Dr. Alex Sinclair
Guest Speaker — 1960 Medical Students Dinner
Thank you for inviting me to your dinner Whatever was in your minds I will not guess—perhaps it is better not to. But I can assure you that it does a good deal for my windblown ego that you have invited me, since a number of you must have suffered in respectful silence on those occa- sions when I have disgorged before you half-grown artificial pearls, dignified by the title of lectures in psychiatry.
Perhaps it was compassion which moved you to do it. As you know, the psychiatrist earns his piteous little living by listening to other people talk, so that it is a rare treat for me to have delivered into my hands a group of men and women who will listen while I talk. I trust I am not borne away by the opportunity and go on and on, be- cause I could do so for hours.
However, even if I do, this should not worry you. You are inured to this sort of thing. You are accustomed to the ordeal of listening to lectures. Most of you have learnt to disguise your suffering and assume a mask of respectful comprehension, put upon the garb of dull pseudo-respect with- out which tribute a lecturer would be lost before he started.
As a psychiatrist, you must forgive me if I wonder as I speak, what you are think- ing about at this time. I must confess that
I haven't the vaguest idea—perhaps you aren't thinking at all, and I don't blame you. But let me guess.
Perhaps someone is thinking about what happened last Sunday night and wondering will it be all right. My hopes go with him.
Maybe one or two of the ladies present are working out whether they will have time to have their hair set, be on time for a dentist's appointment and still fit in a bath in time to be half an hour late for a dinner appointment next Thursday week.
One or two of you may be wondering whether one of the oysters you ate yester- day was as good as it looked. Or perhaps some are merely noting the activity of your bladder reflexes and calculating how long it will be before they give up the ghost.
Some will be looking fixedly at that fellow sitting opposite him and thinking what a terrible prawn he is. A number of you are probably just sitting in suspended animation experiencing that vague sense of uplift that indicates nothing more than a stomach full of good food and wine.
At any rate, all of you will be wondering how long this is going on.
So let us leave this fascinating research and contemplate ourselves as potential members of the medical profession. For we are truly a race apart, an elect body, a
Dedicated Group of Men against Death.
You are all these things in embryo. A few of us at the top table enjoy that full blown state of tattered mental maceration which is synonymous with full medical maturity.
There is no doubt that we were always in- tended to be doctors. We chose this profes- sion for various reasons, all of them of course good. The sadists amongst us have always known that in some way we must channel this awful drive into a form of activity that will be well rewarded as well as socially acceptable—we are compelled to become surgeons. Those more gentle souls amongst us who have always thought it nicer to sit by and passively watch nature take its course will, of course, become Physicians. A few of us, who in our youth could not resist the temptation to take things to pieces to see how they worked, with never a care as to how to put them together again, move naturally toward pathology. Some few who have always been tortured by an inner compulsion to mess around in small dark cavities must obviously become ear, nose and throat sur- geons.
Those of us who have escaped from the bonds of our nice clean upbringing and are no longer content with good old-fashioned hearsay about the birds and bees, seek the exciting truth in the practice of obstetrics.
A few possessing no decent regard for the orderly, exquisitely perfect arrangements of the female pelvic apparatus express their careless disruptiveness in the discipline of gynaecology.
A small eminent group who, as children, Were never allowed to express themselves verbally at the dinner table, strike out in adulthood and become successful University Professors and lecturers.
A very elect few, always having led colourless and uneventful lives themselves, compensate for their sense of deprivation by interesting themselves in the disorderly Passions, torments, conflicts and colourful Perversions of their fellows, and become psychiatrists.
The sturdy citizen who would prefer to have a crack at the lot, takes on general practice.
One way or another then, all of us, upon graduation, become the very picture of a Doctor—devoted to a cause, relentlessly benevolent, wise to the point of the oracular and tireless in efforts to relieve disease, with no thought of personal reward—and withal suitably pompous.
It has been cruelly said that a number of the characteristic fine qualities of the physi- cian do not reside within himself, but in fact are the outward manifestations of pathological processes. For instance, the lean tense face of apparent dedication is in fact the outward manifestation of a chronic duodenal ulcer or chronic constipation, the stooping attitude suggesting medical erudi- tion is in fact caused by the South wind stirring a trio of ill-disciplined capricious haemorrhoids.
