When GPs went the extra mile (even if they had to swim...)

ICAnnOt now clearly distinguish in my memory Dr Lewis from Dr Deighton. they were both kindly scotstoun gPs in the mid-1970s, i was only a small boy at the time and i only saw them when i was very ill.

Which, in the grim winters of that era, was rather a lot, for i was a ‘chesty’ child, constantly going down with bronchitis. But i never set foot in their surgery.

they always came to our house, warm and twinkle-eyed, balding and besuited. i was poked, prodded, auscultated with a chilly stethoscope, and in short order a prescription was scrawled. it was invariably for penicillin – bottled and syrupy – and, after a few days repining with Look and Learn, i was up and around again.

even three years ago, the family doctor on his rounds and making his house calls had become as remote a memory as Peter and Jane go shopping With Mummy. then came Covid – and, suddenly, bewilderingly, we were from all sides exhorted to protect the nHs by not using it.

securing an appointment with your gP is now the stuff of nightmare. You either have to make your case with some dragon of a receptionist or cast yourself on the mercies of nHs 24.

if a doctor does take interest in your malady it is unlikely you will be afforded more than a telephone call. she will sound stressed; in a rush. if the matter is straightforward and you are articulate that may just suffice.

But there is no substitute for the proper, in-person ‘clerking’ of a patient. the best doctors are well trained in this. they keep a sharp eye out for tiny clues – nicotine-stained fingers, slurring or hesitancy in speech, disarray in clothing.

BY seemingly casual conversation they check your alertness. they may even spot something serious, like a tiny rodent cancer on your face or, in one instance of which i read, when a gP realised a man might be diabetic because of white, powdery splashes on his shoes. sugar in the urine, you see.

But if the doctor does not get to see you – or you are the sort of humble soul who is loath to trouble the nHs during so difficult a time – then coming tragedy may not be so far away.

And tragedies quietly unfold all about us after two years when more than half of all gP consultations have taken place over the phone, more than half of us cannot secure appointments over three days in advance, and only 17 per cent, in a recent survey, were able to choose the sort of medical encounter they wanted.

throw in that diffidence so common among older scots, and the real fear of going to hospital at all in an age of Covid – the two friends i lost to it both caught it as inpatients for something else – and there we have the undiagnosed cancers, the deteriorating heart valves and so on.

in the Outer Hebrides many of us enjoy vivid memories of the gP who would go the extra mile. At Carloway, on Lewis, we had for quite a number of years the services of the eccentric Dr John Macrae.

He boasted a long white beard that lent him such a patriarchal air he was fast dubbed ‘Dr Moses’. But he cared for his patients and, especially, the elderly ones, native gaelic speakers with halting english.

He would personally deliver their prescriptions and, if they needed to see a consultant, took them to hospital himself, as patient-advocate and interpreter. My late grandmother thought he was wonderful.

But down on north Uist they went one better. they boasted a dynasty. Dr Alexander Macleod and his family spent seven decades in the service of that community, from his arrival in 1932 and far beyond his retirement in 1974.

Dubbed, variously, ‘Zadok’ or An Dotair Mòr, the Big Doctor, Macleod made his rounds of the huge parish by foot, motor car and – when he had to cross assorted tidal strands – by horseback.

it was not even his own horse – a public-spirited neighbour let him have use of the beast – and it is whispered that, on at least one occasion, Dr Macleod actually swam to a patient.

His wife Julia was also a doctor, who frequently deputised for him when he was away dealing with cases on such outliers as Berneray or Baleshare. she, too, kept house, raised their children – and often resumed medical duties the day after giving birth.

she would ruefully recall those occasions when, detained by a difficult case, her man and his borrowed steed might have to wait hours for the tide to ebb before they could return to the surgery. Patience, Dr Julia said, is a virtue when you live on an island.

Alexander Macleod was, recalled Dr John gillies of the royal College of Physicians in 2014, ‘A man of great observational powers and stamina, and cared for his patients 24 hours a day through a time when most had no transport, no phones and no electricity, visiting on foot and sometimes on horseback. He delivered many children born on the island and had a formidable reputation as an obstetrician.’

Dr gillies, a north Uist native, should know, for Dr Macleod delivered him. Zadok beside did basic dentistry and it was at his insistence the Western isles won its first air ambulance service.

He was succeeded by his son, Dr John A J Macleod, who served until his own retirement in 2000 – if with rather more conveniences and better roads – relaxing, when his duties permitted, in fly fishing.

He had impish memories of his parents. ‘in each of the islands, the surgery was part of the house so our dining room was also the waiting room.

‘there were only occasional visits from dentists so the gP had to do extractions. there was a second door to the surgery and if we saw father carrying his pan of dental instruments through to boil them in the kitchen it became a signal for us to crouch behind this door and listen to the patients’ reactions.’

in our present straits there are new and obvious pressures. the tick-box culture of our day absorbs far too much gP time in onerous and often preposterous paperwork.

Primary care responsibilities are in themselves daunting. A gP who refers rather too many patients to hospital soon wins an unenviable reputation for being ‘soft’. But when a doctor errs in the other direction, people start to die.

And there is a growing shortage of gPs. As health secretary, nicola sturgeon cut the number of funded places for homegrown medical students at scots universities – and many family doctors have simply quit.

And there has also been the sustained erosion of the public service ethos – in professional politics and even in the clergy as much as in medicine. What was a vocation is, for too many today, but their trade – and with a beady eye on the clock.

For the Macleods of north Uist and that medical generation, it was more than their calling. it was their duty.