Richard Asher – British Haematologist and Medical writer


Richard_Asher_for_Wikipedia

Richard Asher was an eminent British endocrinologist and haematologist, working in the first half of the 20th Century in London. He was responsible for the mental observation ward and described and named the Munchausen syndrome in a 1951 article in The Lancet.

He was the father of Jane Asher, who was briefly the girlfriend of Paul McCartney in the mid-sixties, but today I do not want to talk about either hematology or one of the founders of the most influential pop group of all time. I wish to talk about medical writing because Richard Asher was one of the most important writers of his time but I also believe that his ideas are not so outdated, or that things can be learnt from them nowadays, and his style of writing should be appreciated.

He wrote many articles during the fifties and sixties, and although written fifty or more years ago they are still relevant both for their ideas and for their style. Articles include “The dangers of going to bed”, “Why are medical journals so dull?”, “Clinical sense:the use of the five senses” and “The seven sins of medicine”. I think that it is interesting to look back at these articles in the days of EBM and super-specialisation because they hark back to a time when clinical judgement was more important than complementary tests, mainly because there were limited tests to be made, and wit and wile were an essential part of a good medical practitioner. I have enjoyed the dry wit and the writing and do believe that many a writer now could learn a great deal.

In the article entitled “Clinical sense: the use of the five senses” Asher explores the importance of the five senses, and some of his points are as important now as before:

“Clinical knowledge depends upon three processes- observing, recording, and thinking.”

and one observation which I especially like – “The recording and transmission of those stimuli largely depends on the use of words, which according to their suitability and their arrangement, have a far greater influence on medical progrees than is generally recognised.” Too true, too true, and reminds me of Rudyard Kipling, too often believed to be solely a children’s writer who said,

Words,are, of course, the most powerful drug used by mankind.”

And later on in the same article talks about serendipity; ” A special word for this faculty – serendipity- was coined by Horace Walpole in 1754 and defined as “the faculty of making happy and unexpected discoveries by accident”; but luck alone is not enough. You need to be a good noticer. Jane Austen wrote in Emma: Depend upon it, a lucky guess is never merely luck, there is always some talent in it.” And in the article he depicts the senses, sight ” Without doubt sight takes first place”, hearing, where he specifies, ” I only consider the use of the naked ear unaided by instruments”, touch, smell, “Alcoholic breath is easily detectable” and even taste!!!

Another interesting article to comment on is “The Seven Sins of Medicine”, a perspective on medical ethics first published in The Lancet in 1949. For Asher the seven sins that a doctor must not commit are: Obscurity, Cruelty, Bad Manners, Over-Specialisation, Love of the Rare, Common Stupidity, and Sloth. For example with Obscurity Asher is committed to clear communication and plain language both in writing and speaking, extremely important when a doctor has to explain diagnosis, prognosis or possible treatment to a patient, and cruelty seems too harsh a word but maybe unconscious cruelty, if such a concept exists, is more common than we believe, and over-specialisation is obviously needed in the modern day but can sometimes lead, amongst other things, to misdiagnosis. Doctors tell me that love of the rare is fairly common and maybe even more so after the “House” series. Sloth is the old-fashioned, biblical word for laziness and might account for an excessive reliance on tests, rather than spending more precious time to take a clinical history. Time, however, is in short supply.

Richard Asher was writing a long time ago but my point is that, even though the advances brought about in medicine since the 1960’s have been tremendous, and have led to enormous progress in treating the ill, I still think that a “glance at the past” never does us any harm. Our elders ( I am NOT going to say “betters”) have a lot teach us, maybe we should give them more space in our hectic and fretful life.

What the Doctor said by Raymond Carver


In my previous post I mentioned ” A new path to the waterfall” by Raymond Carver, so I thought that it would be a good idea to mention soemthing about this writer. He was one of the most influential writers of the second half of the twentieth century, who died prematurely in 1988 at the young age of fifty. He was considered one of the greatest short story writers of his generation, responsible, some say, for reviving the fortunes of the short story. His stories were peopled with everyday people and everyday problems. At the end of his life he started to produce poetry, and here is an example of one of his last poems, which talks about his encounter with his doctor after being told he had lung cancer.

What the Doctor said 

He said it doesn’t look good
he said it looks bad in fact real bad
he said I counted thirty-two of them on one lung before
I quit counting them
I said I’m glad I wouldn’t want to know
about any more being there than that
he said are you a religious man do you kneel down
in forest groves and let yourself ask for help
when you come to a waterfall
mist blowing against your face and arms
do you stop and ask for understanding at those moments
I said not yet but I intend to start today
he said I’m real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else
I didn’t catch and not knowing what else to do
and not wanting him to have to repeat it
and me to have to fully digest it
I just looked at him
for a minute and he looked back it was then
I jumped up and shook hands with this man who’d just given me
something no one else on earth had ever given me
I may have even thanked him habit being so strong

Richard Smith: It’s hard, perhaps impossibly hard, to be a good doctor


Richard Smith

In the Interview with Dr Manolo Tomas I mentioned this blog by Richard Smith. All of his posts are stimulating and thought-provoking, but this one about what makes a good doctor I found especially interesting. I hope that you enjoy it.

  Dr Richard Smith, former editor of the BMJ