Intended for healthcare professionals


Guest faculty

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:545
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

    Southern California is often portrayed as being on another planet, so it came as a surprise, at a meeting there recently, to find that the doctors did not arrive on roller blades, wearing fluorescent shades.

    Lecturing abroad is straightforward if you have invented a new technique like transspecies fertilisation or minimal access caesarean section. If, however, the purpose of the meeting is local postgraduate education the guest faculty becomes uneasy and asks itself thoughtful questions.

    Just how international is medicine? Global journals and research networks would have us believe it is universal and that the results of trials conducted in South America or Africa are applicable in London or Yorkshire. I am unconvinced, but I find it hard to explain why. It is not just my concerns about informed consent given by people who cannot read but more a feeling that there may be confounding factors which I cannot discern from a distance.

    Colleagues overseas could apply the latter reservation to research here, so is British experience useful to doctors abroad? Are results in our hospital system of trainee based medicine relevant to places where senior obstetricians sleep near the delivery suite? American speakers on the faculty seemed to think so. They cited United Kingdom studies with gratifying frequency, though with a bit more emphasis on our mavericks than on our mainstream opinions. The “gee whizz” attitude is hard to avoid, whichever direction you look across the Atlantic.

    I thought that my postgraduate education was benefiting more than my hosts' was. I had not known that obstetricians on the east coast of the United States use forceps while those on the west coast dare not for fear of litigation. Nor had I realised how much pressure they all feel to reduce caesarean section rates, sometimes against their clinical judgment. Or that many American women use their gynaecologist as their primary care doctor.

    Some of the differences between Leeds and Los Angeles were more spectacular. Our menopause clinic does not as yet offer complementary therapy by a robed and turbaned doctor with a waist length beard. Experience in Beverly Hills suggests that this would be hugely successful and that the practitioner could be caucasian. Whether or not therapeutic efficacy would be altered by a Scottish accent remains to be tested.

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