Dr Adrian Morris FRCP - Retiring
I joined The Swinfen Charitable Trust in 2005, and so, after 16 years, and 147 consultations, I have decided to retire. I realised the time had come when I found that I was no longer at the cutting edge of my specialty (General internal Medicine, and Respiratory Medicine), having retired from full time hospital practice seven years earlier. My association with the Trust has been a most rewarding and a challenging experience, and I thought it might be interesting to share some of my memories and thoughts.
I heard about the Trust quite by chance when a local GP started attending my chest radiology teaching sessions, intended for trainee doctors in the hospital where I worked. He told me that he was going to Nepal for a 3-month sabbatical to work with the Trust in a remote rural clinic. It sounded very interesting, and although I would not be able to go abroad to work, he told me that I could offer specialist advice via the Trust’s global telemedicine network to remote rural hospitals and clinics. I thought I might have something to offer having worked in Africa and in the USA and England. He put me in touch with Lord and Lady Swinfen who enrolled me on their list of specialist consultants.
Referrals came slowly at first, but gradually picked up to about one a month. I had been concerned that my hospital work would make it difficult to cope with too many referrals, and result in a slow response time, but this was never the case. The nature of the work is what interested me particularly. It was unsurprisingly, very different from the work I was trained for in a teaching hospital in England, where there are teams of experts in every field from whom one can seek help and advice at any time. Doctors and nurses working in remote rural hospitals and clinics, often in war torn countries, are having to deal with some of the most difficult problems in isolation and with access to only rudimentary investigations and imaging. I soon realised that theirs was by far the most difficult job. I have nothing but admiration for the people who work in these places. I soon realised that by understanding the limitations of the facilities that they work with, one can give the most appropriate clinical advice. It is no use recommending a CT scan if this is only available three days journey away, and at prohibitive expense to the patient. The information on the Trust’s referral system about the facilities of each clinic or hospital is excellent in this regard.
Language is seldom a problem, but medical understanding is sometimes an issue. Medical information regarding symptoms and signs, as well as names and results of investigations may be different in different parts of the world, as are the names of many drugs. Fortunately, these problems can usually be resolved with the help of Google. Perhaps more difficult is dealing with insufficient information or poor quality images. For example, I have had several referrals for diagnostic help in patients with chronic cough, but with little or no further information. The possible causes are innumerable, and a good history, clinical examination, and a chest X-ray (where possible) could narrow down the possibilities. The quality of images is much better now, but some clinics can only take photographs of X-rays or scans or reports. I remember a photograph of a chest X-ray taken against a bright window where the street outside was more visible than the patient’s lungs! In general, the better the information in the referral, and the more precise the question, the better the response will be.
Some diseases only occur in certain parts of the world (especially infectious diseases), and geographical knowledge of the region can be important. Most doctors trained in the developed western world have relatively little knowledge of these unusual conditions. The more specialised doctors become, the less likely they are able to recognise and manage conditions outside their specialty. This may be particularly important for an organisation like the Trust, where “generalists” are a rarity but have an important part to play.
I am hugely indebted to the support I have received from Lord and Lady Swinfen, and in leaving I would like to pay tribute to them, and to the humanitarian organisation they founded. It was an inspirational idea to connect doctors and nurses in some of the remotest parts of the world with doctors and nurses who have the knowledge and know how, using the world wide web of the internet, like a global teaching hospital. The Swinfen Charitable Trust is testament to their vision and energy, as are the many lives they have changed across the globe.
Image supplied by Dr Morris