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Gold, incentives and meh

Almost a Legend: John Fry, leading reformer of general practice

The tale of one of life's classic outsiders, who pioonered database research in general practice, but ended up working in an 'operational backwater'

The tale of one of life's classic outsiders, who pioonered database research in general practice, but ended up working in an 'operational backwater'

In 1948, GP John Fry started collecting data.

Lacking an evidence base with which to treat his patients, he set up an age-sex register and systematically logged information after every single consultation in his busy day.

He produced a unique database that was the cornerstone of his research and publishing career. This was his great achievement and it is the account of a driven and exceptional man that makes this biography worth reading.

It is not, however, an easy read and Fry is no hero.

In 184 pages of closely written text, Max Blythe accompanies Jewish refugee, Jacob Freitag, on his long journey from 1920s East Poland obscurity to his South London practice and international fame.

At every step it is the journey of an outsider, held back in his early years by his Jewishness and in later life by his personality, for Fry was not an easy man to work with.

Ambitious, self-serving and opinionated, Fry was an outstandingly driven worker, seeing up to 70 patients a day at his Beckenham practice, which must have meant an average consultation length of three minutes at most.

In committees, he would arrive for the agenda items that he was interested in and leave before the end, using any spare minutes to work on his next book or paper. This was not a man for networking or for small talk.

Fry was also outspoken in criticising his GP colleagues and fell out with his practice partner, so that his practice became an un-modernised ‘operational backwater'.

His old medical school, Guy's, chose not to award him its first chair of general practice and in three successive elections, he stood unsuccessfully for presidency of the RCGP.

Not quite a hero, perhaps, John Fry nonetheless made a very significant contribution to the evidence base, independence and status of general practice.

The catarrhal child, published in 1961, was a seminal work for a man whose publishing career as the master of common illness spanned over 40 years.

Almost a Legend is strangely gripping, but never an easy read. No detail appears too trivial for inclusion and it contains some very odd sentences.

On heart disease, for example: ‘Angina was fast eclipsing mitral stenosis as the leading culprit of despair. Coronary artery bottlenecks had become a plague, like lung cancer, across the inter-war years. Behind the digitalis and amyl nitrite rearguards, the cholesterol of slightly wider affluence continued unrestrained, cigarettes and lard still innocent.'

On John Fry's son: 'James just forged ahead, a credit to both of them, the silver fish lapel badge of the St Paul's scholar a glint of satisfaction. Intrepidly, it travelled the commuter routes, four hours a day.'

But when in 1963 Fry receives a ‘dismal review' of Presenting symptoms in childhood, there is no extract from the review.

Longer references from the book's many sources, fewer lists and more reflection would have made for a better and more literary biography, but this is nonetheless a worthwhile read.

Fry was a great among GPs and his story tells us something about the cost of greatness.

Dr James Heathcote

Rating: 2/5

Almost a legend

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