REAL-LIFE DOCTOR'S EXPERIENCE FROM THE 60s

I qualified in 1960 and after nine months in obstetrics and gynaecology, six months in medicine and one year as a trainee GP in Cheltenham, I joined a practice in South Wales as the third partner. I became a full partner in six years. We had 7,000 or so patients and most people in the village knew us.

We worked from a partner’s house, with patients waiting in the doctor’s dining room. We had two small surgeries extended at the back with just room for a desk, two chairs and an examination couch. At this time, there was one receptionist and no appointment system. It’s quite different today.

Our wives were fully involved back then, and would answer our telephone if we were out on call when the surgery was closed. We were on call two nights a week and one weekend in three. Nowadays, doctors use a deputising service for out of hours calls.

We didn’t have mobile telephones or pagers and in case of emergencies, when we were already out on home visits, the secretary would telephone patients that were on our call-list to try to find us. The porch-light of the doctor’s house was also put on, so if we noticed it when passing in the car, we knew there was an emergency.

After about 10 years or so, we occasionally had a local doctor (usually junior hospital staff) as a locum to cover us for the evening and night if the three of us were out at a social function – usually sponsored by a pharmaceutical firm.

Patients would sometimes contact their doctor directly rather than the doctor on call by telephoning or calling at the house.

We had a variable number of maternity patients and 20 chronic patients, who were visited about once a month. If on a particular day there was a large list of new home visits, chronic visiting could be postponed for a day or so.

New requests could amount to 15 to 20 visits for each doctor and most were localised, but we also had patients in outlying areas.

In one location, we held a surgery on one or two days a week in a patient’s front-room, with very few facilities, and we dispensed our own liquid medicines if necessary.

At this time, we used folders for filing purposes, and later this became computerised.

At the start of my career, we managed home deliveries for our pregnant mums. Fortunately we had a superb midwife, so our help was not needed very often. We also attended what were essentially home-deliveries in local nursing homes, including one for unmarried mothers whose babies were subsequently adopted. We were in close contact with, and welcomed visits from, the local midwife, district nurses and occasionally a psychiatric social worker. For many years, the senior partner worked in anaesthetics for three sessions a week.

We had the usual basic equipment in our surgeries but also a full obstetric bag with forceps, a large cylinder of oxygen and a cylinder of Entonox, which we used as pain-relief for accidents and fractures. In the centre of the village, there was a small welfare clinic where local authority doctors immunised babies and children, and nurses dispensed orange-juice and baby-milk powder.

In the 1970s, the local authority built new surgery premises. The three doctors now had a surgery and an examination room each. There was a large treatment room, a consulting room for the local authority doctors and a room with a special chair for chiropody treatment, which took place once a week.

This year, a new medical centre was opened on a much larger site and due to its location at the top of a substantial hill, community transport was arranged to take patients to and from the centre.

In my early career, communication was largely by post but we later had a fax machine, enabling copies of letters to be sent and received. This was superseded by computers and we then had a computer terminal on each surgery desk. I found it easier to write a hand-written note and give it to the secretary. Most prescriptions were written by hand for doctor-patient consultations but repeat prescriptions were written by secretarial staff and a pile would be signed by a doctor after surgeries had finished.

The doctors used to meet after morning surgeries to have coffee, discuss patients, read hospital letters, sign prescriptions and arrange visiting lists. We also used to meet as a group to give audience to visiting pharmaceutical firm representatives.

If we needed to admit a patient as an emergency we would phone “bed-bureau” and be told which hospital would oblige. We would then telephone for an ambulance and give the patient a hand-written letter of introduction for the admitting doctor. In those days rarely would a patient telephone for an ambulance of their own volition. 

If we were caring for a patient with an ongoing illness, we would often invite that patient to contact us if there was a problem, rather than telephoning the on-call doctor. We would also revisit a patient during the day or evening if we were not happy about their progress. Nowadays, patients can book a surgery appointment online and computers are used extensively by doctors and staff.

Prescriptions are computer-generated and patients can ask their local pharmacist to request repeat prescriptions and prepare the drugs ready for collection or even delivery. GPs have more sophisticated personal equipment such as oximeters, electronic thermometers and electronic blood pressure monitors and blood-glucose testers.

I was fortunate to enjoy my life as a GP in South Wales and despite the job having its challenges, the rewards were great. There’s no question the role has changed over the years and there’s no doubt it will continue to change – all in the name of giving good patient care!