Patient and Staff Voices in Primary Care

Description:

This unique work represents the recording and analysis of oral history interviews conducted by the pioneering general practitioner Dr Hetty Ockrim with over seventy patients, as well as office staff and members of the nursing team, between 1989 and 1992 in her former practice in the Ibrox/Govan areas of Glasgow, places of significant socio-economic deprivation. Her focus in undertaking this study was on personal and social, rather than just clinical, issues. The interviews are accompanied by background and commentary for the study, reflecting the full breadth of general practice. Many of the interviewees had memories stretching back before the NHS, providing a unique historical perspective of service development, as well as invaluable directions for improving current and future general practice.

Key Features

• Provides a historical context for the developments in health over several decades prior to the study
• Shows how oral history methods have increasingly been used in medical history research and explores the benefits of this approach
• Covers many of the themes of the oral history which enabled and encouraged patients to comment on what was important to them in their encounters with health care
• Follows the increasing acceptance of women in medicine, demonstrating how women doctors were viewed by patients within the practice compared to changes in wider society
• Presents a ‘history from below’, using voices that are not normally heard in the medical discourse, illustrating the importance of the doctor–patient interface

Supporting a wider understanding of what patient narratives can tell us about the delivery of health care from the perspective of the patients, the front-line users of health services, the book showhow oral history can provide an understanding of health care more broadly, key at a time when social inequality is once again widening in many regions.

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Introduction

This work represents the recording and analysis of oral history interviews conducted between 1989 and 1992 in one practice in the Ibrox/Govan areas of Glasgow, places of signifcant socio-economic deprivation. My mother, Dr Ockrim, who had just retired as Senior Partner in the practice, conducted the interviews of over seventy patients as well as key members of the practice’s ofce staf and nursing teams, besides providing background and commentary for the study based on her extensive experience of general practice. Many of the interviewees had memories stretching back before the NHS and could describe the practice of Dr Stevan George, who had founded the practice in 1924, and how care was delivered at the time. I was also a principal in her practice from 1977 till 2009 and knew most of the interviewees as patients also.

Tis work will show how oral history can provide an understanding of health care and its delivery in an inner-city practice, signifcantly afected by social and economic deprivation. Patient views describe historic health care issues which tells of the past as well as indicating future needs.

Frequently mentioned factors include the major impact of the creation of the National Health Service, how patients’ respect for the doctor’s authority impacts their health care, how stigma and marginalisation afected the health and welfare of patients and issues related to women and medicine. Some of these themes are universal and speak for communities and societies far beyond Glasgow, where people describe past struggles for access to medical care, free at the point of contact, understanding from their family doctor and full coverage from specialised medical services and hospital inpatient treatment.

Te book uses oral history testimonies to present a history from below using voices that are not normally heard in the medical discourse. Te use of oral history will enable the understanding of the following themes:
1. Provide a historical context for the developments in health over several decades prior to the study. To do this will require an understanding of how the practice was formed and operated prior to the National Health Service and how delivery of care within the practice was seen by the patients to change afer 1948.

2. Follow the increasing acceptance of women in medicine, showing how women doctors were viewed by patients within the practice, along with changes in the wider society.

3. Understand what oral history can tell us about the delivery of health care from the perspective of the patients, the users of the health services, illustrating the doctor–patient interface.

I will show how oral history methods have increasingly been used in medical history research and will explore the benefts of this approach. I will also show how this study adds to the growing body of material on the history of general medical practice in Britain through patient narratives, as mediated by one of their own family doctors.1 Tis account of the health care of patients in one urban practice allows for their own understandings in the telling of the story. I will show that the choice of the retired doctor interviewing former patients gives a diferent perspective on oral medical history compared with previous studies where interviews of general practitioners or patients were conducted by social scientists.

When I discovered the interviewer’s ‘Letters to No-One’ afer her death, it became possible for the oral histories to form part of a narrative illuminating not just the practice of medicine in one area of Glasgow but also the remarkable practitioner who conducted the interviews.

The study generated a considerable amount of quantitative data. In 2000, the British Medical Journal printed an article showing that qualitative research, such as in verbatim notes or transcribed recordings of interviews, can produce ‘vast amounts of data’. I have followed this approach which indicates that the analytical process begins during data collection, allowing the researcher to go back and refne questions, develop hypotheses and pursue emerging avenues of inquiry in further depth. It also allows the use of paper systems, which may be considered old-fashioned and laborious but can help the researcher to develop an intimate knowledge of the data. Tis approach can yield issues which may be unlikely to arise in the clinical encounter.

In 2014, with concern about the long-term survival of the audiotapes, the oral history recordings and the transcripts were deposited at the Scottish Oral History Centre (SOHC) which was established at the University of Strathclyde, Glasgow, in 1995, and is involved in a wide range of teaching, research and outreach activities designed primarily to encourage the use of ‘best practice’ oral history methodology in Scotland.

Tus, this study derives from three separate elements. Te frst is the major collection of oral history interviews recorded by Dr Ockrim between 1989 and 1992 following her retiral from general practice in the Midlock Medical Centre and its detailed analysis in the production of this book. She was keen to remain intellectually active and still maintain an interest in medicine, and she was enthusiastic when I suggested the idea of an oral history project to her. Te interviewer was aware of the risks of being the dominant individual in the telling of the patients’ stories. Great care was taken to ensure that she was mainly the silent facilitator for the accounts which emerged. For many patients, memories extended back to the years before the formation of the National Health Service in 1948 and, for a few, back as far or even further than the 1930s.

Te second element follows Dr Ockrim’s assiduous collection of notes, and some of this commentary forms an important part of the study. We have her records of impressions of practice over her decades in medicine, frst as an obstetrician/gynaecologist in hospital and then as a general practitioner, frstly in Cessnock Street (1946–1987) and fnally in Midlock Street (1987–1989). Tere are further notes in a card index of the interviews and on the questionnaires, which accompanied each patient interview. Tis formed a useful guide to the importance of the testimony.

Because it contains much confdential material, it has only been used in exceptional, and clearly noted and attributed, circumstances. Tese notes were fnally supplemented by the ‘Letters to No-one’ which described the retirement process as she saw it. Handwritten over six months during 1987, these three letters illustrate her feelings at this important milestone in her life and add a fascinating additional dimension to the oral history study itself. Te letters were only discovered afer her death in August 2007. Tey are a unique window into her mind.

In the fnal element, we cover many of the themes of the oral history which lets her patients comment on what was important to them in their encounter with health care in the Ibrox and Govan areas of Glasgow. Tis is a rich seam of oral history which deserves a wide audience—especially for health care professionals and the consumers of their services. Next, we will try to understand the individual, and her personality, behind the interviews and the author of the ‘Letters to No-one’. She faced prejudices as a woman on her way into medicine. Tere was family opposition to her entry into medical school in 1938. As a female medical graduate in 1943, she had to face prejudice, ofen from patients as much as from senior colleagues.

Table of contents :

Cover
Half Title
Title
Copyright
Table of Contents
Foreword
Acknowledgements
Author
List of Abbreviations
1 Introduction
2 The Medical Background
3 Study Methodology
4 Practice Organisation
5 Stigma and Marginalisation
6 Clinical Topics
7 Discussion and Conclusion
Appendices: Dr Ockrim’s Study Notes
Index