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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. | |
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02 Diabetes not taught well. Other diseases more common. Asian people reluctant to talk re diabetes.
Came to UK for higher education. | |
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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… | |
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| 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… | |
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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… | |
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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. | |
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| 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… | |
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| 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. | |
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| 09 Outpatients in early ‘70s expanding. Urine testing. Dietitian. Chiropody started. Nurse knowledgeable but not specialist. Many complications. Screening. | |
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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. | |
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| 11 Became GP, 1975 – no training. Remained assistant at diabetic clinic – useful for GP. Inner-city practice, 60% Asian. | |
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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… | |
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| 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… | |
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| 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. | |
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| 15 Main changes at Heartlands 1972-2006: more clinics, physicians, joint clinics with other specialists, chiropody, eye screening… | |
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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. | |
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| 17 General practice unchanged 1975-85. Then more practice nurses. Fund-holding from 1990. Got used to it, then abolished! | |
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| 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. | |
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| 19 More specialists in community. Only special cases referred to hospital. More convenient for patients. | |
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20 Tensions because hospitals losing empires.
I retired partly because too much reorganisation. More administration, less time for patients. Patients demand more. | |
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| 21 Involvement of lawyers. Mutual loyalty decreasing. | |
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| 22 Diagnosis of diabetes now less devastating. Some keep it secret. Some ignore it. Encouraging example of people who’ve had it for years. | |
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