title: Patient and staff Views: An analysis of an oral history study with patients and staff in the Midlock Medical Centre, Ibrox, Glasgow conducted by Dr Hetty B Ockrim between 1991 and 1992
Creators: name: Collins, Kenneth Edward
Publisher: name: University of Glasgow
Year: 2024

description: The thesis consists of an analysis of an oral history project carried out with patients and staff members at the Midlock Medical Centre in Glasgow between October 1991 and February 1992. The interviews were conducted by the recently retired senior partner Dr Hetty Ockrim and her role and that of her predecessor, the practice founder, Dr Stevan George, are fondly but not uncritically recalled. The critical role of the interviewer is also discussed. The thesis shows the issues and challenges in the two parts of the study – the original interviews and their analysis more than two decades later. It considers the background of the clinical consultation, the encounter between patient and family doctor in general practice and shows how the extended format of an oral history interview with participants, former patients of the interviewer, and staff members provides a history from below, representing views not often seen in recounting medical history.

The thesis provides the context for the oral history study and its analysis. This is by extensively reviewing existing literature regarding important topics such as general practice, women in medicine, practice organisation and patient access to general practitioners. It describes Glasgow’s troubled medical history and the deprived area in which the practice is based covering the period before and after the watershed of the National Health Service (NHS) in 1948.

Patients were chosen to represent a sample of ages and health experiences and to reflect the ethnic mix of the practice. Memories of many of the participants stretched back to the 1930s and indicated the source of many of the stigmas related to pre-NHS institutions, heavy handed and paternalistic handling of welfare and the illnesses associated with poverty and poor housing, such as tuberculosis and rickets. The use of the semi-structured questionnaire enabled the interviewer to follow a common track in conducting the interviews yet remaining flexible enough for, even lengthy, digressions Current issues relating to stigma and marginalisation are also considered relating to immigrant communities, substance misuse and mental health problems.

The oral history reflected also how care in the practice was delivered before the era of appointment systems, the heavy burden of house calls and the preference by many for babies to be delivered at home. By recording the testimony of patients and practice staff we can see the tensions between patient expectation and the reality of how clinical time was organised. The thesis shows how the oral history was designed, participants enrolled, questionnaires formulated, and an extensive transcript produced. The transcripts provided the data on which the secondary analysis is based, and carefully selected excerpts reveal participant reflections on their care and the social aspects of health and welfare.

The thesis shows how patient needs and expectations were addressed. This involves testimony from both patients as well as receptionists, administrative staff and practice and district nurses. Topics include how patient and receptionists saw access to the doctor. This involved the patient/receptionist/doctor interfaces, office systems, the function of the waiting room, which doubled as a social hub, and the role of house visits.
In considering the critical issues relating to medicine, as experienced by the participants, a very wide and varied range of clinical topics were remembered. This shows how clinical topics inform our understanding of healthcare provision as well as how the community/hospital interface operated. The topic is laid out thematically dealing with issues which include patient/doctor communication, accuracy of recall, truth telling and coping with loss. Finally, these are considered through such headings as humaneness, recovering lost memories and closure.

The thesis illustrates, above all, the value of oral history in telling the health story from the patient’s point of view, giving participants the time, not usually available in a consultation, to explain memories, feelings, and their interpretation of past events. Participants also showed what was important to them in terms of service provision. The study analysis identifies what was seen to be important to participants, indicating that there needs to be a sensitive understanding of what they felt were key issues. Finally, I will show how the close relationships between doctor and patients in the practice could improve both patient health and general wellbeing.