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Robin Jacoby
DISSECTING ROOM
LIFELINE Robin Jacoby Robin Jacoby qualified in Russian, French, and Medicine at Oxford and Guy’s. After being a medical registrar he took a peep at the Maudsley and stayed 20 years. He is now Professor of Old Age Psychiatry at Oxford, and Chairman of the Geneva Initiative in Psychiatry, a non-governmental organisation dedicated to reform of psychiatry in the former Eastern Bloc. Who was your most influential teacher? Peter Vansittart, the novelist. He showed me that education was more exciting than tables and irregular verbs by drawing a connection between the herring and the hydrogen bomb, and quoting “the hum of the printing presses turning forests into lies”. Which patient has had most effect on your work and why? The first (of several) patients who died because of my incompetence. I tried harder. What would be your advice to a newly qualified doctor? Whinging has a negative effect on morale. “Il faut cultiver son jardin” (Voltaire–—Candide). What is your favourite film? Antonioni’s L’Aventura because Monica Vitti putting on her stockings is the sexiest scene ever filmed. What book are you currently reading? The life and adventures of Private Chonkin by Vladimir Voinovitch (in Russian of course!). One of the funniest tragedies ever written. What books are you not reading? I would never read Harry Potter or anything by Tolkien. I can’t stand the British taste for whimsy. Do you believe in capital punishment? Emphatically not; except perhaps for Hitler, Stalin, Mao, Pol Pot, and Alan Milburn. Describe your ethical outlook. I do not believe that one has to invoke God to do what is morally right. Do you believe in monogamy? Emphatically yes. Self discipline does less harm to children.
896
A window on the world uring a lull between patients, I watched him park. He bashed the car in front, he backed into the car behind. He then mutilated his tyre against the kerb and, after some effort, abandoned his vehicle with one wheel on the pavement. It was a poor prognostic sign. Needless to say, he’d not been looking after himself any better than he cared for his car. And now he wanted me to do something about it, pronto. Having got himself into a jam, it was someone else’s job to get him out. My consulting room is one of the best in the building, especially for anyone like myself who is nosy, because it overlooks the high street. I can see exactly who leaves the front door of our premises and heads straight into the shop across the road to buy cigarettes. My large picture window also affords excellent insights into how people control their cars—or not, as the case may be. There’s the meticulous middle-aged woman who wears what I believe are called driving gloves. Her car is immaculate and so shiny that I have to shield my eyes from the glare. She is an impeccable if somewhat slow parker. When she finally gets out of the car she smooths down the pleated skirt of her silk suit before entering the surgery. When she comes into my room, I feel I should apologise for the mess on my desk and for my casual attire. There is usually very little wrong with her. Sometimes she has a query about a skin lesion so tiny that it is barely visible to the naked eye. When I tell her it is nothing she seems a little disappointed, but is far too polite to disagree with me. At the opposite extreme is one deliciously chaotic family in their people carrier. You can hear them well before they pull up because the mother is bellowing at her squabbling children or else at the dog, any of whom are threatening to empty their bladder imminently. She only manages to park
D
without any fatalities and get the assembled company into the waiting-room because she has promised them all icecreams if they behave. (They do not.) The mother is always grateful for whatever advice or treatment I dispense, so it is a pleasure seeing them. I have to admit it is also a pleasure when they leave and give my eardrums a rest. She drives off in much the same style as she parks, often with some colourful item of clothing caught in the car door, which flaps as they gather speed. Occasionally they are back a few minutes later because they left something in my consulting room. It’s usually baby Chloe’s dummy, but once it was baby Chloe. Sometimes, watching patients park provides valuable insights into their clinical condition. There is one woman who complains bitterly of multiple joint-pains and insists somewhat dramatically that she is paralysed by her symptoms. There is never any visible synovitis. The next time she came to see me (having informed me that someone in her condition really merited a house call), I looked out of my window and noticed that she had no trouble at all hopping nimbly in and out of her fourwheel drive. The other day I spotted what could be a hypochondriac of the future. Walking past the surgery with his mother, a boy of about 5 insisted on coming in to see the doctor. His mother told him he was fine, and that they weren’t coming to the surgery today. He, however, replied that he was sure he had a bit of an earache. Sometimes I wonder how many diagnoses I could make by simply observing people from my window. The next time we have medical students in the practice, I will certainly teach them that observation and inspection begin well before the patient enters the room. Carol Cooper
THE LANCET • Vol 357 • March 17, 2001
For personal use only. Reproduce with permission from The Lancet Publishing Group.
