Medycyna 2000
1
561 establish guidelines that may be used for the planning and implementation of future undergraduate curricula in which clinical teaching can respond to the changing needs and circumstances of health care in the UK. The inquiry is in the form of a three-part consultation which is seeking the views and suggestions of those with important responsibilities for current clinical teaching-the deans and heads of departments in all the UK medical schools. In round I, which took place from May to July this year, participants were given a preliminary set of issues and asked to suggest additional aspects that should be considered in the inquiry. In round II, which is currently in progress, participants are asked to comment on the enlarged set of issues and their implications. These comments will be summarised and circulated in round III (planned for November), when participants will be able to comment further on the range of opinions expressed. The results of the inquiry will be circulated in a report in preparation for a conference in Spring, 1991. The Florey Institute With the publication in The Lancet of the first systematic study of the antistaphylococcal and antistreptococcal properties of penicillin in 1940, Howard Florey established himself as an experimentalist of high repute. It was his name which subsequently became attached to a new research centre at the University of Melbourne, Australia, in 1963. The founding director was Dr Derek Denton, who had begun his academic career with a case report in Nature in 1948 on electrolyte balance. Under Dr Denton’s guidance the institute rapidly evolved a reputation for scientific scholarship, and its origins, research activity, and personalities are now brought together in an entertaining new book by Australian journalist, Tim Hewat.’ 1. The Florey: the story of the sheep Hilton. T. Hewat. London: Angus and Robertson. 1990. Pp 211. £16.25. ISBN 0-207166250. Medycyna 2000 Perestraika is now reaching the medical community. The Foundation of Polish Science Support has started a monthly medical magazine that aims to provide information for Polish doctors and hospital managers about recent advances in European and world medicine. Further information about Medycyna 2000 may be obtained from Fundacja rozwoju nauki Polskiej, Biuro handlowe, 01-805 Warszawa, ul. Lubomelska 12, Poland. In England Now The ecologists have told us for years that any change in a balanced ecosystem will have multiple and unexpected effects. A medical case in point is the Migration of the Stethoscope, a surprising consequence of the new informality of hospital attire which has arisen here in the States. During the preceding golden age 01 medicine, when rank was given its appropriate attention, the medical student donned the long white coat and the house-ofncel the short white coat that identified each. The attending physicians wore either proper dark suits to attest to their position in the world or returned to the long white coat to suggest their attachment tc science and the laboratory. In all cases, the stethoscope resided in a pocket. It was good form for the earpieces to protrude modestly. Bui when the ’60s erupted here in the San Francisco area, youn physicians scorned these badges of hierarchy. Sneakers replacec leather shoes, blue jeans appeared where trousers or dresses hac previously served, and white coats, short or long, were cast aside Initially, the stethoscope was hung dangling from the neck earpieces posteriorly, a position which was the time-honourec alternative to the coat pocket. Perhaps that was why a new carrying place had to be found, one not linked to antediluvian practice. The migration of the stethoscope to the favoured position of the ’70s an( ’80s was rapid and nearly universal in our local teaching hospitals Stethoscopes were all to be carried draped around the neck chestpiece and earpieces both anteriorly. It was a clear sign of medical conservatism to persist in the old posture, and only senior practitioners on unregenerate views retained it. It was surely foolish to expect that the stethoscope would migrate no more, and, in fact, it has now begun its new move. The avant-garde of young physicians drape it over one shoulder only, chestpiece behind, earpieces forward, a position manifestly unnatural and unstable. Is it a non-verbal statement that the stethoscope, for a century the badge of the physician, is now so nearly disposable that it is suffered to cling so precariously? A study cries out to be launched. With suitable funding, I will be happy to investigate the personality attributes of the side-carrying physicians, and if travel allowances are included, a cross-cultural survey is indicated. How are stethoscopes carried in London, Paris, Boston, Tokyo, and other interesting centres of medical practice? The necessity for prospective, longitudinal data is equally clear: whither the stethoscope? My grant application is in the mail. * * * Now that I am retired I find myself involved in the esoteric rituals of Do It Yourself. This is mainly out of sheer necessity; when I was working my answer to