- Email: [email protected]
Moving ahead by degrees
DISSECTING ROOM
LIFELINE Raymond Tallis Raymond Tallis trained at Oxford University and St Thomas’s Hospital. After house jobs he held a crucial research post at Wessex Neurological Centre investigating spinal cord stimulation in multiple sclerosis. Since 1987 he has been professor of geriatric medicine at Manchester University, and honorary consultant for health care of the elderly, Hope Hospital, Salford. Who was your most influential teachers? Frank Swallow, who stimulated my interest in biology at school; Roy Kay, my tutor at Oxford who focused that interest on neurophysiology; and Lee Illis at the Wessex Neurological Centre who fostered the vision of neurological rehabilitation based on neurophysiological understanding. What would be your advice to a newly qualified doctor? You, like everyone else, will make mistakes. Learn how to cope with them by learning from them. Also learn from the mistakes others made and you might have done. How do you relax? By switching stressors. What is your greatest regret? Not to have been allocated a parallel incarnation to write at leisure the books I currently write in a hurry at unsociable hours. What complementary therapies have you tried? Alcohol. Excellent in moderation for minor lows. How would you like to die? Very quickly and very late. What is your favourite book? Out of the shortlist of 100, the following would probably be in the top 10: Robert Musil’s Man without Qualities (a perfect mix of metaphysics and gossip); James Joyces’ Ulysses; and (though “favourite” is the wrong word here) Ludwig Wittgenstein’s Philosophical Investigations. What is your favourite journey? Any walk to almost any pub. What is your greatest fear? The most enduring is fear of a catastrophe striking either of my children. Another front-runner is of being separated from others and from myself by dysphasia.
334
Moving ahead by degrees edical qualifications can be odd. In Britain they used to be the MBChB or the MBBS, the railway degree MRCSLRCP, and the magnificent Apothecaries’ Hall qualification. The Empire was stuck with all of this with the plausible, but impractical, explanation that the MD degree was by thesis and anything else less was a Bachelor’s degree. All very well when the Empire consisted of a quarter of the world. The rest of the world, some variants in Europe excepted, is MD. Higher qualifications were, of course, not university degrees at all, but professional college qualifications. How grand they were with 15% passing at the first crack the illustrious “Membership” and the later election to “Fellowship”. Good stuff, but no longer the fast track compared with MD/PhD, MD/MBA, and MD/LLB qualifications now coming on strong worldwide. Medical licensing can be even stranger. Going abroad with one of these medical qualifications was a bit of a bummer since nobody else understood what they were. An exception was Australia. Entry to the subcontinent at Fremantle was met with “Do you think you could get a chest X-ray sometime?”: and as an afterthought “You know you have to vote in the federal election within the next month or be fined $100”. 18 months later I moved to Canada, which was still fairly easy. The Canadians’ love of “the level playing field” forced all incoming doctors to take medical qualifications again. Despite a faint heart, I cooperated. Peace for 20 years until thoughts of semi-retirement in the European Union. Further mountains of paperwork to climb. The Spanish mountain was a useful experience. Spain is a loosely assorted federation, but permission from Madrid precedes provincial permission to practise. Getting Madrid
M
to even confirm an application is like dealing with the proverbial black hole. Furthermore, being Eurocentric, the Spaniards want only to know about European experiences. So they asked about any ethical misdemeanours I might have committed in the UK, even though I had spent the previous two decades in Canada. The British mountain is different. After many years of paying the fees to the UK General Medical Council and the Royal College of Psychiatrists, there suddenly appeared mysterious accounts of the “T” award. Although I was born and educated in the UK, I am being advised to seek the award as a Canadian doctor. Finally, back in North America, getting a licence is arcane. There used to be exams entitled the ECFMG, the FLEX, and now some awful, forbidding acronym. Facing these at the age of 58 gave me some disquiet. Fortunately, with the help of a delightful local legislator, Missouri state law was altered for me by a Private Members Bill. My gratitude is boundless, even though they insisted on charging me $150 to have my medical degree translated from Latin into English, an account of what I had done professionally every month since I qualified in 1962, and an opinion on my current ethical behaviour in Tasmania, and elsewhere, 25 years after I left there. What does all this mean? To be frank, the real benefits of all this movement have more to do with taxation and income than with medical excellence. Nevertheless, for all we know, the wandering doctors may be pioneers, and when there is world government they may be hauled up before a select committee to be asked, “Just how easy is it to become a general practitioner in Kazakhstan?” Robin Eastwood