LIFELINE Robin Jacoby Robin Jacoby qualified in Russian, French, and Medicine at Oxford and Guy’s. After being a medical registrar he took a peep at the Maudsley and stayed 20 years. He is now Professor of Old Age Psychiatry at Oxford, and Chairman of the Geneva Initiative in Psychiatry, a non-governmental organisation dedicated to reform of psychiatry in the former Eastern Bloc. Who was your most influential teacher? Peter Vansittart, the novelist. He showed me that education was more exciting than tables and irregular verbs by drawing a connection between the herring and the hydrogen bomb, and quoting “the hum of the printing presses turning forests into lies”. Which patient has had most effect on your work and why? The first (of several) patients who died because of my incompetence. I tried harder. What would be your advice to a newly qualified doctor? Whinging has a negative effect on morale. “Il faut cultiver son jardin” (Voltaire–—Candide). What is your favourite film? Antonioni’s L’Aventura because Monica Vitti putting on her stockings is the sexiest scene ever filmed. What book are you currently reading? The life and adventures of Private Chonkin by Vladimir Voinovitch (in Russian of course!). One of the funniest tragedies ever written. What books are you not reading? I would never read Harry Potter or anything by Tolkien. I can’t stand the British taste for whimsy. Do you believe in capital punishment? Emphatically not; except perhaps for Hitler, Stalin, Mao, Pol Pot, and Alan Milburn. Describe your ethical outlook. I do not believe that one has to invoke God to do what is morally right. Do you believe in monogamy? Emphatically yes. Self discipline does less harm to children.
896
A window on the world uring a lull between patients, I watched him park. He bashed the car in front, he backed into the car behind. He then mutilated his tyre against the kerb and, after some effort, abandoned his vehicle with one wheel on the pavement. It was a poor prognostic sign. Needless to say, he’d not been looking after himself any better than he cared for his car. And now he wanted me to do something about it, pronto. Having got himself into a jam, it was someone else’s job to get him out. My consulting room is one of the best in the building, especially for anyone like myself who is nosy, because it overlooks the high street. I can see exactly who leaves the front door of our premises and heads straight into the shop across the road to buy cigarettes. My large picture window also affords excellent insights into how people control their cars—or not, as the case may be. There’s the meticulous middle-aged woman who wears what I believe are called driving gloves. Her car is immaculate and so shiny that I have to shield my eyes from the glare. She is an impeccable if somewhat slow parker. When she finally gets out of the car she smooths down the pleated skirt of her silk suit before entering the surgery. When she comes into my room, I feel I should apologise for the mess on my desk and for my casual attire. There is usually very little wrong with her. Sometimes she has a query about a skin lesion so tiny that it is barely visible to the naked eye. When I tell her it is nothing she seems a little disappointed, but is far too polite to disagree with me. At the opposite extreme is one deliciously chaotic family in their people carrier. You can hear them well before they pull up because the mother is bellowing at her squabbling children or else at the dog, any of whom are threatening to empty their bladder imminently. She only manages to park
D
without any fatalities and get the assembled company into the waiting-room because she has promised them all icecreams if they behave. (They do not.) The mother is always grateful for whatever advice or treatment I dispense, so it is a pleasure seeing them. I have to admit it is also a pleasure when they leave and give my eardrums a rest. She drives off in much the same style as she parks, often with some colourful item of clothing caught in the car door, which flaps as they gather speed. Occasionally they are back a few minutes later because they left something in my consulting room. It’s usually baby Chloe’s dummy, but once it was baby Chloe. Sometimes, watching patients park provides valuable insights into their clinical condition. There is one woman who complains bitterly of multiple joint-pains and insists somewhat dramatically that she is paralysed by her symptoms. There is never any visible synovitis. The next time she came to see me (having informed me that someone in her condition really merited a house call), I looked out of my window and noticed that she had no trouble at all hopping nimbly in and out of her fourwheel drive. The other day I spotted what could be a hypochondriac of the future. Walking past the surgery with his mother, a boy of about 5 insisted on coming in to see the doctor. His mother told him he was fine, and that they weren’t coming to the surgery today. He, however, replied that he was sure he had a bit of an earache. Sometimes I wonder how many diagnoses I could make by simply observing people from my window. The next time we have medical students in the practice, I will certainly teach them that observation and inspection begin well before the patient enters the room. Carol Cooper
THE LANCET • Vol 357 • March 17, 2001
For personal use only. Reproduce with permission from The Lancet Publishing Group.