I was sad to hear of the death of Julian Tudor-Hart recently. I quote from his obituaries:
A visionary general practitioner (GP) who spent his career practising what he preached, Julian Tudor Hart is best known as the author of the inverse care law: “The availability of good medical care tends to vary inversely with the need for it in the population served.” Like Karl Marx, his guiding inspiration, Tudor Hart believed that it was not enough to interpret the world in various ways; the point was to change it.
“He was the first GP to measure the blood pressure of all his patients”, “At the time, hypertension was often thought of as a condition that had to be managed by hospital specialists”. “Julian was a major force in ensuring that it became embedded in primary care.” “When in 1990 he published the results of 25 years of what he’d been doing compared to a neighbouring practice, he showed that mortality was down by about 30%”. This, Watt (Professor Graham Watt, Honorary Senior Research Fellow in Glasgow University’s Institute of Health & Wellbeing) believes, was attributable to a number of interventions besides blood pressure measurements. “The main thing, I think, was that he was providing unconditional personalised continuity of care for all his patients”
Writing in “A New Kind of Doctor” in 1988 he described what he called “Anticipatory Care” as “Professionally, the most satisfying and exciting things have been the events that have not happened: no strokes, no coronary heart attacks, no complications or diabetes, no kidney failure with dialysis or transplant. This is the real stuff of primary medical care.”