The demands of the dead.

As a result of the recent pay negotiations family practice has become immeasurably more popular than hospital practice in the UK. Very bright young doctors are choosing to be trained as general practitioners, where they can look forward to being their own bosses, having no night calls, a day off in the week and the opportunity to refer-on difficult cases, rather than suffer the uncertainty of difficult examinations, chasing training jobs all over the country, remaining a 'junior' doctor until their mid-thirties and having the buck stop with them when the going gets tough.

Perhaps that is what the government intended when they negotiated a contract so favorable to GPs.

There have always been very good GPs but there have also been some shockers. I remember one family practice from my younger days of whom it was said by the senior surgeon, "One of them doesn't read letters and the other one can't."

Perhaps you remember the scene in one of the Richard Gordon "Doctor" films. A perennial medical student finds that his great aunt's legacy (which supported him as long as he remained a medical student) had run out. It became necessary for him to pass the exams and earn a living. Passing exams was not something he was awfully good at, so he decided to take one of the back-door entries to medicine that used to be available in the 1940s and 1950s. He decided to become a Licentiate of the Apothecaries of Cork. He travelled over to Ireland to take the examination and was met by an old man in a pony and trap with a straw in his mouth (played I think by Cyril Cusak). As they drove along the old Irishman began to question him. "What can you tell me about urea?"

"Do you mean the chemical substance or my lug-hole?" asked the ignorant medical student.

"Oh well, as long as you know the difference." said the examiner, satisfied.

And that was the examination passed. It is a calumny against the Irish, of course, but these two doctors really were Irish.

Another practice made great use of the domiciliary consultation. In those days specialists from the hospital would do house calls on difficult cases rather than fit them into an already over-booked out-patient clinic. This particular practice used to request more domiciliary visits than any other and used the service indiscriminately. So much so that the senior surgeon and the senior physician used to meet for coffee at a local hostelry to swap referrals.

When I was very young I used to moonlight in GP evening surgeries. In those days the £5 fee was important to my financial survival. I remember one evening surgery when I deputised for a big-wig in the British Medical Association. I believe he was a member of the Ethical Committee. Perhaps I should have been warned by that. One member of the Ethical Committee has since been convicted of murdering his wife and another was involved peripherally in sale of donated blood to a pharmaceutical company. Anyway, this particular surgery was a doddle. Nobody came. At least until the last minute when a young woman came in. I asked her name and she told me it was Pauline Collins. (I have changed her name because I can't remember what it was.) I fished out her records from his filing cabinet. "That's strange," I said, "according to this you are 104 years old."

We checked the name and address, which were obviously correct, but when I gave the date of birth the penny dropped. "That must be my grandmother. She had the same name as me, but she died in 1949. Why have you still got her records?"

Why, indeed. GPs were paid a capitation fee by the NHS for every patient on their list. They were supposed to send back all medical records or patients who had died. But what a wonderful scam to hold on to them. One way of ensuring very little work and plenty of pay. And plenty of time to sit on BMA committees. Dead patients make very few demands.