Doctors notebook - Times have changed in medicine

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I saw Call the Midwife on Sunday evening, a new TV series based on the memoirs of Jennifer Worth about delivering babies in a poor part of London in the 1950s.

It is atmospheric, good on detail and sickeningly realistic.

I was a boy in the 1950s and I was the last baby to be born in our family, but I do, of course, remember my life as a young family doctor in the 1970s. How different it was then. There were four partners in our practice at the top of St Peter’s Avenue in Kettering. Before I was appointed we had a “trial by sherry”, when Ann and I met the partners and their wives. That was because Ann had to be home at lunchtime to take her turn in answering the telephone and at night and weekends… so she was interviewed too.

There were no bleeps, no mobile phones; in fact many of our patients did not have a telephone. One local practice still had a message takers’ flat where people could call, leave a note and request a visit. Repeat prescriptions were taken by telephone, the requests were often imprecise. I remember one patient ringing up and regularly asking for 30 of his blue boys and 30 “moggies” – his sleeping tablets. How dangerous it was.

Morning surgeries were short to enable enough time for home visits, anything between four and 10 visits per day for each partner. In a flu epidemic it could be considerably worse – the record in our practice as 150 home visits shared between four doctors. At weekends I would give Ann an approximate running order of visits so she could find me via a patient’s telephone if there was an emergency.

And emergencies there were. I remember one young pregnant mum bleeding so heavily I sent the husband down into the garden to find bricks so we could raise the foot of the bed, before I leapfrogged garden fences to find a house with a telephone to arrange for the flying squad to give her a blood transfusion before we moved her.

Afternoon surgery could go on for hours and become evening surgeries. Anybody who wanted to be seen would be, the same day.

Night visits increased over time. When I joined the practice in 1972 we got out of bed every other night on call, 20 years later there were at least two late night calls every night. They took their toll on you, but there was a sense of commitment and a dedication to the idea of providing personal care. That might sound like criticism of the present system but it is not meant to be. Medicine has changed and produced many different pressures that have required a very different way of working.