07.Fading Memories of dead colleagues

After I had been shortlisted for the consultant post at Barnet General Hospital, my first visit had two purposes: to get an idea of the travelling distance from Woodford, and to meet some future colleagues. It would have been unwise not to show courteous interest. It also showed them, that this 'ex-Israeli' spoke fluent English, wore a suit, and behaved acceptably. Much later I heard, that at Barnet the news of my appointment was circulated as 'The Israeli got it'. -And I do not even have an accent!

The senior physician Dr Oliver Garrod showed me round. His one remark that I remember was, that at Barnet all patients washed before they attended. Presumably he assumed that at Westminster hospital, where I was working, the slum dwellers and Salvation Army beggars were all filthy. He introduced me to Ken Stone, the orthopaedic surgeon. But not to his colleague Dr Royston, the other consultant physician. I soon found out that they loathed each other. Soon after I started work, I introduced myself to Dr Royston. He was clearly pleased that I had shown the courtesy to meet him.

On the evening before the meeting of the appointment committee, a sherry party was held at the hospital. All interested consultant have copies of the CVs of all four shortlisted candidates and can ask questions informally. Then the candidates leave, and the consultants decide on the one that their representative will support at the appointment committee. I remember being asked how importantly I regarded a physiotherapy pool. There wasn't one at any of the hospitals where I had trained, and I had heard that at the new Royal free the pool leaked into the floor below. I replied that upgrading the antiquated physiotherapy department was of greater priority. But it was never done during my tenure...

Much later I heard a vague roumour, that shortly before, a large donation had been received specifically to create a physiotherapy pool. I could never obtain details but some of my colleagues obviously used that money for other purposes.

My predecessor Dr Talbot had been a consultant in physical medicine - dealing non-surgically with skeletal problems. He knew little about rheumatoid arthritis or its medication - these patients were referred to, and managed by, the general physicians. Dr Talbot just ordered physiotherapy and gave local injections. When I was shown round, there was a bottle of smelling salts, used for those who fainted during the large volume injections that he gave. I changed all that.

At Finchley memorial hospital, Dr Talbot's one-line clinical notes were written as instructions on the physiotherapy card. This entry was followed by a series of date stamps - indicating the patient's attendance for treatment. Then followed Dr Talbot's next entry: a variable number of 'v's followed by 'm.' and 'i.'. It was explained to me that this meant a variable number of 'very', up to 'very very very very', followed by 'much improved'.

I asked to write my clinical notes in the patients' medical record. For diagnosis, and for safety, I needed to see other clinical documentation. As expected, the medical records officer claimed that this could not be done. In that case, I said, I shall not see any patients from next week. The 'Israeli' got his way.

At Barnet I saw my patients in one of the cubicles of the physiotherapy department. I was told that the purpose-built outpatient department was fully committed for prior colleagues. Only years later, did I get 'squatters rights' when someone left.

The washbasin, used also by all the physiotherapists, was diagonally across the corridor - and it was busy. So I asked Bill Brewer, the hospital secretary, for a new washbasin in my clinic cubicle. He replied within days, that the plumbing and drainage only existed along the opposite wall.

So I sent Bill Brewer a draft letter, that I intended sending to all patients on my waiting list, for his advice. I explained that the distance to the washbasin and the occasional extra waiting there probably reduced by one or two the number of patients that I could see per session. Within a fortnight, I had my own washbasin built and connected.

The physiotherapy department had a single telephone line. It was in the office, further away than the washbasin was. But Bill Brewer explained that unfortunately all the lines of the hospital exchange were fully committed. So once again I showed Bill a draft letter to the Regional Hospital Board, asking for their help. To my delight, a telephone line for my clinic was found almost immediately.

Computers were becoming fashionable. Judith and I even attended evening classes to learn about them. At Barnet, sheets of self-adhesive identity labels were now prepared for attending patients. No longer did I have to write these details on request forms for up to 5 different investigations. It was bliss.

I checked and initialled all results of investigations. Occasionally the patient had to be recalled sooner unexpectedly to make sure, or for safety reasons. And although the identity labels had addresses and dates of birth, they had no phone numbers. So I visited the computer office - far posher than my cubicle. But they explained that there was no additional 'field' available for a phone number to be added. From my evening classes I knew that this was a lie.

The solution was simple. After each outpatients session, when I dictated letters, I put aside all medical folders where the result of an investigation was awaited. And when the result came, my secretary would put it in the notes and, if necessary, contact the patient - the phone number was in the folder, though not on the label. Medical records had extra work on patients, who also attended other departments, while I was 'hanging on' to the notes. Too bad.

A few months before I retired, out-patient appointments were due to be computerized. A man came to ask for my preferences. There were two problems. First, There was no back-up for the computer that was used. Once a month, the data were sent to 'the Region', he reassured me. I had visions of clerical staff scurrying round at the start of clinics when the computer was 'down'. And sure enough, I observed such episodes.

And second, there could only be clinics of either 'new patients', or 'follow-ups', and no flexibility of time length for individual patients. Whereas I always mixed 'new patients' and 'follow-ups', and I did read the GP letters to decide on expected duration of each interview as well as the urgency. There were two indications for early appointments: one was a GP description that suggested an early assessment. The other was a letter from one of 2 or 3 local GPs, whose clinical knowledge was clearly poor: they were unable to recognize potentially serious conditions. Their identity was well known also among my colleagues.

Once again, the solution to the computer scheduling of my clinic lists was simple. I refused the new programme, but took the appointment book into my clinics, found the appropriate slot for the next visit and filled it in both in the book and on the patient's appointment card. It took just a few seconds. My successor complained to me, that he had not been able to maintain my system. And occasionally chaos did indeed ensue, when the computer was 'down'. Receptionists and nurses had to wait until patients arrived for their appointment, before they could search for their notes.