OUT OF PRACTICE

By Robert E Stewart
Contact the author via Chris Johnstone by e-mail at christopher.johnstone@ntlworld.com

General Practice in the 1950's. In the 1950's, posts in general practice were difficult to obtain because of a glut of doctors returning from the war. In order to get my foot on the ladder, I had to accept a lowly post of live-in assistant without a view to a partnership. My contract was for six months only during the winter months and I would be asked to leave in the summer when the work load was lighter.

I arrived full of enthusiasm and was required to stay in the doctor's house in a bleak mining village in Lanarkshire. I was given a warm welcome and made to feel one of the family. Being high up in the moors, the climate was severe and on many occasions I left my family in rainy Glasgow to arrive at the village in deep snow. Morale in the village was low as many of the local pits were closing and miners were drifting west to the newer mines in Fife.

My employer introduced me to his surgery which was held in a small shop near to his house. The front shop was the waiting room and was generally full with many patients standing. A woman was employed to keep order here and her main function was to lock the front door firmly when the surgery hour was up. Patients were then carefully let out after they had seen the doctor and any latecomers firmly prevented from sneaking in. The picture was far removed from the luxurious health centres of today.

The doctor's premises were in the small back shop. Here a roaring fire in an old fashioned iron range produced a welcome heat. On it was a kettle bubbling with boiling water. I shall tell you its use later. An old fashioned wooden chest held all manner of curious items. Two chairs and a small table for the doctor filled the remainder of the tiny room. Frequently patients were seen standing and were discouraged from sitting down There was no couch, so any proper examinations had to be carried out at the patient's home after surgery was finished.

Tonics were often requested. The 'green one' was popular and so was the 'red one'. Neither had any pharmaceutical value but their placebo effect worked miracles. For sore throats the miners asked for a 'steel gargle'. This contained an iron preparation which caused an astringent effect at the back of the throat. Antibiotics were just being introduced and sulphonamides ('M & B' tablets named after the firm May & Baker) were popular. Penicillin was being introduced and was often given by injection. Like a car at a filling station, the patient received a large amount in his buttock which ensured an adequate level of the drug for three or four days.

In fact, injections were greatly prized and the procedure to be adopted was a curious one. A drawer of the chest was opened and there lay a fearsome selection of syringes and needles cradled in a bed of dusty cotton wool. After selecting an appropriate combination, I was instructed to fill it with boiling water from the kettle and rinse this out carefully. The medication was then drawn up and the patient duly stabbed. I never saw a single case of sepsis during my time in this practice.

When the statutory hour had passed, it was disheartening to find the waiting room packed with patients who had managed to arrive in time before the door was locked. The National Health Service had been in place for only a year or two and was very popular. Free spectacles, teeth, elastic stockings and trusses were all available with a note from the doctor and many a miner or his wife simply could not believe their luck.

You may consider that this type of general practice was a rough and ready affair. But in some ways patients got a better deal than at present. Anyone could see the doctor on any day by attending the morning or evening surgery. There was no such thing as asking for an appointment first. Unlike today, if a home visit was requested, this was undertaken the same day without question. Patients with chronic diseases were visited assiduously every two, four or six weeks and there was little chance that serious deterioration would be missed. All this was achieved without today's army of secretaries, practice nurses, health visitors and counsellors. By and large patients were very grateful for the attention they received and the many grumbles we hear about the N.H.S today were not expressed then. For many, the service on offer was an amazing improvement on what had been available before.

Life for the average family doctor in those days was extremely hard. Off duty was at best one half day each week and every second Sunday. Morning and evening surgeries were conducted daily, sometimes including Saturdays, and home visits occupied the time in between and might amount to 15 to 20 daily. Late evening and night calls were common and yet the doctor was expected to be alert and pleasant at the morning surgery next day. The doctor's wife too had an arduous life and was expected to handle calls and telephones without any payment from the N.H.S.

Amongst the older generation there is a wistful longing for this former pattern of family doctoring to return. But present day doctors would never accept such unremitting toil. General practice in urban areas is now a 9 to 5 affair and is largely staffed by part time doctors, the majority of them women. Furthermore, no doctors have to undertake out of hours emergencies unless they wish. Except in rural areas, the luxury of a personal family doctor is not available and a new era of general practice has begun. But for the majority of family doctors and their wives, life is sweeter and healthier and patients need no longer fear being attended to by a tired and worn out doctor.

Other hoolet online articles by Robert E Stewart can be found at:
hoolet edition 47 - Out of Practice
hoolet edition 37 - Practical Skills in General Practice

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.