKinsey. 493 01:07:31,450 --> 01:07:40,840 Right. Because George Pickering, no monkey talk to another millionaire monkey called Kouda and Talor then went and got something 494 01:07:40,840 --> 01:07:48,990 organised when he went to the King's Fund or whatever it was set up this enquiry into Oxford, 495 01:07:48,990 --> 01:07:56,860 much of which came to Coquille. Mm hmm. And the guy who did that was a man called Maximalism. 496 01:07:56,860 --> 01:08:02,860 I've never actually talked about that, but actually everything went on this place. 497 01:08:02,860 --> 01:08:10,780 But McKinsey works by making some major discovery of efficiency and so some here. 498 01:08:10,780 --> 01:08:16,940 So he was employed by McKinsey. And he's a good, nice, honest, good man. 499 01:08:16,940 --> 01:08:23,680 Well, he's a lovely chap, but some head had to fall and that head was. 500 01:08:23,680 --> 01:08:29,380 Yes. And he was fat. Mm hmm. Mm hmm. And then he wrote this wonderful book. 501 01:08:29,380 --> 01:08:33,340 What a gentle, discerning Christian man that was. 502 01:08:33,340 --> 01:08:39,640 He wrote a book and he knew it backwards. And he was his old guard, civil servant. 503 01:08:39,640 --> 01:08:43,310 And now the government of getting rid of those known and the civil servants are 504 01:08:43,310 --> 01:08:47,620 a very vulnerable brood breed now because they are they should be above party, 505 01:08:47,620 --> 01:08:49,750 but they are now being big party hacks. 506 01:08:49,750 --> 01:08:55,790 But to come back to burrow, he is a limitation of degrees of freedom, prevented him from doing the things he wanted to do. 507 01:08:55,790 --> 01:09:00,070 Yes. Yes. So we were very blessed. 508 01:09:00,070 --> 01:09:06,610 Now we have administration. I admire the current chief executive enormously, but then his office. 509 01:09:06,610 --> 01:09:13,370 But what worries me is that they never come out of their office. The chief medical officer has never seen them. 510 01:09:13,370 --> 01:09:19,030 He is meant to be a paediatric physician and he probably does half a day. 511 01:09:19,030 --> 01:09:28,390 But I mean, he knows nothing about what's going on. And we had a good clinician who was David Wells, Rita, whatever it was. 512 01:09:28,390 --> 01:09:33,160 Mm hmm. Whose name I got to say this. I can't remember, but you know who I mean. 513 01:09:33,160 --> 01:09:38,260 And he went to become the chief of the bunch and he became a guy with a clipboard. 514 01:09:38,260 --> 01:09:41,650 Yeah, that's as bad as anybody else is. Crispen, you. 515 01:09:41,650 --> 01:09:46,270 No, there's no sense of corporate leadership that I learnt about in the Army. 516 01:09:46,270 --> 01:09:55,960 Yeah, yeah, yeah. You know, you can't get people to go in all different ranks and so forth pulling on the same boat when if you if you don't get on. 517 01:09:55,960 --> 01:10:04,330 So they all feel part of the show together when one of them was going to get killed, you know, now you don't get killed. 518 01:10:04,330 --> 01:10:09,670 No, that's the problem. Yeah. Yeah. There isn't the corporate responsibility. 519 01:10:09,670 --> 01:10:17,800 And we now have a situation which is beyond all of them a sense because the place is so big, 520 01:10:17,800 --> 01:10:26,230 the old model that you and I know about before, even when they went up the hill first nice. 521 01:10:26,230 --> 01:10:33,070 It was level. They were in place if were told about that. So it wasn't very much bigger, had more people in it. 522 01:10:33,070 --> 01:10:37,210 But it's now got to a size efficient mass where it's so big nobody can communicate. 523 01:10:37,210 --> 01:10:39,640 Yeah, no, I think that comes into it. 524 01:10:39,640 --> 01:10:48,430 And I know the long corridor, the old reactive, very different from the lifts and the general active for meeting people, just for meeting people. 525 01:10:48,430 --> 01:10:58,390 I mean, the experiment, they did try hard to try and make people do it together, but everybody takes sandwiches and they never meet either. 526 01:10:58,390 --> 01:11:05,400 They send emails to. Never send an email to talk to the person first about anything important that never happens. 527 01:11:05,400 --> 01:11:11,310 Now we've covered a lot, but is there anything you'd like to be talking about that I haven't done? 528 01:11:11,310 --> 01:11:21,900 I think really what I would like over lunch, we talked about, I think what you're doing when it goes to the to the Bodleian, 529 01:11:21,900 --> 01:11:29,370 one of the things that is happening now, we have so much information that it never gets out. 530 01:11:29,370 --> 01:11:41,700 It's never syntheses, because I think basically if there's so much information that there's there's no information. 531 01:11:41,700 --> 01:11:46,110 And so the result is that all the same mistakes will be made again. Mm hmm. 532 01:11:46,110 --> 01:11:48,330 And there is something that requires a state of affairs. 533 01:11:48,330 --> 01:11:55,230 And I don't think it's anything to do with changing the way is the young doctors are trained or the responsibilities or the after hours. 534 01:11:55,230 --> 01:12:03,270 But that requires us that all the after hours it takes and giving people time off and so forth, that was done in our day. 535 01:12:03,270 --> 01:12:12,480 But there was a situation where together we we realised that we could provide that full hand, but we didn't have to be legislated for it. 536 01:12:12,480 --> 01:12:21,660 So we have to get back to a corporate sense of vocation or duty to start with and organise ourselves and not have to have new systems put into place. 537 01:12:21,660 --> 01:12:28,110 But more importantly, I don't think that business is going to be done until the next generation or 538 01:12:28,110 --> 01:12:32,610 two or three generations of young men and women coming into medicine come in 539 01:12:32,610 --> 01:12:37,470 with their eyes shining like that for young men going in and saying he wants to 540 01:12:37,470 --> 01:12:42,720 wants to do good and good and was ridiculed because that's what's happened. 541 01:12:42,720 --> 01:12:50,190 The people I meet have that sense of what I've just met a medical student, a one such person aged 17, 542 01:12:50,190 --> 01:12:59,790 whereas somewhere he doesn't think he's going to get into a medical school because he doesn't think he's going to get enough high grades. 543 01:12:59,790 --> 01:13:03,400 Right. When he's when he has a deep sense of purpose. 544 01:13:03,400 --> 01:13:15,840 Yes. Yes. That there is a requirement for a very much more particular generation to come along and that'll take time. 545 01:13:15,840 --> 01:13:21,870 Well, that's been a splendid interview, closing down this interview. 546 01:13:21,870 --> 01:13:23,386 That's all that makes.