every problem was to get someone in to see to it-or, rather, tell my wife to get someone, as I would be far too busy myself. Now I realise that (a) getting someone is virtually impossible, (b) if one does get someone it costs the earth, and (c) the only answer is to tackle the job oneself. The trouble is, I have never been good with my hands (I am not, you will gather, a surgeon) so the results of my efforts have not been wholly satisfactory. Part of the problem is my inherent clumsiness; many people are gifted amateurs at being clumsy, but I raise it to a professional art form. For example, it has been proved in repeated trials that, given an empty room 6m x 4m and an open pot of paint on the floor of that room, I cannot traverse the floor without pedal impingement on the said pot. So disastrous have been my efforts at decorating that the Domestic Authorities have taken on the job in person, leaving me to fill the role of scrub nurse, passing a brush here, scissors there, and swabbing down in between times. I am little better at woodwork, though this is an area to which the Domestic Authorities do not, as yet, aspire. The correct tools are, of course, essential, and I would recommend the following: a saw (preferably sharpish), a hammer, a supply of nails, several packets of sterile dressings, a few butterfly sutures, some 1 % hydrogen peroxide solution, and a bottle of whisky for donation at Christmas to the local accident and emergency surgeon. I do have some success with self-assembly furniture kits, and I am willing to share my methods. The first thing is to lose the instructions; then take any two pieces which look as if they could conceivably go together and fasten them, but not in such a way that they cannot be dismantled. I then call in a neighbour, an orthopaedic surgeon who is also an expert carpenter (well, he would be, wouldn’t he) and tell him I cannot get the thing to go together. This, of course, is taken as a challenge, and, in the absence of instructions, a challenge worthy of his full attention. I go off and have a cup of tea and a nourishing slice of fruit cake, by which time the job is usually completed to perfection. International Diary 3rd workshop entitled Gastroduodenal Pathology and Helicobacter pylori is to be held in Toledo, Spain, on Nov 8-11: Oasis, Conde Penalver 51, 28006 Madrid, Spain. An international conference on Ageing-Nutrition and the Quality of Life will be held in Marbella, Spain, on Nov 12-14: International Life Sciences Institute, Europe, Avenue E Mounier 83, Box 6, B-1200 Brussels, Belgium (32 3 771 00 14). A conference on Psychological Treatment in Human Disease and Illness is to be held in London on Nov 26-27: Dr S. Moorey, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK (071-352 8171 ext 2777).
Transcript of Medycyna 2000
561
establish guidelines that may be used for the planning andimplementation of future undergraduate curricula in which clinicalteaching can respond to the changing needs and circumstances ofhealth care in the UK.The inquiry is in the form of a three-part consultation which is
seeking the views and suggestions of those with importantresponsibilities for current clinical teaching-the deans and heads ofdepartments in all the UK medical schools. In round I, which tookplace from May to July this year, participants were given apreliminary set of issues and asked to suggest additional aspects thatshould be considered in the inquiry. In round II, which is currentlyin progress, participants are asked to comment on the enlarged set ofissues and their implications. These comments will be summarisedand circulated in round III (planned for November), whenparticipants will be able to comment further on the range ofopinions expressed. The results of the inquiry will be circulated in areport in preparation for a conference in Spring, 1991.
The Florey Institute
With the publication in The Lancet of the first systematic study ofthe antistaphylococcal and antistreptococcal properties of penicillinin 1940, Howard Florey established himself as an experimentalist ofhigh repute. It was his name which subsequently became attachedto a new research centre at the University of Melbourne, Australia,in 1963. The founding director was Dr Derek Denton, who hadbegun his academic career with a case report in Nature in 1948 onelectrolyte balance. Under Dr Denton’s guidance the instituterapidly evolved a reputation for scientific scholarship, and its
origins, research activity, and personalities are now broughttogether in an entertaining new book by Australian journalist, TimHewat.’
1. The Florey: the story of the sheep Hilton. T. Hewat. London: Angus and Robertson.1990. Pp 211. £16.25. ISBN 0-207166250.
Medycyna 2000
Perestraika is now reaching the medical community. TheFoundation of Polish Science Support has started a monthlymedical magazine that aims to provide information for Polishdoctors and hospital managers about recent advances in Europeanand world medicine. Further information about Medycyna 2000may be obtained from Fundacja rozwoju nauki Polskiej, Biurohandlowe, 01-805 Warszawa, ul. Lubomelska 12, Poland.
