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Christopher Lawrence
LIFELINE Christopher Lawrence Christopher Lawrence qualified at Birmingham in 1970. He trained in general practice in the Shetland Islands, but forsook medicine in 1973 for history. He is currently professor of the history of medicine at University College London, and at the Wellcome Institute. His principal research is on the relation between the basic sciences and clinical medicine since 1700. Who was your most influential teacher and why? My teacher of Spanish at grammar school who always had faith that I was not just a naughty boy. What would be your advice to a newly qualified doctor? Remember that the way we learn and practise medicine was not written on stone tablets by an extraterrestrial of higher intelligence. How do you relax? Horse racing (not always relaxing), cooking, and gardening. What is your favourite film and why? The Ladykillers. It confirms the genius of Alec Guiness, Peter Sellers, Ealing Studios, and Boccherini. What is your favourite journey and why? Driving to the Cantal to enjoy the superb aligot at the hotel Les Voyageurs in Pont Salars. What is your greatest fear? Not being taken humourously. What are you currently reading? Peter Mandler, The Fall and Rise of the Stately Home (All good specific history is based on a wide knowledge of general history). What is your worst habit? Resisting temptation. What is your greatest regret? Not backing Burrough Hill Lad at 33/1 to win the Cheltenham Gold Cup (which he did). What alternative therapies have you tried? None, but thankfully, I don’t get sick often. What is the greatest love of your life? Listening to live recordings of Max Miller on stage, How would you like to die? Very quickly after enjoying a good bottle of claret.
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Trifles hen you go to the doctor a questionnaire is waiting for you, especially on the first visit. The receptionist has the clipboard and pen ready. In the USA, naturally, the first priority is the patient’s insurance, followed by whether the patient is mad or just a little neurotic; this leads into alcohol drunk per week stated in ounces or millilitres (this is tricky because the patient, according to the ancient joke, knows that he is a problem drinker only if he actually drinks more than the doctor). The patient cannot really understand these measurements, being more at home with brimming pints and tots. Finally, there are the doctors preferred illnesses. These questions may seem impudent but they can be worse. For immigrants to the USA there is Form 1–485. The 14 questions include such gems as “Do you plan to practice polygamy in the US?”, “Have you knowingly committed any crime of moral turpitude?”, “Have you within the past 10 years been a prostitute or procured anyone for prostitution or intend to engage in such activities in the future?”. So help me God. Returning to the clipboard among the information captured may be the “anamnesis”. This means both “the faculty of memory” and “the past history of a patient and his family”. The anamnesis is a lengthy enquiry based upon the principle that most features of a patient’s history are relevant. Given that you are a serious and honest person, how do you reasonably help the doctor with his inquiries? He might sincerely want to garner every scrap of information from you. You turn your mind back, scratch your brain, dig up every incident and fantasise, while mixing up your metaphors.You start off with being an embryo. Your youngish parents conceive at mittelschmerz. You are among the minority that survive conception and become a fetus. The amniocentesis needle does not stab you
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in the eye.Your placenta is parked in the right spot. Your mother avoids alcohol and nasty drugs. You arrive on the expected date of delivery. Your father drives you and your mother to hospital on time. The doctor and the nurses are on the ball. The labour does not last too long. You do not get too much oxygen. Yet you are in the pink! Thereafter, gorgeous mother feeds you. You lie on your back and avoid sudden infant death syndrome. Removal of prepuce, tonsils, and adenoids and immunisation are a piece of cake. In puberty the transition is easy, with no acne, blushing, PMT, or ADD. You avoid AIDS, marriage is a delight with no rows, no major mental illness, and a row of adjusted kids who go through on scholarship. And so on and so on. Charming, blissful, and prototypic media stuff. What about actuality? Since this is anamnesis or conscious experience we can skip the early stuff. Let us imagine possibilities for life charts. What about a