Category Archives: consultants

Black comedy in the ward

Like something from Hancock's Half Hour, only blacker

Like something from Hancock’s Half Hour, only darker

Once as a medical student, writes Dalrymple,

I was deputed by a hospital consultant to tell a family that their loved one was dying of lung cancer.

The imparting of such information was not regarded by the consultant as very important,

indeed he thought it almost a distraction from the serious business of curative medicine.

Without any guidance as to how to do it, Dalrymple told the family

in a very straightforward way, not because of any commitment to honesty but because I could think of no other.

To Dalrymple’s horror,

one of the relatives was very hard of hearing, so I had to raise my voice to so high a volume that my voice echoed round the ward. It would have been comical if it had not been so appalling.

In any case, the dying patient might have guessed that he was in a bad way because,

when the medical notes were put out at the end of the bed before the consultant’s ward round, those that contained a diagnosis of cancer were left out. In other words, if you were lying in bed and the notes failed to appear at the end of your bed, you knew the diagnosis was bad, despite the doctor’s assurance that it was ‘just a little ulcer’ in your lung or your bowel.

Harley Street paved with gold

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Harley Street: view from Cavendish Square

Iatrophobia is a serious medical condition (focal sepsis is very often present), though it is sometimes highly treatable — and at the very least can be managed and palliated — if the patient is constrained to undergo a colectomy and adjuvant frontal leucotomy along with inguinal orchiectomy and Metrazol-induced convulsion therapy.

The psychotic delusional condition of iatromisia, on the other hand, though it can be treated with the above methods — applied perforce with much greater intensity and with the addition of comprehensive salvage insulin coma therapy (Insulinschockbehandlung) — is sadly not so tractable.

Harley Street: view from Cavendish Square

Harley Street: view from Cavendish Square

Indeed, writes Dalrymple, carcinoma iatromisia is metastatising,

not among the general public, which on the whole retains its respect for and trust in doctors (a fact borne out by all the surveys), but among the intelligentsia — literary folk, journalists and so on.

This kind of people,

perhaps because their own crafts are held in such low public esteem, believe that doctors should be taken down a peg or two.

Harley Street: view from Cavendish Square

Harley Street: view from Cavendish Square

Dalrymple says there are two main charges against doctors, particularly hospital consultants:

  • they are on the golf course most of the time
  • they are making a fortune from their private practices

These two complaints, Dalrymple points out,

are not strictly compatible. Doctors are often quite clever people, but even they have not mastered the art of being in two places at once, and the only way of making money out of private practice is to work very hard at it. Doctors are not paid for a birdie three or an eagle two.

On the part of journalists and the literati, Dalrymple observes,

141 Harley Street

141 Harley Street

the primordial antagonism towards doctors is not fully rational: it is a little like anti-Semitism.

Jews, to the anti-Semite, are simultaneously

  • capitalist plutocrats
  • communist agitators

In the same way, doctors, to the iatromisiac, are simultaneously

  • incredibly lazy
  • ferociously avaricious
Crœsus of consultants: Thomas Horder, 1st Baron Horder, lords it over his patients in his consulting-room at 141 Harley Street. Note the photograph of Neville Chamberlain on the mantelpiece

Crœsus of consultants: Lord Horder at 141 Harley Street. Note the framed photo of Neville Chamberlain

How fortunes are made effortlessly from private practice

The golf course is to iatromisia

what ritual murder is to the anti-Semite: a myth to keep a hatred warm.

Dalrymple explains that

doctors as a group are better than many groups of comparable size.

Of his own professional circumstances he writes:

I am on duty one night in five, and have been for years. I do no private practice, apart from some medico-legal work. I never refuse to get up in the middle of the night to see a patient, and if I do get up, I still have to go to work the following morning, however tired I may feel. My pay is adequate, and I do not complain about it: my wife, who is also a doctor, and I live well but not extravagantly. Certainly, many people with less strenuous lives earn much more than we do. As far as I am aware, I have not lost a single patient through carelessness in all those years.

Harley Street looking north from Weymouth Street

Harley Street looking north from Weymouth Street

And what Dalrymple does

is only what thousands of other doctors do.

