My first book

By the summer of 1967 I had enough original published work and more in progress to give me confidence that I could link it all together and submit a dissertation to the University of Adelaide for my MD. My qualifying university degree was MB, BS, bachelor of medicine and bachelor of surgery; the MD is a higher degree that is approximately equivalent to PhD, obtainable by submitting a thesis on original work. Usually this work is a single research project done in a university department with a supervisor. I departed from convention by submitting a thesis based on approximately seven years of research work, all of it providing a perspective on an aspect of general practice. In combination these separate research projects gave me a series of perspectives of the structure and process of general practice; missing however, were studies linking structure and process to outcome. Nevertheless I had more than enough material for a very credible MD thesis. Indeed it was overkill: Perhaps I could have divided my research into two equal parts and submitted half for my MD and the other half for a PhD in epidemiology.

From the outset I regarded this venture as a potential book.  A Mr. Macmillan who was acquisitions editor of E & S Livingstone, the Edinburgh-based medical publishing house, got wind of my proposed MD thesis and contacted me.  I told him that the provisional title of my dissertation would be “Quality of General Practice” and the body of the text would consist of descriptions and commentaries on my work, much of which had been published by then in peer-reviewed journals. The work consisted of a series of epidemiological studies that I had carried out at the MRC Social Medicine Research Unit in London, the School of Public Health and Tropical Medicine, University of Sydney, the Department of Epidemiology and Community Medicine at the University  of  Vermont, and at the Usher Institute of Public Health at the University of Edinburgh. I had a few scientifically primitive observations that I had made as a young GP in the Western Clinic in Adelaide. Considered all together, it was quite an impressive body of work. Mr. Macmillan made the good point that a published book would be greatly strengthened if it also contained observations and commentary by a scholarly general practitioner.  As it happened, I had talked about this idea with my friend Ian McWhinney, a well-known scholarly general practitioner based in Shakespeare’s home town, Stratford-upon-Avon.  Ian had told me he was thinking about writing a book describing and analyzing his experience in general practice.  That evening after my meeting with Macmillan, I phoned Ian McWhinney.  He listened patiently while I told him about my discussions with the man from Livingstone’s publishing house, then confided in me that he was in an advanced stage of discussions with the dean of the medical school at the University of Western Ontario. He would not be able to collaborate with me on a co-authored monograph on general practice. As the future unfolded, Ian and I worked together again in Canada but of course neither of us knew then what the future would hold for us.

The University of Adelaide required me to submit my thesis according to precisely defined specifications. It had to be typed, double-spaced, on A4 paper with even the margins of specified dimensions; it had to be bound in stiff black covers; the university required the original and three carbon copies. For readers who don’t know what carbon copies are, these are produced by slipping a sheet of carbon paper between each sheet of paper. When the keys of a manual typewriter are hit really hard, the pressure produces an image on the paper, which by the time it gets through to the bottom copy of the six a good touch typist can make, is very fuzzy, often almost illegible. I retained the bottom copy of the six my typist, Edith Brodie, was able to type on the massive Underwood typewriter that the University of Edinburgh supplied. It is a tribute to the quality of Edith’s typing thst this bottom copy is perfectly legible. When I read over the texts that Edith typed for me, I often wanted to change them. If the changes led to retyped text that was substantially longer than it had been earlier, Edith Brodie often had to type not just the one page, but several following pages. 

Of course all these specifications  are immensely easier to adhere to in the modern era of word processors. In the late 1960s, word processors weren’t even a gleam in the eye of IT specialists. The specialty of Information Technology hadn’t even come into existence in those days, let alone computers and word-processing programs. It’s unbelievably easier to comply with the rather picayune regulations for dissertations now that word processors have simplified and abbreviated these tedious and perhaps unnecessary requirements.

My thesis was accepted and passed by two examiners, by acclamation: unusually, they requested no revisions or corrections, no oral defence. In my conversations with one of the examiners and with the dean of the medical school, I got the impression that I had set the bar very high for others who might follow where I had led. 

It was nice to receive the fulsome praise of the dean and the examiner but I was more concerned to press on with publishing the thesis as a book. Macmillan remained keen for me to take on a co-author.  I tried unsuccessfully to persuade him that I could draw upon my own experience in general practice to provide the perspective he wanted, but he was adamant.  I began to explore possibilities with other scholarly GPs in Britain. I knew most of them quite well but none with the graceful literary style, insights, and empathy of Ian McWhinney.  While I was still considering and trying to decide who would be the best collaborator, my own life was evolving and changing. In the summer of 1969, Wendy and I decided sadly and reluctantly that it would be in the best interests of our children for us to move yet again, back across the Atlantic to North America. I flew to Boston to explore a fascinating and in most ways unique cross-appointment between the Harvard Medical School and the School of Public Health. I planned to visit other places from which I had received invitations to consider academic positions.  I told Mr. Macmillan that my proposed monograph on general practice would have to rest on the back burner for the time being.

John in Adelaide MD robe
Honorary MD Uppsala hat, 1992

In the end, my first book was never published. I have that bottom carbon copy on my bookshelves.  Looking at it half a century after I wrote it, I can see ideas and arguments in well-wrought paragraphs that could be published now with little or no change; other parts of the dissertation have dated, some a lot, others only a little bit.  While working on it, I learnt a great deal about how to write a scholarly book, and at the end of it I got the right to add the initials MD after my signature, and to wear a fine scarlet robe at academic functions. So the effort that went into this work wasn’t wasted.  By far the most important of all that I learnt while composing my MD thesis was the conceptual framework required for a serious scholarly work, a task that demands a level of intellectual discipline and philosophical thought that were orders of magnitude greater than anything else I had ever attempted. It was worth while for that alone.

Rebecca, B Comm (Ottawa)
with John in MD robe and hat

David and John in academic regalia,
Royal Military College, 1981