From paternalism to partnershipBMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7152.221 (Published 18 July 1998) Cite this as: BMJ 1998;317:221
- Sue MacGregor., radio broadcaster and journalist
Medical reporting on the radio has changed from the paternalistic advice given by the early radio doctors to a consumerist, partnership approach to health care, says broadcaster Sue MacGregor
The anniversary celebrations of the NHS–and don't we journalists love anniversaries?–and an invitation from the Royal College of Physicians to address them on their college day gave me a highly entertaining chance to trawl through the BBC's archives to look at how radio had reflected medical issues over 50 years.
I'd heard of Charles Hill, the radio doctor, of course, but until I listened to some of his early broadcasts I'd no idea how pioneering he really was in those wartime days and beyond. It wasn't all roly poly references to bowels and muddy tongues; there was a pretty frank discussion that he chaired about venereal disease and how you could (and couldn't) catch it, aimed at the intelligent teenager, which–apart from the impossibly posh voices–wouldn't have been out of place today.
That was before the birth of the NHS, a momentous event which, extraordinarily enough, the BBC couldn't cover at the time in its topical programmes. The “fourteen day rule” meant that a national issue couldn't be talked about on the radio for the two week period before the relevant legislation was debated in parliament. Quite the reverse obtains today, of course, when media interest grows and peaks before parliamentary debates and often dwindles away once the bill has been passed.
It shouldn't have surprised me, of course, but I was struck by how deeply ingrained was the paternalism of the medical profession in the late 1940s and early ‘50s. In 1958 a long discussion on the Home Service chaired by George Scott on possible reforms of the NHS 10 years after its inception involved–for they were still bound by the rules of anonymity–a “town doctor” and a “country doctor” discussing how waiting lists worked and patient interviewing techniques. Lord Taylor, a former general practitioner, sympathised with those who had no truck with an appointments system. He referred to the “difficulties that working class people experience in making an appointment–ringing up in advance and all the rest of it,” while the country doctor often found his patients plain irritating: “They will always talk to you while you're writing things down. Occasionally one has to say: Now look, I'm making careful notes about this complaint. If you go on talking I shall write complete nonsense.'” So much for listening to what the patient is trying to tell you.
The 1960s brought rather more enlightened attitudes. The well publicised issues of abortion and heart transplants (Professor Barnard's pioneering operation in Cape Town was quickly followed by others around the world) brought more open discussion and a recognition that lay opinion mattered. And journalists on pioneering radio programmes like The World at One (on which I was a junior reporter) took a much more rigorous and sceptical approach to interviewing the medical profession. It was perhaps the beginning of an acceptance that doctors might be called to account for their actions.
There were further changes in the ‘60s and ‘70s. Medical issues began to be seen (and heard) more from the point of view of the consumer, and there was a growth within BBC radio of “social action” broadcasting, with the use of telephone helplines, targeting particular audiences, especially the young and particularly young men, many of whom were until then out of touch with the health professionals. Radio One's AIDS helpline in the early ‘80s was an important success, and the rock musician Ian Dury's warnings about unprotected sex had true “street cred” with his audience.
The ways that the media, including radio, covers medicine are now as diverse as medicine itself. There's a recognition that health is not just about illness and cures, but about politics, the environment, the structure of the NHS, and the quality and promptness of treatment. All this often has to be conveyed by the specialist correspondents in bitesize bits of 30-40 seconds. The relationship between the medics and the media people is still a symbiotic one, but there's a new spirit of openness and accountability creeping in. A firm public commitment to that from all the royal colleges would be the best of medical bequests from them to all of us as we move into a new millennium.