To be told that he belongs to

an avaricious, power-mad, privileged and lazy cabal by people whose prerogatives are distinctly those of the harlot sticks a little in my throat.

Dalrymple does not claim to love humanity,

Harley Street looking north from Weymouth Street

Harley Street looking north from Weymouth Street

but I do get up at 3am if I am required to do so. It is far, far easier and less demanding to write an editorial; I know because I have done both.

Iatromisia, he points out,

coheres with governments’ increasing fear of professions that escape their complete control. Disproportionate criticism of the medical profession by journalists and authors serves governments’ goal of a totally managed society.

91 Harley Street. At left, the chauffeur keeps the Bentley engine running, ready to take the consultant to the golf course or the bordello at any time of the day

91 Harley Street. Note the parked Bentley. The chauffeur keeps the engine running, ready to take the consultant to golf course, club or bordello at any time of day

91 Harley Street

91 Harley Street

13 Harley Street

13 Harley Street

Consulting-room at 13 Harley Street. Note the painting of a young Margaret Thatcher

Consulting-room at 13 Harley Street. Note the painting of a young Margaret Thatcher

73

73 Harley Street. Architect: W. Henry White

73 Harley Street. Architect: W. Henry White. The French Loire style, brick with plenty of terracotta decoration on a small, playful scale (Pevsner)

73 Harley Street. ‘The French Loire style, brick with plenty of terracotta decoration on a small, playful scale’ of which there are several specimens in and around Harley Street, ‘characterised by heavy curved door canopies, shallow bay windows, Tudor mullions and transomes, steep gables’. (Pevsner)

83 Harley Street

83 Harley Street

Fireplace in a consulting-room at 83 Harley Street. The consultant stands before it, delivers a homily — with the patient maintaining a respectful silence — on bowel regulation or the virtue of broccoli ingestion, then it’s off to the links, his club or his mistress's Belgravia flat

Fireplace in a consulting-room at 83 Harley Street. The consultant stands before it, delivers a homily — with the patient maintaining a respectful silence — on bowel regulation or the virtue of broccoli ingestion, then it’s off to see the mistress in her Belgravia flat, or else to the links or the club. Yes, life is good

88 Harley Street

88 Harley Street

88 Harley Street

88 Harley Street

92 Harley Street

92 Harley Street

92 Harley Street

92 Harley Street

Harley Street viewed from Cavendish Square

Harley Street viewed from Cavendish Square

Shameful, degrading, awful, appalling

Screen Shot 2016-04-05 at 09.28.06The unnameable

Dalrymple writes that on one of the wards in which he worked as a young doctor, there was

a strange ritual. Before the chief did his rounds, the medical notes of all the patients would be put out on their bed tables, ready for him to consult – except those of the patients with cancer. They were not the only patients on the ward with potentially fatal conditions, of course; but cancer was regarded as a disease so awful, with an outcome inevitably so degrading, that it shamed the patient and doctor alike, and therefore could not be named or referred to. Cancer was held in a peculiar kind of appalled awe.

So you want to be a consultant

Dalrymple is third from left

The young Dalrymple is third from left

Dalrymple remembers the advice proffered by a senior consultant to himself and other young people at the outset of their clinical studies. The consultant

was teaching us how to examine patients. He had just discovered that he had cancer of the bowel, which he took to be a sentence of death. His life was at an end, he said, and now he realised that he had devoted it to a worthless ambition, namely to become a consultant in a teaching hospital.

To achieve this he had led a deformed life for many years. He had

  • been endlessly on duty at night, ruining his family life
  • toadied for years to men whom he detested
  • failed to develop other interests
  • played silly academic games by doing research which he knew from its inception to be futile, since it was undertaken from a desire for promotion rather than from love of knowledge
  • lived his entire adult life in a single institution, knowing nothing of the world beyond

And now

it was too late, he was dying.

I know you don’t like me,’ he said, which was no more than the truth, for he had been an irascible and intimidating teacher.

But I want to give you a piece of advice. You won’t take it, I know, but I’ll give it you all the same. On no account pursue a career only for power or prestige. To live an interesting life, that is the main thing. You don’t appreciate it yet, but this is the only life you have, so make the most of it. Don’t do what I’ve done. The world is much bigger than any hospital.

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