Cardiology: a transatlantic view (1).

As a cardiology trainee at the Massachusetts General Hospital I studied with Paul Dudley White. When Dr White reminisced about his medical career I heard tales of Sir Thomas Lewis and the events that led to the description of the Wolff-Parkinson-White syndrome. Dr White's experience in Britain formed the basis for the development of American cardiology. He brought back with him clinical and experimental views of the electrocardiogram, insight into the value of a careful detailed history and physical examination, and an admiration for clinical investigation that was reflected in his own subsequent work. American cardiology owes much to its British heritage and I have the sense of a personal continuum with that legacy. During 1984-85 I was a visiting professor and consultant at the National Heart Hospital. I practised cardiology and was responsible for a firm within the hospital. I was also provided with laboratory facilities and support from the British Heart Foundation in order to carry out a laboratory project. I should like to reflect on some ofmy experiences with patient care and research during that period. Many American commentators have reported on the organisation and administration of the National Health Service as an institution, comparing it with the fee for service arrangement in the United States.1 2 I prefer to focus on the function of British cardiology rather than on its organisation. My perspective was principally limited to experiences in London teaching hospitals with an occasional visit to the provinces and to general practitioners. As a consultant, however, I dealt with physicians throughout the country and met many general practitioners participating in continuing education within the National Heart Hospital.