little enuresis, some school phobia, and a dollop of trichotillomania. A driblet of acne may follow and then some facial blushing and a stammer. Crowding of teeth requires dentistry. Difficulty learning may be laziness, ADD, or being in the wrong field of study. Over zealous games of rugby may produce broken noses and schaphoid bones. Marriage brings in early retirement from playing rugby and rugby team boozy evenings. Sleep becomes restless as work stressors mount. There is a remembrance of female ancestors having depression. Was it only in the female line? Minor chronic illnesses like proctalgia fujax, acne rosacea, athlete’s foot, and retinal migraine set in. All can be lived with. Middle age is sailed through apart from the mild hypertension found accidentally at the pharmacists. So, goes our hero. Do these little things count? Are they incremental? Or just part of dear old life? Robin Eastwood
THE LANCET • Vol 355 • January 15, 2000
244
Trifles hen you go to the doctor a questionnaire is waiting for you, especially on the first visit. The receptionist has the clipboard and pen ready. In the USA, naturally, the first priority is the patient’s insurance, followed by whether the patient is mad or just a little neurotic; this leads into alcohol drunk per week stated in ounces or millilitres (this is tricky because the patient, according to the ancient joke, knows that he is a problem drinker only if he actually drinks more than the doctor). The patient cannot really understand these measurements, being more at home with brimming pints and tots. Finally, there are the doctors preferred illnesses. These questions may seem impudent but they can be worse. For immigrants to the USA there is Form 1–485. The 14 questions include such gems as “Do you plan to practice polygamy in the US?”, “Have you knowingly committed any crime of moral turpitude?”, “Have you within the past 10 years been a prostitute or procured anyone for prostitution or intend to engage in such activities in the future?”. So help me God. Returning to the clipboard among the information captured may be the “anamnesis”. This means both “the faculty of memory” and “the past history of a patient and his family”. The anamnesis is a lengthy enquiry based upon the principle that most features of a patient’s history are relevant. Given that you are a serious and honest person, how do you reasonably help the doctor with his inquiries? He might sincerely want to garner every scrap of information from you. You turn your mind back, scratch your brain, dig up every incident and fantasise, while mixing up your metaphors.You start off with being an embryo. Your youngish parents conceive at mittelschmerz. You are among the minority that survive conception and become a fetus. The amniocentesis needle does not stab you
W
in the eye.Your placenta is parked in the right spot. Your mother avoids alcohol and nasty drugs. You arrive on the expected date of delivery. Your father drives you and your mother to hospital on time. The doctor and the nurses are on the ball. The labour does not last too long. You do not get too much oxygen. Yet you are in the pink! Thereafter, gorgeous mother feeds you. You lie on your back and avoid sudden infant death syndrome. Removal of prepuce, tonsils, and adenoids and immunisation are a piece of cake. In puberty the transition is easy, with no acne, blushing, PMT, or ADD. You avoid AIDS, marriage is a delight with no rows, no major mental illness, and a row of adjusted kids who go through on scholarship. And so on and so on. Charming, blissful, and prototypic media stuff. What about actuality? Since this is anamnesis or conscious experience we can skip the early stuff. Let us imagine possibilities for life charts. What about a little enuresis, some school phobia, and a dollop of trichotillomania. A driblet of acne may follow and then some facial blushing and a stammer. Crowding of teeth requires dentistry. Difficulty learning may be laziness, ADD, or being in the wrong field of study. Over zealous games of rugby may produce broken noses and schaphoid bones. Marriage brings in early retirement from playing rugby and rugby team boozy evenings. Sleep becomes restless as work stressors mount. There is a remembrance of female ancestors having depression. Was it only in the female line? Minor chronic illnesses like proctalgia fujax, acne rosacea, athlete’s foot, and retinal migraine set in. All can be lived with. Middle age is sailed through apart from the mild hypertension found accidentally at the pharmacists. So, goes our hero. Do these little things count? Are they incremental? Or just part of dear old life? Robin Eastwood
THE LANCET • Vol 355 • January 15, 2000