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|01 Born India. Family of lawyers. Qualified 1967. Came to UK 1970. Reasons for choosing medicine. |
At medical school, Bihar State, `63, `64, saw patient started on insulin – big event. Sent blood to lab.
|02 Diabetes not taught well. Other diseases more common. Asian people reluctant to talk re diabetes. |
Came to UK for higher education.
|03 Got General Medical Council registration before coming. No initiation to hospital. Locums in East England, mostly paediatric. |
Moved to Nottingham `70, `71. SHO in general medicine. Diabetes clinic at General Hospital…
|04 …now University Hospital – huge numbers. Urine testing – blood results came week later. Podiatrist there, but not in subsequent hospitals. Dietitian. Consultants made decisions re calories. Some went by portions…|
|05 …dietitian had to produce diet sheet. East Birmingham Hospital (Heartlands) consultants still using portions, early ‘70s – consultant asked me to produce Asian diet sheet. |
In Nottingham calories related to patient`s work. Unrealistic target. Mainly Type 2. Type 1…
|06 …portions spread through day. |
Nottingham nurses possibly worked harder then - 4 urine samples daily. Patients stayed long time. Insulin in 3 different units.
At Heartlands, mother in hospital throughout pregnancy.
|07 After Nottingham General - Highbury Hospital, Nottingham, then St. Chad`s, Birmingham – emergencies. Then registrar at East Birmingham – chest medicine. Chest consultant also ran diabetic clinic: I got involved in clinic & ward. One Asian man looked sad…|
|08 …thought we`d said he couldn`t eat! Another thought he had to eat usual food plus diabetic diet! Many Asians in East Birmingham Heartlands. I wrote Asian diet sheet in different languages – not then done at Birmingham General.|
|09 Outpatients in early ‘70s expanding. Urine testing. Dietitian. Chiropody started. Nurse knowledgeable but not specialist. Many complications. Screening. |
|10 No special patient education. Gave details of British Diabetic Association. |
General ward. Stabilising on insulin, ketoacidosis, complications. Woman who wouldn`t give up chocolate. Pregnant women cooperative. Joint obstetric clinic from mid-‘70s.
|11 Became GP, 1975 – no training. Remained assistant at diabetic clinic – useful for GP. Inner-city practice, 60% Asian.|
|12 Diabetes increasing. GPs` involvement minimal. More involved recently – new contract. |
Clinical assistant same as registrar without ward work.
Initially overlooked high incidence among Asians. Obvious from 1980…
|13 …One Heartlands clinic expanded to whole department. Clinics full when I worked there until last April. As GP, I fear mass screening would double numbers. Already testing at places of worship. Theories re Asian prevalence…|
|14 …not much in India in ‘60s. Lifestyle. Obese boy considered a good labourer. Need mass education rather than mass screening. Few Asian mothers breast-feed.|
|15 Main changes at Heartlands 1972-2006: more clinics, physicians, joint clinics with other specialists, chiropody, eye screening…|
|16 …specialist nurses – avoid need to admit for insulin stabilisation or for whole pregnancy. Specialist nurses began mid-‘80s. I got on well with them; some GPs felt threatened. |
Became hospital practitioner, 1986/7.
|17 General practice unchanged 1975-85. Then more practice nurses. Fund-holding from 1990. Got used to it, then abolished! |
|18 Had more money for nurses & dietitian. In last 3/4 years major shift to community-based clinics. At first, I was afraid we didn`t have resources, but have had own clinic for last 5 years.|
|19 More specialists in community. Only special cases referred to hospital. More convenient for patients. |
|20 Tensions because hospitals losing empires. |
I retired partly because too much reorganisation. More administration, less time for patients. Patients demand more.
|21 Involvement of lawyers. Mutual loyalty decreasing.|
|22 Diagnosis of diabetes now less devastating. Some keep it secret. Some ignore it. Encouraging example of people who`ve had it for years. |