Corpus - conversations about medicine and life

Keith Macleod: radically rethinking the clinical relationship

8 May 2017 Leave a Comment

Sue Hallwright

University of Otago Medical School, Dunedin

I have strong memories of being taught by Keith Macleod when I was studying medicine at the University of Otago in the 1970s. He had a unique approach to teaching in action. I recall him, for example, discussing the profession of medicine in a tutorial. He challenged our shared view that medicine is all about curing and healing. He mooted that people are dying from the minute that they are born, that every second of every day people are treating their terminal condition by taking their next breath. Only when people fail in their self-treatment and when their friends and families are unable to help them, do people eventually seek help from doctors. On this basis, medicine is a failure-based system and ultimately all people must die, so we must fail with every single patient.

Keith Macleod: a unique and powerful teacher

1 May 2017 1 Comment

Sue Hallwright

My recollections of Keith Macleod date back to the late 1970s when I was studying medicine at the University of Otago. Keith’s views regarding the role of clinical medicine in people’s lives, his focus on patient experience and his methods of teaching all had a major impact on me. All that I learned from Keith in my early medical education has stayed with me and remained relevant over the years.

This was an era in which most doctors and patients tended to view the doctor as the ‘expert’: the person with all of the knowledge about illnesses and how to treat them. The patient’s job was to provide a good history of the condition, make themselves available for examination and investigation, and then, once diagnosed, to follow their doctor’s instructions regarding treatment. As I recall it, the importance of the patients’ expertise, the meaning of their condition in the context of their lives and the limits to medical knowledge and practice were not acknowledged within the medical school curriculum at that time.

Fallout from the Jones Fracture

1 May 2017 1 Comment

Kath Beattie

GP to orthopedic specialist: “Yes, a Jones fracture. At the base of the left foot fifth metatarsel. She’s here with me examining the x ray and swearing…”

True, I did remark, “Oh bother!” (or something similar). After all it was December 10^th, and I was booked to travel to my sister’s 90^th birthday party in Auckland on the 21st, followed by tramping with a niece, then a flight to/from Whakatane to visit my youngest sister… get the picture? And I was being told that the fracture was serious, that the moonboot was to be worn day and night and most importantly the foot was never, never to touch the floor.

Like playing the piano blindfold: “Life on the Spectrum”

1 May 2017 1 Comment

Sue Wootton

Musician and teacher Julie Hanify has played the piano since she was a child, but for most of her life she felt like she was “playing blindfold”. In her memoir Small Blue Thing: Life on the Spectrum, Julie writes:

I had the sense that each note was in its own world and that the next note was a total surprise, as if it were on the following page. Reading music was like leaping note to note over an abyss. I lived my life like this. I’d be in the moment with no forward thought or planning for the next.”

When she was 43, Hanify was diagnosed with attention deficit hyperactivity disorder (ADHD). The prescribed medication improved her brain’s capacity to filter and sort multiple stimuli. Now, for the first time ever, she could sight-read music. More generally, she was able to sense the present moment as having been shaped by the past and as contributing to the future. With a sense of sequence as a frame for life’s experiences, Hanify could grasp previously elusive concepts like anticipation, planning, and cause and effect. “Medication”, she writes, “changed my life”.

‘The Next Patient in the Waiting Room’: Keith Macleod and the clinical encounter

24 April 2017 1 Comment

Gwynnedd Somerville and Charlotte Paul

What are you here for, if not to treat difficult patients?”

“How to take a history from and examine a sick person would seem an unusual starting point to create a philosophy of life … but that did not deter Keith”, writes psychiatrist Sandy Macleod in The Next Patient in the Waiting Room, a book of essays about his father, which we have edited. Keith Macleod joined the Department of Medicine at the University of Otago in 1951 and became a neurologist at Dunedin Hospital. Following his interest in the borderland between neurological and psychiatric disorders, he later became a neuro-psychiatric consultant at Ashburn Hall, retiring in 1983. He was also a philosopher, poet and great talker. The essays in the book explore Keith’s philosophy of life from the point of view of colleagues, family, patients, students, and friends. Here we take the title of the volume to touch on some of his maddeningly difficult ideas.

An ode to clutter

24 April 2017 2 Comments

Lorraine Ritchie

I flick through the House and Garden mags at the supermarket (although I do have an old collection of my own) and wonder at the perceived modern beauty of black and chrome kitchens and tidy open living spaces: “where is all their stuff?!” I think to myself.

When we were young, the local grocer’s shop at the corner of the next street was owned at one stage by the Clutterbuck family. I fell in love with the sound of their surname and, most probably, the fact that it contained the word ‘clutter’.

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