THE LANCET • Vol 352 • July 25, 1998
LIFELINE Raymond Tallis Raymond Tallis trained at Oxford University and St Thomas’s Hospital. After house jobs he held a crucial research post at Wessex Neurological Centre investigating spinal cord stimulation in multiple sclerosis. Since 1987 he has been professor of geriatric medicine at Manchester University, and honorary consultant for health care of the elderly, Hope Hospital, Salford. Who was your most influential teachers? Frank Swallow, who stimulated my interest in biology at school; Roy Kay, my tutor at Oxford who focused that interest on neurophysiology; and Lee Illis at the Wessex Neurological Centre who fostered the vision of neurological rehabilitation based on neurophysiological understanding. What would be your advice to a newly qualified doctor? You, like everyone else, will make mistakes. Learn how to cope with them by learning from them. Also learn from the mistakes others made and you might have done. How do you relax? By switching stressors. What is your greatest regret? Not to have been allocated a parallel incarnation to write at leisure the books I currently write in a hurry at unsociable hours. What complementary therapies have you tried? Alcohol. Excellent in moderation for minor lows. How would you like to die? Very quickly and very late. What is your favourite book? Out of the shortlist of 100, the following would probably be in the top 10: Robert Musil’s Man without Qualities (a perfect mix of metaphysics and gossip); James Joyces’ Ulysses; and (though “favourite” is the wrong word here) Ludwig Wittgenstein’s Philosophical Investigations. What is your favourite journey? Any walk to almost any pub. What is your greatest fear? The most enduring is fear of a catastrophe striking either of my children. Another front-runner is of being separated from others and from myself by dysphasia.
334
Moving ahead by degrees edical qualifications can be odd. In Britain they used to be the MBChB or the MBBS, the railway degree MRCSLRCP, and the magnificent Apothecaries’ Hall qualification. The Empire was stuck with all of this with the plausible, but impractical, explanation that the MD degree was by thesis and anything else less was a Bachelor’s degree. All very well when the Empire consisted of a quarter of the world. The rest of the world, some variants in Europe excepted, is MD. Higher qualifications were, of course, not university degrees at all, but professional college qualifications. How grand they were with 15% passing at the first crack the illustrious “Membership” and the later election to “Fellowship”. Good stuff, but no longer the fast track compared with MD/PhD, MD/MBA, and MD/LLB qualifications now coming on strong worldwide. Medical licensing can be even stranger. Going abroad with one of these medical qualifications was a bit of a bummer since nobody else understood what they were. An exception was Australia. Entry to the subcontinent at Fremantle was met with “Do you think you could get a chest X-ray sometime?”: and as an afterthought “You know you have to vote in the federal election within the next month or be fined $100”. 18 months later I moved to Canada, which was still fairly easy. The Canadians’ love of “the level playing field” forced all incoming doctors to take medical qualifications again. Despite a faint heart, I cooperated. Peace for 20 years until thoughts of semi-retirement in the European Union. Further mountains of paperwork to climb. The Spanish mountain was a useful experience. Spain is a loosely assorted federation, but permission from Madrid precedes provincial permission to practise. Getting Madrid
M
to even confirm an application is like dealing with the proverbial black hole. Furthermore, being Eurocentric, the Spaniards want only to know about European experiences. So they asked about any ethical misdemeanours I might have committed in the UK, even though I had spent the previous two decades in Canada. The British mountain is different. After many years of paying the fees to the UK General Medical Council and the Royal College of Psychiatrists, there suddenly appeared mysterious accounts of the “T” award. Although I was born and educated in the UK, I am being advised to seek the award as a Canadian doctor. Finally, back in North America, getting a licence is arcane. There used to be exams entitled the ECFMG, the FLEX, and now some awful, forbidding acronym. Facing these at the age of 58 gave me some disquiet. Fortunately, with the help of a delightful local legislator, Missouri state law was altered for me by a Private Members Bill. My gratitude is boundless, even though they insisted on charging me $150 to have my medical degree translated from Latin into English, an account of what I had done professionally every month since I qualified in 1962, and an opinion on my current ethical behaviour in Tasmania, and elsewhere, 25 years after I left there. What does all this mean? To be frank, the real benefits of all this movement have more to do with taxation and income than with medical excellence. Nevertheless, for all we know, the wandering doctors may be pioneers, and when there is world government they may be hauled up before a select committee to be asked, “Just how easy is it to become a general practitioner in Kazakhstan?” Robin Eastwood
THE LANCET • Vol 352 • July 25, 1998