24 JULY 1971, Page 10

PERSONAL COLUMN

I've got here too late

VERNON COLEMAN

I was still in short trousers when I decided that I would like to be a doctor. My reasons were then simple enough; I had no great vocation, no urge to cure the world of all its ills, no desire to find a wonderful new cure for some dreadful old disease. I just wanted to be a doctor because from what I'd seen of our rather elderly, oldfashioned family general practitioner, medicine was a rather dignified profession. It seemed a good way to live, ninety per cent of the time one could manage one's work in a fairly leisurely fashion, and for ten per cent of the time there was enough excitement and fever to keep one on one's toes. No relatives of mine had ever practised medicine, the nearest we'd ever come was an uncle who made false teeth in his spare time, so my view was strictly from the outside. Nevertheless I don't think it was very far from the truth. In those days, twenty years or so ago, general practitioners were badly organized, they blundered through their days with little more administrative help than a diary.

I thought that sort of life would suit me. Whenever I've had a desk I've always kept it in a mess, I always note down appointments but half the time I lose the notes; I always reply promptly to the letters I receive, but half the time I put the wrong letter in the right envelope or forget to post the thing altogether. And yet no great harm seems to be done and I muddle through well enough. It was in that sort of way that our family doctor muddled through. His one big asset was that he was interested in people. He like to sit and talk, and he always had time to talk. He was kindly, gentle and full of sympathy which he handed out freely and generously. He was far more careful with the pills and lotions.

Heaven knows what the poor old fellow would think if he were still in practice today. I wonder what he'd make of all the gadgets which have been introduced—the tape recorders, secretaries, answering machines, filing systems, group practices, appointment systems, and heaven knows what else. The advances in diagnosis and therapy have been few enough but there have been plenty of advances in administration in the last twenty years. The managers have taken over; the business of general practice has been rationalised. The time and motion study boys have looked it over and cleared away the comfortable old desks, the piles of letters, the dog-eared diary and replaced them all with shiny steel cabinets, forms and more forms and baby computers. Everything is organised. now. You can be ill from nine to ten but after that you must wait until six unless you telephone before twelve in which case you can be seen from three to four on Mondays and Wednesdays and four to five on Tuesdays, Thursdays and Fridays. In the evening you see a different doctor and at night you see yet another different face. At weekends you probably see someone else.

The continuity has gone out of medicine. The whole thing is carefully arranged so that the doctor can have six out of seven evenings off to watch the telly in peace and three out of seven weekends free to spend in his boat. Five, six or even more doctors share ten or twelve thousand patients; there is no longer any such thing as ''our doctor.'

Even the surgeries have changed. The doctor used to practise from a room at home. When he wanted a break he slipped into the kitchen for a cup of coffee. Sure the magazines in the waiting room were old, the paint was peeling and the notices were a bit out of date. But it was a place. It wasn't just a concrete, steel and glass shell wherein doctors go through the motions of being doctors and patients hardly dare go through the motions of being patients. The doctor is now a technician. He is no longer known and loved as one of the family. Medicine isn't practised any longer, it is just done. It's a job of work and it pays well if you have it organised properly. If you play your cards right and have a good appointment system, enough special grants and a few efficient secretaries and receptionists you can do a few sessions at the local hospital. You can get a few jobs at the clinic too. There's lots of opportunities for making money as long as you don't have to spend too long with the patients.

Having only just qualified I feel redundant already. I feel as if I've come on the scene about fifty years too late. It's rather like arriving at your own funeral. I don't want to put the clock back to the days when single-handed practitioners fought heroically against all sorts of odds to see their patients and comfort them on their death-bed. It's not that I want to even go back to the days when the doctor was the local conscience, the respected man with the stethoscope, ears and no mouth. I just want to go back to the days when medicine was practised by men who cared about people, not technicians who cared about statistics. I want to organise my life my way, make my own mistakes and see my own patients. But I think I've got here too late.