farmdoc's blog post number 488

Adding to my posts about my medical influences [1, 2], today I write about Richard Asher (pictured). Born in Sussex in 1912, he was an eminent London endocrinologist and haematologist. But it wasn’t his clinical work he’s remembered for. Rather he was, and is, famous for his medical thinking and writing. He warned of the dangers of prolonged bed rest [3], he was the first to write of the relationship between thyroid disease and mental function [4], he described the Seven Sins of Medicine (i.e. obscurity, cruelty, bad manners, over specialisation, love of the rare, common stupidity, sloth) [5], and he was presciently concerned that many clinical notions are accepted because they’re comforting rather than because there’s any evidence to support them. He wrote superbly and published widely. I own a copy of his 1959 book Talking Sense which remains the bible on medical method and medical writing. Medically Asher’s best known for describing and naming Munchausen syndrome in a 1951 article in The Lancet. Munchausen syndrome’s still in the news [6]. Asher suicided in 1969. (My Dad’s years were also 1912-1969.) And for trivia buffs (like I) he was the father of Peter Asher (half of the singing duo Peter & Gordon) and Jane Asher (who once was betrothed to Paul McCartney).

farmdoc's blog post number 455

My first post about my medical influences was this one on 25 May 2008 when I wrote about Drs Bell and Doyle. Today I write of another man who had a major effect on the way I doctor. Richard Robert Haynes Lovell (pictured) was born in England in 1918, trained at St Mary’s Hospital in London, and graduated in Medicine in 1941. After five years as a Royal Navy surgeon, he undertook postgraduate studies in London. In 1950 he returned to St Mary’s – first as a Lecturer and then a Senior Lecturer – where his life-long interest in epidemiology began. In 1955 he became Melbourne University’s inaugural Professor of Medicine – based at Alfred Hospital and then at The Royal Melbourne. He was the first Professor of Medicine in Melbourne and, I think, Australia. Though a good clinician and researcher, he was an outstanding teacher. I first experienced his teaching as a fourth year student in 1966. He was a stickler for thorough and rigorous clinical (i.e. interviewing and physical examination) skills. I took to his approach readily, and the book he co-authored, An Introduction to Clinical Medicine, was my clinical bible. In 1971, my second year after graduation, I worked a term in his department as a Senior Resident. It was he who arranged for me to study Statistics and Epidemiology at the London School of Hygiene in 1972. From 1973 to 1977 I was on his staff as a Junior Lecturer, during which time I wrote my PhD thesis. After that I had little to do with him. He retired from his Department in 1983, and he died in 2000. The main reason for whatever success I enjoy in my work today, is the scrupulous clinical method he taught me. Thanks, Prof.

farmdoc's blog post number 35

Because in the 19th century there were no MRI scanners, reaching diagnoses relied more on interview and physical examination findings than is so today. Joseph Bell (1837-1911), a Scottish surgeon and Edinburgh University lecturer, prided himself on using all his senses to diagnose the seemingly undiagnosable. In 1878 Bell’s clerk was a medical student then named Arthur Doyle (the Conan came later) whom Bell selected as his assistant. Doyle, after presenting his case findings to Bell, was astounded by Bell’s deductions even before Bell had questioned or examined the patient. And so, history records, Bell was the inspiration for the most famous detective ever – Sherlock Holmes – who first appeared in 1887 in A Study in Scarlet. Since I can’t remember when, I have been a Holmes devotee. I am the proud owner of a modest collection of Sherlockiana comprising books, a deerstalker hat, and an authentic brick from 221B Baker Street which was demolished in 1980. And for a time I was a member of the Sherlock Holmes Society of London. Since 1987 my doctoring work has had forensic undertones. Though no medical genius, I am methodical and obsessional. I adhere to the aphorism that in medicine more is missed by not looking than not knowing. Therefore I look. Holmes, Doyle and Bell have taught me well.