In England Now
The ecologists have told us for years that any change in a balancedecosystem will have multiple and unexpected effects. A medical casein point is the Migration of the Stethoscope, a surprisingconsequence of the new informality of hospital attire which hasarisen here in the States. During the preceding golden age 01medicine, when rank was given its appropriate attention, themedical student donned the long white coat and the house-ofncelthe short white coat that identified each. The attending physicianswore either proper dark suits to attest to their position in the worldor returned to the long white coat to suggest their attachment tcscience and the laboratory. In all cases, the stethoscope resided in apocket. It was good form for the earpieces to protrude modestly. Buiwhen the ’60s erupted here in the San Francisco area, younphysicians scorned these badges of hierarchy. Sneakers replacecleather shoes, blue jeans appeared where trousers or dresses hacpreviously served, and white coats, short or long, were cast asideInitially, the stethoscope was hung dangling from the neckearpieces posteriorly, a position which was the time-honourecalternative to the coat pocket. Perhaps that was why a new carryingplace had to be found, one not linked to antediluvian practice. Themigration of the stethoscope to the favoured position of the ’70s an(’80s was rapid and nearly universal in our local teaching hospitalsStethoscopes were all to be carried draped around the neck
chestpiece and earpieces both anteriorly. It was a clear sign ofmedical conservatism to persist in the old posture, and only seniorpractitioners on unregenerate views retained it. It was surely foolishto expect that the stethoscope would migrate no more, and, in fact, ithas now begun its new move. The avant-garde of young physiciansdrape it over one shoulder only, chestpiece behind, earpiecesforward, a position manifestly unnatural and unstable. Is it anon-verbal statement that the stethoscope, for a century the badgeof the physician, is now so nearly disposable that it is suffered tocling so precariously?A study cries out to be launched. With suitable funding, I will be
happy to investigate the personality attributes of the side-carryingphysicians, and if travel allowances are included, a cross-culturalsurvey is indicated. How are stethoscopes carried in London, Paris,Boston, Tokyo, and other interesting centres of medical practice?The necessity for prospective, longitudinal data is equally clear:whither the stethoscope? My grant application is in the mail.
* * *
Now that I am retired I find myself involved in the esoteric rituals ofDo It Yourself. This is mainly out of sheer necessity; when I wasworking my answer to every problem was to get someone in to see toit-or, rather, tell my wife to get someone, as I would be far too busymyself. Now I realise that (a) getting someone is virtuallyimpossible, (b) if one does get someone it costs the earth, and (c) theonly answer is to tackle the job oneself.The trouble is, I have never been good with my hands (I am not,
you will gather, a surgeon) so the results of my efforts have not beenwholly satisfactory. Part of the problem is my inherent clumsiness;many people are gifted amateurs at being clumsy, but I raise it to aprofessional art form. For example, it has been proved in repeatedtrials that, given an empty room 6m x 4m and an open pot of painton the floor of that room, I cannot traverse the floor without pedalimpingement on the said pot.
So disastrous have been my efforts at decorating that theDomestic Authorities have taken on the job in person, leaving me tofill the role of scrub nurse, passing a brush here, scissors there, andswabbing down in between times.
I am little better at woodwork, though this is an area to which theDomestic Authorities do not, as yet, aspire. The correct tools are, ofcourse, essential, and I would recommend the following: a saw(preferably sharpish), a hammer, a supply of nails, several packets ofsterile dressings, a few butterfly sutures, some 1 % hydrogenperoxide solution, and a bottle of whisky for donation at Christmasto the local accident and emergency surgeon. I do have some successwith self-assembly furniture kits, and I am willing to share mymethods. The first thing is to lose the instructions; then take any twopieces which look as if they could conceivably go together and fastenthem, but not in such a way that they cannot be dismantled. I thencall in a neighbour, an orthopaedic surgeon who is also an expertcarpenter (well, he would be, wouldn’t he) and tell him I cannot getthe thing to go together. This, of course, is taken as a challenge, and,in the absence of instructions, a challenge worthy of his fullattention. I go off and have a cup of tea and a nourishing slice of fruitcake, by which time the job is usually completed to perfection.
International Diary
3rd workshop entitled Gastroduodenal Pathology and Helicobacterpylori is to be held in Toledo, Spain, on Nov 8-11: Oasis, Conde Penalver51, 28006 Madrid, Spain.
An international conference on Ageing-Nutrition and the Quality ofLife will be held in Marbella, Spain, on Nov 12-14: International LifeSciences Institute, Europe, Avenue E Mounier 83, Box 6, B-1200 Brussels,Belgium (32 3 771 00 14).
A conference on Psychological Treatment in Human Disease andIllness is to be held in London on Nov 26-27: Dr S. Moorey, Royal MarsdenHospital, Fulham Road, London SW3 6JJ, UK (071-352 8171 ext 2777).
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