Improving medical students' attitudes towards the chronic sick: a role for social science research.

BACKGROUND: Many medical students are negatively disposed toward the elderly and chronic sick. The present study assessed the impact of a community-based teaching initiative, the Life History Project, on students' attitudes to these groups. METHODS: A questionnaire including Likert based responses and free text comments was distributed to all first-year MBChB students after completion of their Life History coursework. Data was analysed using SPSS and content analysis. RESULTS: A high proportion of students believed the Life History Project had increased their understanding of both psychological and social aspects of health and illness and the role of the humanistic social sciences within this. We discovered that the Life History Project not only gave students first-hand experience of the elderly and chronic sick but also had a positive effect on their attitudes towards these groups. The qualitative free text comments corroborated these views. CONCLUSIONS: It is possible to positively influence medical students' attitudes towards these stigmatised groups; it is therefore important that we continue to enhance opportunities for learning about the impact of chronic illness on individuals and society throughout the curriculum.

Death and Doctor Hornbook by Robert Burns: a view from medical history.

Robert Burns's poem, Death and Doctor Hornbook, 1785, tells of the drunken narrator's late night encounter with Death. The Grim Reaper is annoyed that 'Dr Hornbook', a local schoolteacher who has taken to selling medications and giving medical advice, is successfully thwarting his efforts to gather victims. The poet fears that the local gravedigger will be unemployed but Death reassures him that this will not be the case since Hornbook kills more than he cures. Previous commentators have regarded the poem as a simple satire on amateur doctoring. However, it is here argued that, if interpreted in the light of the exoteric and inclusive character of 18th century medical knowledge and practice, the poem is revealed to have a much broader reference as well as being more subtle and morally ambiguous. It is a satire on 18th century medicine as a whole.

A witness seminar: the development of old age psychiatry in Britain, 1960-1989. Themes, lessons and highlights.

OBJECTIVE: To create a record of the development of old age psychiatry in Britain, as seen through the eyes of some of the people who participated in building it, from the earliest days until it was officially recognised as a specialty by the Department of Health in 1989. METHOD: Group reminiscences and discussions in the format of a witness seminar which was audio-recorded and transcribed. Witnesses also provided written biographical information. RESULTS: The annotated full record created at the seminar is available on line. This paper reflecting themes, lessons and highlights has been derived from it. CONCLUSIONS: Early old age psychiatrists often encountered opposition and incredulity from other health care professionals and managers. However, their experiences were demonstrating just how much could be achieved in improving the lives of older mentally ill people. They conveyed their enthusiasm for their work in both clinical and university settings. Clinical creativity, support when working in relative professional isolation, and dealing with opposition benefited from both the development of the Group for the Psychiatry of Old Age at the Royal College of Psychiatrists and from close links with geriatric medicine.

Re-expressing the division of British medicine under the NHS: the importance of locality in general practitioners' oral histories.

This paper, based on original oral history research in a single locality, re-examines the impact of the structural division of British medicine, especially between community and hospital-based medicine, on rank-and-file general practice. Interviews were carried out with 29 retired and practising National Health Service (NHS) general practitioners (GPs) in Paisley, Scotland. In contrast to the historiography and literature of academic general practice, most retired and working family doctors who were interviewed rejected the significance of the division, and instead placed emphasis on the positive relationships between primary and secondary care in their locality. Particular stress was placed by these interviewees on the significance of local medical relationships in crossing the divide between primary and secondary medical practice. An analysis of the oral testimonies, informed by the work of Bakhtin [(1984). Problems of Dostoevsky's poetics. Minnesota: University of Minnesota Press] and Schrager [(1983). What is social in oral history? International Journal of Oral History, 4(2), 76-98] identified multiple discourses within single accounts. These discourses contained 'dialects' that suggested a commonality of beliefs, especially when social and clinical networks were detailed, but they also contained 'traces' of oppositional narratives. These 'traces' of alternative perspectives suggest both the power of imagined solidarity and the exclusion of a minority of practitioners. Thus imagined solidarities, based on the making of local identities, combined with imagined oppositional positions, in which those who were constructed as not belonging were given voice. We argue that, to understand alliances between community and hospital medicine it is necessary to appreciate the position of the excluded. Those family doctors who were identified in the oral histories as outsiders tended to serve the more deprived populations. The role of private medicine was especially significant in the process of exclusion, especially the pattern of general practice referrals of patients from the NHS to secondary private care.