His appointment in 1972 as Consultant Neurologist at St Bartholomew's Hospital, London, was controversial. To Bart's, a hospital which had then the reputation of appointing its own, he was a foreigner, having trained at Guy's. At 35 he was thought too young, and too inexperienced clinically. He had come from the stable of the National Hospital, Queen Square, where he had trained under Roger Gilliatt, whose reputation for academic accuracy, if sometimes combined with an acerbic tongue, occasionally broke through in Hopkins's own manner.
But he continued to climb, becoming Physician in Charge of the Department of Neurological Sciences at Bart's in 1976. In clinical neurology, he was before his time in many developments. He established "hub and spoke" links (links between the Teaching Hospital and District General Hospital) in the Bart's department some 15 years before it became a term used by the NHS Executive and others. He realised not only that it improved clinical practice and quality of consultant staff, but that it would become a necessity for the survival of specialised units in a changing NHS. We noted, however, that Hopkins remained very much at the centre of the hub.
Major clinical research projects followed, in diverse fields, as he established a neurological department. With Dr Richard Greenwood he carried out tests studying changes in the reflexes in subjects falling from a height, dropping even Edward, his infant youngest son, as part of his research.
A perceptive (and quite unconnected) study on the everyday problem of headaches followed. One of the commonest symptoms of human beings, headaches had been studiously disregarded by most neurologists until Hopkins addressed the subject. Collaborating with sociologists, rather than doctors, he measured the size of the problem, pointing out the cost of 1,600 people per 100,000 consulting a doctor for headache each year, while fewer than 10 had any serious disease.
Several studies on the epidemiology of epilepsy followed, resulting in the publication of Epilepsy (1987). Finally, with Dr Elizabeth Davies, he turned to the care of patients with malignant brain tumours, recording in meticulous detail the care which this unfortunate group of patients and their families actually receive. His findings were roundly criticised, having irritated the cancer doctors' establishment, but he was very ready to defend them - and his last words on this matter will be published posthumously.
One common theme ran through these studies. They recorded and researched what happened, for better or worse, to patients, in a general population rather than in an ideal medical setting. Each, in its way, remains a landmark study.
Whilst he gave a first-class clinical opinion, medicine at the bedside was not his forte. He was able to acknowledge this to those close to him, confessing impatience and irritation. It was however in his writing about clinical events that he portrayed a softer side, and one of deep human understanding. Clinical Neurology: a modern approach (1993) is an example of economy of style, readability and clinical wisdom.
His mid-consultant career was marred by some personal disappointment. He failed to be appointed to the Chair of Medicine at Bart's, and later to the post of Dean of the Medical School, his applications an indication that he was looking for a role as a leader in the profession. In an unusual but wise move for a clinician in a then flourishing hospital, he left Bart's in 1988 to become Director of the Research Unit of the Royal College of Physicians, a post where he could develop his interests in Health Economics, Clinical Effectiveness, Audit and Outcome. He soon penetrated the NHS Executive, and sat on seven of its advisory groups, though he indicated that many colleagues there frustrated him because "they seemed to change their minds so often, following political fashion".
Numerous other appointments followed, from work with the Chief Economist on quality and effectiveness measures, through a galaxy of Royal College committees, to liaison with patient support groups, the editorial boards of six journals and the King's Fund Centre Committee. If these were not enough, in addition he managed to be the main author of 10 major publications in the last year.
Those of us who respected his intellect found ourselves a lifelong ally, and one who was ready to understand our anxieties, and to encourage unusual career moves. Hopkins was suspicious of the present trend of increasing dogged specialism and questioned the value and the effect of cloning specialists who, he argued, would have to carry out progressively mundane work as their numbers increased.
In the weeks before he died, Hopkins was proposed as one of eight candidates for the forthcoming Presidency of the Royal College of Physicians. Whether he would have succeeded remains conjecture, but the seven survivors who strive for election would do well to heed his understanding of that savage arena between Government, health care and the medical profession itself.
To his friends Anthony Hopkins seemed on the threshold of a new era. This slightly gaunt figure, with a lifelong ambling gait, a shock of dark hair, piercing brown eyes and a slight stoop was unmistakable. Our friendship lasted nearly 20 years, but for many others he was not an easy man, particularly when a combination of his intellectual crispness and caustic turn of phrase clashed with the medical establishment. It is hard to capture this complex, resolute soul.
Charles Clarke
Anthony Philip Hopkins, neurologist: born Poole, Dorset 15 October 1937; Consultant Neurologist, St Bartholomew's Hospital 1972- 76, Physician in Charge, Department of Neurological Sciences 1976-88; Director, Research Unit, