Last year I finally hung up my stethoscope, two weeks after my 80th birthday and after more than 50 years in general practice.
Several people (including Jenni Murray on Radio 4's Woman's Hour) have asked me what I consider the greatest changes in general practice since I started in the early 1960s.
My first year in practice was in Aberdeen. There was no appointment system. The patients queued, sitting on wooden benches in the waiting room, shuffling along until their turn came.
The practice was on call 24/7 and I did my share of night visits. Some of the older, more experienced doctors carried out tonsillectomies on the kitchen table, with a colleague anaesthetising.
Babies were mostly delivered at home or in a midwife-led maternity unit with the GP in attendance.
I had five children in my first nine years in general practice, taking only eight weeks off with each one. This seemed quite generous at the time.
However, I was not superwoman, and after my first year and just before baby number two arrived, I reduced to part-time work.
When we moved from Scotland to England, I spent the next 15 years in quite a deprived area of Manchester, where many of the patients had neither telephones nor cars.
We did a lot of home visits for patients who were unable to get themselves, or their children, to the surgery.
In those days, before mobile phones, if I had to get a patient into hospital, I would go to the nearest public phone box and, provided it was not vandalised, call the local hospital - often hanging on (while putting more coins in the slot) until I had arranged my patient's admission. Then it was a matter of telephoning for an ambulance, from the same phone box.
When I eventually moved to a suburban practice in South Manchester, nearly everyone had a telephone and a car. It was bliss.
There, our house calls were mostly to care homes, nursing homes and elderly housebound patients.
Towards the end of my career, the latter were often younger than me, the difference being that I was fit and they were not.
Patients are much more health conscious nowadays. They are more aware of the dangers of smoking and as a result, smoking-related diseases have dramatically decreased.
Forty years ago, one would see inoperable breast cancer, a mass fungating through the skin and with clinical signs of secondary spread. The patients must have known it was cancer, but they assumed it was a death sentence, so they presented late. Nowadays, they present very early, when the disease is treatable.
In my time as a GP, I have also witnessed the introduction of cervical screening in the 1960s and breast screening in the 1980s, which must have saved many lives.
When I went into general practice, poliomyelitis vaccine had just been introduced, which has now virtually eliminated this dreadful disease. As a new GP, I saw children with disabilities acquired as a result of polio, some wearing leg braces.
Childhood infectious diseases were also more common and caused much misery, particularly measles and its associated persistent cough. I remember being up most nights when my two older children had it. When the measles vaccine was introduced in the late 1960s, it was a relief to know my younger children were protected from it.
Another condition GPs used to see fairly frequently was rheumatic heart disease.
Drugs and training
The introduction of more effective drugs has made some previously common surgical operations almost obsolete. For example, chronic peptic ulcers were mostly treated with gastric surgery, involving long stays in hospital. With the advent of PPIs and H2 antagonists, this can mostly be managed in general practice.
Postgraduate training has improved - from being non-existent to five years' training. In the old days, any qualified doctor could set up in general practice without GP experience ('putting their plate up' as it was known). This is unthinkable now.
But the greatest advance in the past 15 years has been the computer. This has simplified practice and made it much more efficient. No longer does one have to shuffle through handwritten notes in Lloyd George folders to find details of past operations, letters and pathology reports.
Throughout my 50 years, I have always found general practice interesting, varied and challenging. The service delivered to patients during my career has changed - in fact improved - out of all recognition.
- Dr Russell is a retired GP from Cheshire