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Sunday, May 7, 2017

Making of a Child Psychiatrist: (74) The General Practitioner (19); Blue Sky Dreaming

I scoured the medical and psychiatric journals looking for possible registrar training positions in psychiatry. The issue with the English jobs was the salary; slightly less than half what I earned as a GP. We discussed the issue, and neither of us thought it was a good option to give up our house and job and go back into some sort of struggling penury. I discussed it with Ken Fraser, and I know he was on the lookout for possible jobs that might suit me. But nothing came up on his radar either. So that was that.
I decided to focus on general practice, and had some discussions with a GP colleague David Diggens who was also a Round Tabler and godfather to Rod, our second son. David had been gearing up to take the examination for Membership of the Royal College of General Practitioners (MRCGP), and although his wife and partner Elizabeth was not taking the exam at the time, she was helping with the coaching. The Membership sounded like a good idea, I had served enough time in practice to qualify to take the written paper so, over a couple of months, David and I did some joint studying, reviewed past papers, and applied to take the exam.
We travelled up to London together, and went to 14, Princes Gate in Kensington (at that time the headquarters for the College). I have to admit the examination process is now very vague. As I remember it, there was only one paper. It addressed both some general practice organisational matters, but also a range of clinical situations. Surprisingly there was quite a lot of psychiatry, and that made me feel quite comfortable. But in other areas, I now had a wealth of case based knowledge, and was able to respond to the questions using real life examples and experiences. The same was true at interview with the three examiners. They had case based scenarios for discussion with a range of questions to be addressed. I emerged from the interview believing I had done reasonably well. In due course I was delighted to receive a letter to say I had passed, and asking whether I would be attending the ceremony in London – which on this occasion I could not. My certificate of Membership arrived through the post a couple of months later.
The membership would have made little difference to how I worked in General Practice, but was an important marker that I had the knowledge and experience to be a member of yet another Royal College. Sadly, I was never to take the next step and seek Fellowship of the College. Events took their own course, and life changed direction.
Looking back, I realise that in many ways I have been a life long and somewhat obsessive collector. Since childhood I had a thirst for knowledge, and collected the names of books I had read, attempting to read everything a particular author had written. This transferred to Medicine, and I continue to this day with a need to read widely around clinical issues with which I am confronted. In General Practice, I devoured the two journals I received each month, as I do with the journals I currently receive. Ultimately step by step, I collected an impressive list of diplomas and degrees throughout my career as a doctor. Most of the letters after my name have now been discarded as being no longer relevant to modern day practice, there is not enough wall space in my study for all the certificates, and mostly they have taken up a new life of filling cupboards. All of the precious medical and psychiatric books collected along the way have had a similar fate. They are displayed in author order on the overfilled bookshelves, only occasionally being taken down to fact check, or derive a quotation. Nobody reads books any more, or wants to collect them in this electronic age when the old style libraries are dying and all knowledge is available electronically in brief quotes or sound bites, or as a downloaded .pdf or eBook. But I am getting ahead of my story.
Another example would be my stamp collection, such as it is, mainly focused on Great Britain and Australia. Begun in childhood with a stamp album from Joan and Harry as a gift for being a 4 year old pageboy at their wedding, it has grown in fits and starts. When I was in the final six months building up to finals, I had an obsession with particular issues, and began to buy job lots at auction which required immense and focussed sorting – far more important than the textbooks I should have been completing. A distraction, yet one which may have kept me sort of sane. In general practice, I had another episode of philately, beginning to collect British first day covers, which were published in a prolific manner for all sorts of national events. I had a subscription to continue with this for many years. The covers, like the albums and bags of stamp miscellany, are carefully stored in a dry place awaiting the next set of exams in life and the intense need for distraction that comes with them. There is a vague fantasy connected with my grandfather ‘Pop’ Martin. In his 80s he focused on his large stamp collection, and stamp by stamp sold them to the highest bidder at auction. I had always shared my own passion with him whenever we got together. Perhaps I had a fantasy he might leave the collection to me – the only other known Martin philatelist. But that was never to be. I do believe he supplemented his pension very well at the time; perhaps I could emulate him.
It was in the British Journal of Psychiatry I came across an advertisement for a registrar training job in Child Psychiatry. Whoever got the job was expected to join the Postgraduate Psychiatry Training Program. The problem was that it was in Adelaide, South Australia at the Children’s Hospital. The pay appeared to be generous by British standards, with all the ancillary benefits. I broached the topic with Jan, and we talked for days about the implications for our wonderfully settled lifestyle and the plans we had made for the future of our boys, the implications for extended family, and the possibility of leaving our beautiful home. Jan knew I had been keen to get back into psychiatry, and this looked like a promising option, but the upheaval was unthinkable. Strangely, we had had the experience of spending three months in Adelaide in 1963 so, at one level, it was not a totally strange city. There was a sense of fate taking a hand in our lives. If it had been another city, perhaps we would not have given it a second thought.

Ultimately, drawing a shared deep breath, we decided to apply, to see what happened. It sounded like a grand adventure and, if it did not work out, we always had the option of returning to England. I worked on my CV to bring it up to date, and sent a letter off with copies of memberships and certificates to the Director of Psychiatry, a Dr. Jeffrey Gerard. The response was encouraging. The job had already been allocated for the 1974 year to a local doctor (a Dr. Kerry Callaghan, with whom I was to become quite close later on). But the letter suggested I might be interested in taking the job for calendar year 1975 – which of course would allow plenty of time to arrange sponsorship, visas, travel and accommodation. It would also allow a suitable planned withdrawal and handover to a new GP for Birchington.

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