All our experience throughout the train- ing period in medicine moulds us for our destiny. A good grounding in mathematics, physics and chemistry lays the foundation for that deep culture which must be the envy of our legal and philosophical col- leagues. Long hours spent in the dissect- ing room drowsing beside a cadaver bring us into that intimate relationship with our fellow men which is so essential to the for- mation of deep interpersonal relationships with sick people. Training in biochemistry assists us later in practice when ordering various biochemical tests to be done, for at least we are able to spell the names of the tests correctly. A solid training in pharma- cology assists us to understand something of what may be in the mind of those peri- patetic technical wizards from drug firms who grace our waiting rooms.
But the real business begins in the hos- pital year, when we discard the turtle neck and the corduroy for the worsted and the short white coat. A new vista opens for us. Now, for the first time probably, we are permitted to instruct one of our fellow beings to remove her clothing without running the risk of a sense of guilt or a short jail sentence.
At the bedside, perhaps for the first time you are exposed to the solemn spectacle of moribundity—you are in the presence of the honorary clinician. It is at the bedside,
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whilst you are receiving clinical instruction with osmotic fervour, that you receive the first great lessons in the art of healing—
courage, endurance and fortitude. You learn to triumph over the numbing threat of sleep and the paralysing toxins of ennui.
As the second hour passes into the third, when the lower limbs and other dependent organs are congested by hypostatic blood, leaving your cerebral cortex bleak, anaemic and unresponsive, you learn to proffer those appropriate gestures of understanding and aquiescence so essential in the development of the bedside manner. Recurring contact with your honorary cannot fail but to im- press you with the great disparity in the mental stature of yourselves and himself—
and for this reassuring lesson you must remain eternally grateful.
As you work unobtrusively about the wards you become aware of the quiet power and influence of a great teaching hospital, and as time goes by you may be permitted a word or two with the central focus, the very epitome of this power—the ward sister.
It is here that you learn the necessity to win friends—or else.
It is true that there will be for you occa- sional moments of sadness, loneliness and frustration. At times you will feel lost in the hospital—and in one of the greater teaching hospitals at least, you will in fact get lost. But there is always comfort to be found. You will find it in the most unex- pected places, usually in the less frequented places—such as the pan room—a gentle kindred spirit will offer you comfort. She is usually very shy, very blonde, very beautiful, very junior and very definite in her plans for the future, and, like you, in her first hospital year. Her eyes will grow moist when you recount to her the story of your sad life, your frustrations and your disappointments, and will grow wide and admiring as you modestly admit to her your occasional clinical triumphs. You may rest assured she will watch over you very care- fully, offering you appropriate comfort throughout your hospital years, and as you emerge from the state of parasitism on to well-paid professionalism you will find her loyal and determined by your side, at the altar prepared to love, honour and answer the telephone for you and quiet your happy
little brood of perishing facsimiles because father has had a busy and a clever day and is tired.
Let me be serious for a moment. I have said that doctors are an elect body of people, and I believe it. I don't believe this is so because, individually we are a different class of people from others. On the con- trary, we are drawn from a glorious brother- hood of idealists, opportunists, saints and rogues, known as the average man. But in some strange way, when we become part of a great professional structure we tend to become like it and to absorb the accepted attributes of its greatness.
Apart from this we form a group of workers who enjoy a very enviable freedom to do as we like, think as we like, work when we want to, for a grade of reward which we shall determine ourselves. We are subject only to the demands of our patients and guided only by our own medical conscience and the opinion of our professional colleagues. This is a unique freedom.
May I suggest that you never let this freedom go and become like any other worker. There is a great force at work ready to seduce you. It is known as the Welfare State in Medicine. It is the more attractive because it has as its stated aim the responsibility for the care of all sick people by the State. This would seem a noble concept, and in many ways it is be- cause it is as free and as open-handed as the taxpayers' purse. Although it is not clearly apparent as yet, the writing is on the wall if not on the statute books. The aim of the Welfare State is nationalisation of medicine. The initial financial rewards appear great; other inducements are strong.
The way seems easy. All you need do is discard your freedom, drop your own sense of personal responsibility and allow your lives to be governed by a system of bureau- cratic control. You will have little to worry about and as time goes on you may find you have less and less the capacity to worry and you may not find it as easy to voice your independence, to insist that you treat your patients as you wish, think and say as you will and be rewarded by as little
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or as much as you think it just. Even the best of us can be seduced by talk of secur- ity, superannuation and limited responsi- bility.
It may well be that having accepted such a concept you will become just as ordinary as you were before you began a medical course, because you have become part of a medical system which is in itself ordinary.
Please don't think I believe that all state controlled medicine is objectionable. That is not so, but I believe that universal nationalisation of our profession will de- grade the profession.
You won't have any part in it if you stop first to judge whether, in having a part of it, your freedom is in danger.
The price of freedom is eternal vigilance.