BMJ 1996; 312 doi: (Published 18 May 1996) Cite this as: BMJ 1996;312:1264
  1. Anthony Abrahams

    The importance of communication

    It is 1956. The limousine draws up before the portico of Guy's Hospital and out steps Dr Arthur Henry Douthwaite, senior physician to Guy's Hospital, in full morning dress and bowler hat. Waiting to greet him at the top of the steps are the sister, senior registrar, junior registrar, senior house physician, assistant house physician, senior students on the firm, and junior students—one of them me.

    We proceed to the ward gravely and by the time we reach the first bed the crowd has swelled threefold as others join voluntarily to gather wisdom. At each bed the grand round takes its usual pattern. The unusual part is that Dr Douthwaite speaks to each patient about his medical problems lucidly but in language the local residents understand.

    One day he asks the house physician, “What can we do to help Mr Jones?” The house physician has no idea but suggests, “We could try him on Mist Probono Publico Cum Asafoetida, Sir?” or something like. “Sister, a bottle of Mist Probono Publico,” orders Dr Douthwaite, and Sister sends the message down the hierarchy of her minions and the bottle appears. Dr Douthwaite requests that first the house physician and then every person on the round should taste the medicine. Mr Jones is spared and another lesson is learnt.

    Dr Douthwaite was a great physician and textbook writer. An expert on drugs, he dissuaded the Home Office from banning heroin for medical use, for which we must still give thanks. Unfortunately, he made one of his rare errors all too publicly at the John Bodkin Adams trial, where his evidence was crucial in securing the acquittal of that genial general practitioner, whose rich patients bequeathed him generous legacies. Legend had it that that cost him the presidency of the Royal College of Physicians. Legend also had it that Dr Douthwaite walked into the casualty department in his usual morning dress and greeted the casualty officer, “I am Arthur Henry Douthwaite and I have just perforated my duodenal ulcer, please arrange my admission.” He had.

    He was a great man. He taught me that the truly great man cares for his patients and communicates with them. It is a lesson not yet learnt by some great men but it has served one humble general practitioner well.—ANTHONY ABRAHAMS is a general practitioner in Oxford