Richard Asher: Some words of wisdom

Jonathan McFarland

February 2013

Short Biography He was an eminent British

endocrinologist and haematologist. Asher himself described the modern

haematologist as an individual who “instead of describing in English what he can see, prefers to describe in Greek what he can’t”(1)

As the senior physician responsible for the mental observation ward at the Central Middlesex Hospital he described and named Munchausen syndrome in a 1951 article in The Lancet.[2]

The Beatle Connection The Asher family home above his

private consulting rooms at 57 Wimpole Street was briefly notable when Paul McCartney lived there in 1964-1966 during his relationship with Jane Asher

In 1964 Asher suddenly gave up his hospital post and perhaps all medical activities.

He suffered from depression in later life and reportedly died by his own hand at the age of 57.

Medical Writing Asher was regarded as "one of the

foremost medical thinkers of our times“.(3)

He emphasised the need "to be increasingly critical of our own and other people's thinking".(4)

Medical Writing Asher was particularly concerned that

"many clinical notions are accepted because they are comforting rather than because there is any evidence to support them.”(5)

Asher is remembered today mostly for his "refreshingly provoking"[articles(6)

Medical Writing He thought that medical writing should

provide "useful, understandable, and practical knowledge instead of allotov-words-2-obscure-4-any-1,2-succidin-understanding-them.(7)

Anthologies of his articles were well-received,with the Talking Sense collection being described as still the best advice on medical writing

Medical Writing Many of his papers have a timeless quality, and

like some medical classics deserve to be reread from time to time.

They include, among others, the following: “Why are medical journals so dull”(8) “Straight and crooked thinking in medicine”(9) “The dangers of going to bed”(10) “Clinical sense: the use of the five senses”(11) “Six honest serving men for medical

writers”(12)

Medical Writing In the first he states in the concluding

paragraph, “Medical articles should, like after-dinner speeches, finish before the audience’s interest has started to wane”

“The dangers of going to bed” was an influential paper at a time when the hospital stay for patients was considerable.

Medical Writing In the “Clinical Sense” he begins, “ Clinical knowledge depends upon

three processes-observing, recording, and thinking.”

And proceeds to talk about the importance of each of the 5 senses

Medical writing “Six honest serving men for medical

writers” is taken from Rudyard Kipling who wrote:

(13)

The seven sins of medicine But today I wish to concentrate on one

article. “Seven sins of medicine”, published in

the Lancet in 1949.

The Seven Cardinal Sins

What are the seven sins?

GLUTTONY

LUST

ENVY

SLOTH

WRATH

GREED

And in Medicine? And what are the “Seven Sins of

Medicine”?(14) Please write down what you consider to

be the 7 sins that a doctor must NOT commit

And why?

Asher considered the seven sins to be: OBSCURITY- “Obscurity is bad, not only because it is

difficult to understand but also because it is confused with profundity.”

Bad Manners Often overlooked, rudeness or poor

taste in humour is condoned with hospitals

Asher states” If students do not learn good manners while they are learning medicine they will be at a great disadvantage in dealing with patients, nurses and colleagues”

CRUELTY- He states that mental cruelty is

common, and there are 3 ways: 1) by saying too much 2) by saying too little 3) and by the patient being forgotten

OVER-SPECIALISATION “It is right that a doctor should have

special interest and knowledge about one subject. It is wrong for him to show special indifference and ignorance about all other subjects”

SPANOPHILIA Or “Love of the rare” He says that this is common in medical

students

COMMON STUPIDITY Or the “opposite” of common sense, “

but I think the commonest type is what might be called therapeutic automatism”

“ …patients should never be treated by rote and rule, for there may be special circumstances”

SLOTH He says that mental sloth “..is commoner and more important.

Especially in history-taking is sloth the great danger. If the day is hot, the patient deaf, the doctor in a hurry, and the history garnished with reminiscences and irrelevances, it requires enormous patience and concentration to distil the essence from it.”

And never forget –

“Lastly, beware of sloth of thinking.” He reiterates the importance of: Healthy Doubt ( without being unduly

sceptical) And ends ( in his true, witty style) “Please adopt this attitude with

everything I have said, and realise that much of it may be nonsense”

Take home message Modern society is fast and furious; no

time to stop and think. With an emphasis on change, on the

new, the young. Once in a while read something from

the past; it can still be useful. “Study the past if you would define the

future” (15)

Bibliography 1)“Making sense”, Asher,R, The Lancet, 19592)“Munchausen’s syndrome”, Asher,R, Lancet, 19513)“Richard Asher talking sense by Avery

Jones(review),Drew,R,Proc R Society,1973.4)“Straight and crooked thinking”,

Asher,R,BMJ,19545)“Talking sense”,Asher,R,University Park

Press,1972.6)“Richard Asher and the seven sins of Medicine”,

Rowat,B, Humane Health Care,19857)“All the vitamins”, Asher,R,BMJ,19478) BMJ,19589) BMJ,195410) BMJ, 194711) BMJ, 196012) JAMA, 196913) “The Elephant’s child”, Kipling,R, 190214) The Lancet, 194915) Confucius