Professor Peter Abrahams—GP, author, and academic clinical anatomistBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39582.641748.CE (Published 24 May 2008) Cite this as: BMJ 2008;336:s182
- Peter Gogalniceanu, academic foundation trainee in surgery
Peter Abrahams is a general practitioner in Willesden, London, and professor of clinical anatomy at the University of Warwick. He is a fellow of Girton College, Cambridge, and examiner for the Royal College of Surgeons.
How did you become interested in medicine?
I originally intended to become a geography teacher. I did A levels in geography, history, and French and then went with VSO to the jungles of Borneo to teach geography to schoolchildren. While I was there, they discovered that I had done a first aid course. Consequently, I ran a clinic every night for a year, 50 miles from the nearest village, let alone hospital. I enjoyed it so much that when I came back to England I decided to take up medicine. The irony, of course, is that I still ended up being a geography teacher—only I teach the geography of the human body.
You have travelled and worked from Borneo to Grenada. How has this impacted on your career and clinical practice?
I think the fact that I spent my youth in a Third World country gave me insights into how difficult are the lives of people around the world. As an academic I’ve always been sympathetic to people from underdeveloped countries—whether teaching, examining, or lecturing. I also worked with the World Health Organization to help set up a medical school in the desert area of Beersheba in Israel—a model copied all over the Third World by WHO.
How does one become a clinical anatomist today?
That’s difficult. There is no dedicated career pathway for anatomists. I started off as an academic in an anatomy department and kept my clinical medicine going. I was “clinical anatomist” at University College London and later I went to Cambridge. Anatomists develop either through the academic anatomy pathway or through the surgical tree followed by early retirement or reduction in operating commitments. I think both directions have equal validity, although I expect I have a wider view of anatomy as I have practised more than “surgical” anatomy.
Is clinical anatomy important to all doctors?
I am a practising GP. Every GP is a better diagnostician the more anatomy they know. I don’t think I’m a particularly all rounder doctor, but I think my diagnostic skills are above average because I know every little part of the body. The commonest complaint a patient presents with is pain. If you know your anatomy, it’s not too difficult to work out what particular structure is causing the pain. You need good anatomical knowledge to be a good diagnostician.
What are the advantages of being both a clinician and an academic?
A clinical subject is difficult to teach without clinical practice. I see anatomy as a living entity every week that I practise. When I teach I am taking everything from its rich clinical origins back to basic science. The real advantage is that I can walk into a lecture and say, “Last week I saw a patient with this condition, and this is why you need to know this particular fact.”
What are the challenges and satisfaction of writing textbooks?
It keeps you on your toes and it makes you work with other people. All my books are combined author books, which is rewarding as I have had the chance to work with the most talented anatomists from America, South Africa, and Britain. I think it also makes one think about the way people learn and about the practical aspects of education and not just the theoretical educational jargon. Nevertheless, when books are about to be published it is not an easy time. One could be working 20 hours a day just to get the proofs finished. This does cause stress with your family and spouse.
Is undergraduate medical education in the United Kingdom being dumbed down?
It certainly is being dumbed down at an anatomical level. I think the next Tomorrow’s Doctors report will swing the pendulum towards basic science. The change in focus from basic life sciences towards the social sciences has meant that a lot of young doctors no longer have the knowledge needed for some specialties—this is particularly relevant to the young surgeon. I am an examiner for fellowship (FRCS) and membership (MRCS) exams for the Royal College of Surgeons and have been for 26 years. The knowledge of the British surgeon is now well below that of doctors from Egypt, Iran, Iraq, and India. People failing their MRCS are often British graduates because they no longer learn enough anatomy as undergraduates. Many people starting surgery now don’t know where their knife is going and what structures they may damage if the knife slips.
Should medicine become a postgraduate subject?
I think the answer is yes. I speak as somebody who has spent 30 years teaching British undergraduates aged 17 and 18. Undergraduates are intelligent but less focused than the graduate students. I teach not only at a postgraduate medical school in Warwick but have taught postgraduates for 15 years in the Caribbean and America. It is definitely a more rewarding experience. People are too young at 18 to know that they really want to go into such a committing career as medicine.
Should anatomy demonstrating be part of surgical training?
This is an absolute must for two reasons: firstly, young surgeons need time to learn their anatomy, and secondly there are now no young surgeons to teach medical students. Where will undergraduates learn their clinical anatomy? There are few people like myself who are medically qualified anatomists. Most anatomists are molecular biologists. In fact, I doubt if there are more than 30 qualified “clinical” anatomists in Britain—that is less than one for each medical school.
What is the most humbling experience of your career?
Any GP will tell you that every single week one says: “Oh my God, if only I had noticed or done something, that patient would still be alive or in a much better state.” This is the one thing that keeps my feet on the ground. Being an academic you can easily become aloof to the realities of the world.
Name: Peter Abrahams
Position: General practitioner and professor of clinical anatomy at the University of Warwick. He is a fellow of Girton College, Cambridge, and examiner for the Royal College of Surgeons
Biography: Trained at the Middlesex Hospital Medical School after doing VSO teaching in the jungles of Borneo. Wrote “Clinical Anatomy of Practical Procedures” with Webb in 1973, which led to him being awarded a British Fulbright scholarship to the University of Iowa in anatomical education. Appointed clinical anatomist at University College London and then the University of Cambridge, before becoming professor of clinical anatomy at Kigezi International School of Medicine