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Logo of oenvmedOccupational and Environmental MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Occup Environ Med. 2007 July; 64(7): e1.
PMCID: PMC2078477

The other side of medicine

Reviewed by R L Maynard

P Tate. Radcliffe Publishing, 2006, £21.95, pp 136. ISBN 9781846191541

Deciding on whether to review a book of general interest is always a problem: you need to read it to know. So I read Peter Tate's collection of articles from Education for Primary Care. As the author would say, let me declare an interest—I am not a clinician. But, like all medically qualified non‐clinicians, I might have been and thus books like this have an appeal. The author has had a long career as a general practitioner, he has thought hard about the problems facing general practitioners and has been an enthusiastic trainer and examiner. He is also a practised writer with a clear style that is sometimes submerged by a desire to be funny. This does not always work: jokes about unfortunate patients and using the 9/11 disaster in New York as the basis for a laboured and not very funny analogy should be eschewed. Nor was I much impressed by “the slings and arrows of outrageous medicine”.

The author actually writes about three areas:

Philosophy. This is sometimes amusing but not really very important. How can the Great Pyramid be “literally unbelievable”? And what are we to deduce from the observation that dinosaurs did not invent mobile phones? We are told that attitudes “tend to come from the mid brain”—really?

Patients and diseases. This is much better, though a little like Richard Gordon, A J Cronin or James Herriot in places. Yes, general practice clearly can be rewarding, depressing, funny and tragic—a bit like real life.

Modern general practice. This is the best part and the most worrying. The author explains much that itself explains the sharp decline in students attracted by general practice. I was bemused by the diabetic register (“there are 16 points available if 50% of diabetics have an Hb1c of 7.4 or less, and 3 points if 90% …”). This is amazing to a non‐clinician. The descriptions of “reactive explanation”, “shared understanding(s)”, “core competencies” and so on left me thinking that if general practitioners have agreed to all this they can blame only themselves for a lack of recruits. Running through the author's prose is a clear sense of disenchantment with the system for all its touchy feely aspirations. Do patients really want it? Do doctors really want to provide it? The author's view that when seeking a heart surgeon, technical skill is of the utmost importance—even if the surgeon might be “ruder than Lancelot Spratt”, is very understandable.

So: an odd book, but a good read—especially if you are a non‐clinician seeking reassurance about your career path.


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