Sir Lancelot Spratt – an obituary

By Tim Mitchell

Public fascination with all things medical continues to spawn a range of books, films and television programmes both fictional and based on reality. The nature of clinical medicine with its plethora of interactions between staff and patients is fertile ground for story-telling. Every doctor, nurse and other healthcare worker has a catalogue of anecdotes, some decades old, which can be deployed to amuse colleagues or shock family and friends. Humour abounds, often as a way of dealing with the bizarre and distressing situations that are encountered on a regular basis.

The Doctor novels, a series of 18 books written by Richard Gordon, the pen name of Gordon Stanley Ostlere (1921-2017), drew on his experiences as a medical student at St Bartholomew’s Hospital and his subsequent career as an anaesthetist and ship’s doctor, before he left medical practice in 1952 to concentrate on writing. The early novels set in St Swithin’s, a fictitious London teaching hospital introduced the irascible surgeon, Sir Lancelot Spratt, later immortalised by James Robertson Justice in the film Doctor in the House. It was the most popular film of 1954, starring Dirk Bogarde, Kenneth More and Donald Sinden, and followed by six sequels as well as a television and radio series.

Quoted in Ostlere’s obituary, Professor Sir Simon Wessely, former President of the Royal Society of Medicine and Honorary MWF Member, stated that the Doctor books “spoke to a hierarchical system, epitomised by the benign dictatorship of Sir Lancelot Spratt – the hours of work offset by the camaraderie of the doctors’ mess, and in which patients by and large had a bit part existence supplying comedy material.”1

I suspect that most doctors, and certainly those in the second half of their careers, will recognise aspects of Spratt in Consultants, whom they encountered at medical school and in their training. Gordon’s observational comedy, a forerunner of the likes of Phil Hammond and Adam Kay, was undoubtedly based upon his personal experience of the characters and system typical of the time.

It speaks to a period that continued to the latter part of the last century, when the firm structure remained in place, led by a largely autocratic chief, whose word and authority would rarely be challenged. I still hear older colleagues talk fondly of their days “on the house” when they were begrudgingly granted a day off to get married and were expected to be available at any time that the boss decided to conduct a ward round. Of course, these are colleagues who thrived under this system and likely have a sense of pride in doing so.

Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, observed that “although written 25 years before I qualified, the world of medicine portrayed by Richard Gordon was one that I, and those of my generation, could recognise. Yet, it was in part his writing that contributed to the end of that era, portraying professionals who had once been held in reverence and awe as objects of amusement, although in the kindest of ways.” 1

The caricature that is Sir Lancelot is inextricably linked to his portrayal by James Robertson Justice; pompous, portly, dictatorial and largely benign. Certainly, I doubt that he would actively have meant anyone harm, but woe betide those on the receiving end of his acerbic wit. Think before you respond to “What’s the bleeding time?”2

Of course, Spratt’s other obvious defining characteristic is that he is male, along with all the doctors in his entourage. Undoubtedly, this is a phenomenon of the time, but it is clear that surgery has been much slower than other disciplines in seeing an increase in female recruitment. Figures from the Royal College of Surgeons of England indicate that only 13% of Consultant surgeons are women, increased from 11% in 2016.3 And yet, more than 50% of the intake to UK medical schools has been female since 1990.4 In 2017, women represented 45% of doctors on the GMC medical register and 58% of doctors in training.5

In part, this may be explained by a lag phase through to Consultant appointment, the legacy of Consultant appointments over the last 30 years, and a proportion of registered doctors not working or working less than full time. Nevertheless, the percentage of Consultant surgeons who are women remains very low and is only increasing slowly. This suggests that there are factors that discourage or discriminate against women pursuing a career in surgery.

Writing in the Financial Times recently in relation to the wine trade, Jancis Robinson observed that “if half of the young people who might potentially work in wine do not find the business welcoming and safe, then the industry – and all of us wine professionals – will be in even deeper trouble.”6 She might just as easily have been referring to careers in surgical specialties.

It is hard not to reach the conclusion that there is a systemic problem, despite initiatives such as the Women in Surgery Forum to encourage women to pursue surgical careers. This national programme aims to provide advice, guidance and pastoral support to current and aspiring surgeons, as well as showcasing the varied lifestyles of female surgeons and promoting attitudinal change within the profession. The Royal College of Surgeons of England is committed to identifying and addressing barriers to recruitment and progression of female surgeons. It has responded to concerns about diversity in its own leadership by commissioning an independent review chaired by Baroness Helena Kennedy QC which will report in early 2021.7

As a profession we must look to the future and dispel the stereotypic views of surgeons and surgical careers. To quote Martin McKee again: “Gordon contributed to the democratisation of British medicine. Who could ever take those who emulated Sir Lancelot Spratt seriously?”1 There is still much work to be done.

References:

  • 2017 Lancet 390: 1022

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32364-4.pdf

  • “Equality and diversity in UK medical schools”. British Medical Association, October 2009

https://www.nuffieldtrust.org.uk/files/2019-11/1575040339_bmastudentreport2009.pdf

  • “An update on the Medical Schools Council’s work in selection and widening participation”. Medical Schools Council, November 2018

https://www.medschools.ac.uk/media/2536/selection-alliance-2018-report.pdf

  • FT Weekend Magazine, 14/15 November 2020

 Biography

Tim Mitchell is a Consultant ENT Surgeon in Southampton and Vice President of the Royal College of Surgeons of England. He was awarded honorary membership of MWF in 2019.