Out of characters

An increasingly favorite topic being discussed in the current journals I receive is that of medical education. Its various aspects are closely appraised and, in particular, the newer methods and standards of postgraduate training are spiritedly scrutinized.

However, in my opinion not enough attention or print is devoted to the teachers themselves. This got me thinking of some of the clinicians under whom I trained, and there then emerged an impression that I am certain is correct. Namely, that in modern medicine and its teaching, there are not enough characters.

I am fortunate to have enjoyed the company, tutelage, and subsequent friendship of several such individuals. What makes a character? To be sure, ability, wisdom, experience, and the gift of communicating are essential for a good teacher to possess. But there has to be something else. Style, class, humor, even eccentricity may set such an individual apart.

One has to admit that there may be negative aspects to be included. Rudeness, blustering, and stubbornness have all been experienced, but these were, for me, few and far between.

Current “political correctness” was then unknown and I feel we were all the better for that.

I was lucky to be trained by several notable individuals, including two knights of the realm, and without exception they were, in their different ways, definitely characters.

Let me introduce you to a few. Sadly, perhaps save one, all are no longer with us, but they most certainly live on in my fond memory.

In the mid-1960s I was appointed, to no small surprise of myself (and perhaps others), to be chief resident and resident assistant surgeon at the world-renowned Hospital for Sick Children at Great Ormond Street in London. This brought me into close personal contact with those at the centre and pinnacle of pediatric surgery in Britain.

Retired, but still active, was Sir Denis Browne, who was famous for his treatment of club feet, hare lip, and almost everything in between. He was also an inventor, gadgeteer, and Wimbledon-class tennis player. Each Tuesday he would do a private case from anywhere in the world and it fell to me to prepare everything and to assist him. I recall him, on one occasion, operating on a vital part of a Belgian boy’s anatomy, the patient coming from semi-royalty. With a twinkle in his eye, he allowed that this operation was being done for “future dynastic reasons.”

DB, as he was called, had achieved one distinction, which however hard and long I tried I could not emulate. He was driven to work by his anesthesiologist!

Sir David Innes Williams was the pre-eminent children’s urologist of the time, X-rays and patients being sent for his opinion from all over the world. One day I accompanied him to a consultation and I watched as he tried in vain to get the resident presenting the case to relax and be coherent and lucid. In his delightful, whimsical manner he smiled and joked, but to no avail. As we left, he took my arm and said softly, “Graham, one of the most dreadful of all congenital anomalies is …,” he paused, and as I eagerly awaited some precious surgical pearl of wisdom, he continued, “to be born completely devoid of a sense of humor!”

How true. David was a superb surgeon, gentleman, human being, and friend, and we corresponded until quite recently.

Predating these two giants in my career was a Dr Callum McLeod. He hailed from the outer Hebridean Isles and had that soft lilting accent of those parts. Callum was to provide me with a gambit that I used over many years to have a little fun with an earnest resident or student. He invented “McLeod’s disease.” When we would go to Callum with, to us, a completely bizarre puzzling string of symptoms and signs, he would nod knowingly and sagely, and place his hands together, making a steeple of his fingers. He would then rock gently on his heels, look into the far distance, and pronounce wisely in that soft voice of his, “Ah yes. You get that sometimes.” He would then quietly walk away leaving us feeling no wiser but thinking that we were!

Wonderful doctors all: wise, famous, respected, and very definitely characters.

There were inevitably examples of less-enviable traits of personality to be observed in some of my mentors. Nonetheless, I am prepared to forgive their eccentricities, not to mention their occasional salvos of outrageousness, not to say warped sense of humor. One such, long departed, I will protect out of fondness by using only his initials, GM. He was a pioneer in the then-emerging specialty of vascular surgery and, like many of that ilk, was a stickler for detail and regulated decorum. Naturally, he was completely against all forms of smoking.

On one occasion during ward rounds, he discovered a patient sneaking a few quick puffs by a nearby window, whereupon GM rounded on the head nurse and bellowed “Sister! Fetch this man’s trousers. He is leaving!” And so he did, to return only a few days later, much chastened, and with no vestige of tobacco anywhere near his person.

On another day GM was loping along the corridor in his dark gray suit and inevitable suede shoes, when the nearby patient’s relative’s phone rang at his elbow. Snatching it up, he barked, “Yes, what?” A rather timid voice said, “Can you please give me the latest report on Mrs Gunn?”

“Certainly,” replied GM, “Bang! Bang!” and slammed the instrument down, striding on his way.

I often wonder what would be the result of that today! But I forgive him because he was a splendid clinician and his operative results were amazing. Also, his true sense of humor was delightful and he was very kind and encouraging to me.

Of necessity, I have provided you with a series of names. I have one more.

Lord St. John Stevas is, perhaps, the most staunch, loyal, and well-known royalist in England. He said, “One should be careful, when writing or speaking, not to mention too many names. One simply must avoid, at all costs, to be labeled as a name dropper, as Her Majesty remarked to me only last week.”


Dr Fraser is retired from pediatric general surgery at BC Children’s Hospital, where he was head of surgery. He enjoys reading, writing, and erratic golf.

Graham C. Fraser, FRCS, FACS. Out of characters. BCMJ, Vol. 51, No. 3, April, 2009, Page(s) 140 - Back Page.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply