Health: Dr Phil Hammond's Column

Sixty years ago teaching hospitals had sub-Minstrel singers and slash-happy surgeons: so what progress have we made since then?

Thankyou, thankyou, thankyou to John Lord, the eagle-eyed sub- librarian at the University of London library. Back in July, I published a letter from a retired doctor who reminisced about his time as a "Christmas Nigger" at Guy's Hospital. I subsequently received a small clutch of hate mail from Guy's alumni denouncing the letter as a fraud and berating me for besmirching the good name of the flagship of the Tory reforms. Well, John was flicking through some old periodicals when he stumbled on Guy's Hospital Gazette, Vol. L (New Series) 1936 (p7).

"The Niggers, Christmas, 1935: The group of coloured gentlemen gathered before a camera on the steps of the Colonnade on the morning of Christmas Day were not, as we heard an old lady suppose, distinguished visitors being introduced to the hospital by its chaplains. It is true, however, that in a sense they were missionaries. They were, in fact (reader, you have guessed it), the `Niggers' performing their annual mirth mission."

What follows is a five-page review, including a photograph of 29 boot- blacked Guy's doctors. To be fair, the racism doesn't permeate further into the act except for a tendency for these white, ex-public schoolboys to refer to each other as "Massa." Their songs "warmed us in the first verse and brought us to fever pitch in the second" and had a distinctly macho flavour, eg:

Oh! We do like to open the abdomen, / Oh! We do like to play with all the guts, / Oh we do like to see the blood go splash, splash, splash / As the RSO goes slash, slash, slash. / So just send us up your favourite patient / We'll wield a very pretty knife / Four we are four house wizards, / And we'll whip out all your gizzards / We're doing service, we're saving life.

Have you guessed the tune? Of course all this was more than 60 years ago, when every teaching hospital may have had a sub-Minstrels singing troupe and it was perfectly acceptable for unsupervised junior surgeons to go slash slash slash and whip out your gizzards. But what progress have we made since then?

Guy's medical school has now merged with St Thomas' and both have a sufficiently enlightened admissions policy that no-one need use stage make-up to effect a multicultural mix. But racism remains a big problem in medicine. In 1992, Drs Sam Everington and Aneez Esmail sent fake applications to junior hospital doctor posts, identical in all but surname. Half were Asian, half Anglo-Saxon. The latter were twice as likely to get an interview. The research was repeated this year, with marginally less depressing results.

The pair also discovered that the GMC was six times more likely to discipline an ethnic minority doctor than a white doctor. This was not due to a persecution of ethnic minority doctors, but rather that white doctors are far more likely to get away with misconduct. This research led to an internal inquiry within the GMC and a number of "racial awareness" reforms.

At present, 23 per cent of all NHS hospital doctors come from ethnic minorities, yet only a handful of these reach consultant grade - while 69 per cent of staff grade posts (the consultants' skivvies) have non- white occupants. And if non-white doctors do make it to consultant their chance of picking up a lucrative merit award is a quarter that of white peers. The legacy lives on.

As for slash-happy surgeons, the image is perhaps a little unfair. The majority are as diligent as their experience and training will allow. In the Niggers' day, you could learn from your mistakes because patients didn't rise again in the mortuary (well, not often) and relatives didn't sue. Today, doctors are expected to get it right first time, every time. In a surgical context, the minimum requirement should be that the surgeon is competent to operate. Alas, audit is so backward in medicine that many surgeons have little insight into how competent they are - or if they do, they don't share it with the patients.

In June, Professor Janet Wilson from the University of Newcastle published a national survey that found that two thirds of all operations performed by surgeons in training are unassisted - even major operations being done for the first time. Senior house officers (hardly experienced surgeons) were left alone to do their first salivary gland excisions, hernia repairs and stomach, spleen and gall bladder removals with their senior "support" not even present in the hospital.

Most operations went surprisingly well, others didn't. But in all cases the surgeon couldn't give the patient the prior undertaking that he was competent to perform the operation or would be closely assisted by someone who was. This seems a bizarre and ultimately very unsettling state of affairs. Far less stressful to lie back, think of England and sing along with the Niggers...