A memorable locum job

BMJ 2002; 324 doi: (Published 08 June 2002) Cite this as: BMJ 2002;324:1391
  1. Stan Bloxham, general practitioner (retired) (stanbloxham{at}
  1. Clent, Worcestershire

    “Today you go to root.” Surely a curious instruction to a trainee general practitioner starting his first locum job. As the principal raised herself in her sick bed and went on to tell me where the various visits were and the characters of the patients concerned, I eventually realised she was talking about the village of Wroot.

    After the five mile drive along an empty ditch-lined road through the fens, I spent the morning listening to inarticulate, generally healthy folk giving histories of “bellyache” or “spots.”

    Returning to the surgery, I had to make up the medicines for the last Wroot patient seen to collect. In the tiny dispensary there were rows of bottles with coloured liquids and scraps of paper with suggestions for some of the repeat prescriptions. There was a kitchen weighing machine and a few domestic spoons. A shoebox full of drug samples completed the pharmaceutical arrangements.

    When evening surgery came I feared a crowd but saw about six, mostly elderly, rural, and poor, again with vague chronic symptoms. I sat on a high stool in the dispensary, with the patient in a low chair facing me, knees almost touching my shins. When a patient sensed that I was confused or bored or I expressed a wish to examine, he or she would point to one of the coloured medicines, saying, “She usually gives me some of that.” The most popular medicine seemed to be a mixture of a clear green tincture of digitalis with a pink stomach mixture containing phenobarbitone. Sometimes I cheated by giving out a drug sample; these were never so well received.

    For the first three days, I and my pregnant wife stayed in the local pub—the elderly partners had been suffering from salmonella poisoning and had to delay their shooting holiday. When they eventually tottered off and we moved in, the housekeeper revealed the freezers bulging with game several seasons old.

    There may have been another source of infection. The consulting room was a dark enormous cavern, in which the gentleman partner still carried out experiments with fungating agar plates, Bunsen burners, and fume cupboards. The two ancient couches were covered in books, papers, and racks of test tubes. The doctor said he had worked with Alexander Fleming. Because of the (largely pending) research work, patients could not be seen in this room; hence the intimacy of the dispensary consultations.

    There was little pathology among the unsophisticated stalwarts who had stuck with the partners over many years: several uninvestigated anaemias; one night visit, to a girl with a grand mal fit, whose speedy recovery with intramuscular phenobarbitone was greatly appreciated; and a man with a probable gastric carcinoma who reluctantly agreed to be hospitalised. We even managed an afternoon swim in a neighbouring practitioner's pool while he manned a silent telephone.

    What had I learnt from my locum job on the Isle of Haxey? That general practice had once been an accepted, eccentric part of rural life? Maybe. I certainly heard no hint of criticism or any suggestion that the general practitioners I worked for needed bringing up to date, auditing, or revalidating. They had simply fitted in.

    So when was this episode—in the 1930s or 40s? No, I'm not that ancient, it was in the “Swinging Sixties.”

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