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Dr Asher`s junior medics (A Wright left)

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Dr Asher`s junior medics (A Wright left) Cambridge biochemists, 1958, (A Wright, front, 3rd from right) Queen Mother opens Kings  medical school extension, c 1960
George Alberti opens Walsall centre, 1999 Alex Wright, 2007 63. 01 Urine testing chart
63. 02 1956 Carbohydrate portions
 
 
Interview 63 Alex Wright

Consultant in Diabetes
Born in Sutton Coldfield in 1937.


Overview: Dr. Alex Wright was Senior Lecturer and Honorary Consultant at Birmingham from 1973 to 1997, mostly at the General Hospital and latterly at the University Hospital, Selly Oak. He is now Honorary Senior Lecturer and works part-time at Manor Hospital, Walsall and Heartlands Hospital, Birmingham. He has also seen private patients on Saturday mornings for over 25 years. He has published on many aspects of diabetes and was part of the policy advisory group for the UK Prospective Diabetes Study, a 20-year trial which showed that the life-threatening complications of type 2 diabetes can be significantly reduced by appropriate treatment.

Please note that Overview relates to date of recording 09 May 2007

 Short samples

1 While training at King’s in 1958, he took blood samples from patients on the diabetes ward and, when technicians were absent at weekends, did the laboratory tests himself. At outpatients’ clinics in the 1960s, blood testing was also a major difficulty [ 48 secs ]

2 He considers that in most respects the history of diabetes care in recent decades has been one of great improvements in both technology and treatment, but he is critical of the current number of guidelines, protocols and very specific targets [ 64 secs ]

 
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01 Good school science. Cambridge. Extra year biochemistry. King`s – diabetes locum influential. Central Middx. Brompton H. – chests. Diabetes career began 1964 - Russell Fraser, Hammersmith H. Research fellow, then registrar. McMaster University. Senior lecturer, General Hospital, Birmingham…
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02 …Hoffenberg, Malins & Fitzgerald. Now part-time – diabetes & ophthalmology.
Cambridge biochemistry anti-medics.
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03 King`s – small intake, personal tuition. Stayed for house jobs. Didn`t do National Service. Oakley, Pyke & Taylor. Taylor – possibility of viruses causing diabetes.
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04 Hierarchy, but knew each other. Senior ward sisters ruled.
First saw diabetes during locum. Diabetes team started ketoacidosis treatment in A & E, then ward. I took blood samples & did lab tests. Taught patients urine testing. No blood self-testing.
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05 Asked patients to fast before clinics; waited for blood test results.
At King`s, some admitted to diabetes ward, some elsewhere - feet treated by orthopaedic surgeon; pregnancies admitted last 4 weeks.
Invited RD Lawrence to give talk.
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06 Lawrence`s 10g portions have endured. Now carbohydrate counting for Type 1s.
Mixing insulins tedious. Different strengths caused mistakes. New insulins & delivery systems revolutionary. UKPDs used Ultratard.
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07 Central Middx, 1962-4, then Hammersmith. Diabetes as part of general medicine. Contacts. Met Arthur Rubenstein.
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08 Hammersmith 1964-9 – Radioimmunoassay research. Russell Fraser interested in maturity-onset diabetes, later called non-insulin-dependent, now Type 2.
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09 Good pregnancy outcomes. IGTs well-recorded. Now less prematurity, more Caesarians. Mortality still higher than in general population.
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10 Joined new medical school at McMaster – Moran Campbell. Taught endocrinology & diabetes. Pioneering – problem-solving education & Bill Spaulding said specialist nurses should run clinic.
Poor control on Indian reservation.
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11 I recommend experience abroad. American Diabetes Association fantastic. Met Best. Saw Osler`s childhood home.
Got job at Birmingham medical school – expanded to include General Hospital – failed to introduce problem-solving education or integrated teaching. Both happen now.
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12 Diabetes suited to problem-solving. Students select option.
1973 - huge clinic, 3 or 4 desks, little privacy, little nurse involvement. Diabetic ward useful for education.
Saw first specialist nurse education, pioneered by Janet Kinson.
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13 DSNs good re technicalities & protocols & more accessible. Also need doctors, dietitian, chiropodist, social worker. General Hospital had these in 1973 - not everywhere. Chiropody done jointly works best.
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14 Clinics large - diabetes treated in hospital. Interested GPs assisted in clinics. Clinics saw large numbers because treatment simpler. Now routine management in primary care.
In 1973, more blindness, less renal disease - people died.
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15 Eye problems - could offer nothing. Wonderful now to tell patients they can preserve sight.
BDA important. I learnt from children`s camps.
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16 At General Hospital, asked by Robert Turner to be 1 of 6 pilot centres for UKPDS. 18 years. Policy advisory group. Post-study follow-up results due shortly. Importance of control of diabetes, blood pressure, lipids.
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17 Hard to get funding for UKPDS, but cheaper than drug trials.
General Hospital moved to Selly Oak. Semi-retired. Part-time at Walsall & Heartlands. Retain academic connection with Selly Oak.
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18 Private practice Saturday mornings. Convenient for patients, but must recognise limits. Must continue relating to GPs - basic care & prescriptions. Privilege of free prescriptions.
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19 Too many protocols now – stifle innovation, slow trials of new drugs.
I was slow to abandon urine-testing or recommend injecting 4 times a day. Insulin pumps good, but cost less elsewhere.
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20 Some dislike 4 times a day, some prefer pork insulin – respect them so long as it`s educated choice. Education not same as compliance!
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