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|01 Born Florence 1935. Father Jewish from Poland - professor of organic chemistry. Racial laws introduced 1938 came to England.|
|02 Bombed in London. Father interned, Isle of Man. Moved to Manchester. Father`s family perished. Bury Girls` Grammar School. Place to do Medicine at St. Hilda`s.|
|03 Oxford training excellent - Le Gros Clark, Alice Stewart, Honor Smith, George Pickering, David Pyke, Harold Ellis, Sam Corrie. Met husband on clinical course - 2 women & 6 men admitted to Radcliffe Medical School, 1958. Hands-on medicine.|
|04 During pre-clinical, diabetes part of biochemistry Hans Krebs. Realised impact of diabetes when started clinical. Insulin & diet don`t remember tablets. Didn`t talk re Type & Type 2. Patients felt they`d eaten too much sugar & carbohydrate cut out. Some admitted for months stayed in bed.|
|05 Dr. Cook specialised in diabetes did locum with him. Glucose monitored by venous blood samples. Patients did urine testing. |
Emphasis on connection between lifestyle & obesity.
|06 Patients not told much relative told. Patients didn`t ask questions. Some doctors told truth brutally. Diabetes patients told re short-term effects, but not long-term perhaps not fully realised.|
|07 Radcliffe wards long. No privacy shouted questions in deaf patients` ear trumpets! Sister ruled ward. Grand ward rounds talked re patients in front of them, ignoring them.|
|08 Patients wheeled into lecture demonstrations before 50 to 60 people. |
Outpatients crowded & chaotic. Patients complained - saw different person each time.
|09 After training, did surgical house job worked night & following day. |
Appalling living conditions. Disapproval of married housemen like us.
|10 Married 1960. 1st child 1961. Moved to Southampton for husband`s house jobs. Moved to Mill Hill 2 more children. No part-time medicine I wasn`t fully registered. Did marriage guidance for 10 years counselling techniques proved useful.|
|11 Moved to Hedingham, Essex. Got job at Broomfield Hospital huge changes after 10 years.|
|12 After gap 1962-72 (in fact longer), no difficulty in taking history or physical examination well-trained. But treatment different short hospital stays. Better for diabetics to be stabilised in normal conditions. Blood testing replaced urine testing.|
|13 Gap in fact 1961-74 crucial years. Danger of deep vein thrombosis known patients kept on move. Diabetic stabilisation more realistic. Diet moving to wider range of food.|
|14 More education for diabetics more involved in own management. They told us re new developments learnt from Diabetic Assoc. Got own practice, 1978. We appointed DSN around 1987 |
|15 Partnership with Dr.Veater patients told me about him & didn`t want changes from his treatment. He predicted how long they`d be ill. They preferred his illegible handwriting to mine!|
|16 Rural dispensing practice. Small building. Dispensing important close involvement. Fridge for insulin. Disposable needles.|
|17 General hospital 20 miles away. Had emergency kits large glucose vials & huge syringes for hypos, intravenous drip for comas.|
|18 We treated emergencies, 24 hours on call. Diabetics` routine checks at hospital not always diabetologist, but general physician with special interest. HbA1c introduced. Diabetics came to us with other problems. We cared for pregnant diabetics.|
|19 Shift from hospital to GPs in 1980s. Our patients had far to travel to hospital, poor transport. Dispensing meant we were close to diabetics. More diabetes hospital couldn`t cope. Others became involved in our team local ophthalmologist, district nurse, practice DSN. Chiropodists began to work in practices, late 1980s. New 1990 contract encouraged us to do more.|
|20 Transferred diabetic register to computer. Husband devised user-friendly checklist.|
|21 Hospitals were bad at informing us re their admissions & prescriptions.|
|22 Some elderly diabetics didn`t come to surgery. Much home-visiting. One man well-controlled without complications into his nineties. Another very brittle, despite being conscientious, lost sight but lived to late seventies. |
|23 One well-educated lady denied condition & lost leg. One teenage girl didn`t want to follow diabetic regime & had complications.|
|24 Another adolescent girl chaotic, but eventually took responsibility. Patients often don`t take advice. Usually come round. Sometimes a bit late for diabetics. |
Diabetes diagnosed after recurrent thrush or large baby or child`s sickness & diarrhoea.
|25 We started fund-holding in 1990s. Appointed fund manager for several practices opportunity to share experience. Gave us financial control over hospital care.|
|26 We chose which hospitals best. Got quick appointments for difficult cases. Hotline to diabetologist`s DSN. Diabetologist set up district register research tool. |
|27 Rural dispensing safe & instant. Dispensers spot problems. Doctor on hand to answer queries. Deliveries for remote patients.|
|28 Training of dispensers important. Dispensing under threat from wholesalers & government changes I work to safeguard it with Dispensing Doctors` Assoc. With diabetes, government pressure to keep down costs.|
|29 Diabetes was regarded as metabolic now increasingly seen as cardiovascular. Huge increase in numbers. Better outlook for patients, if resources mustered. |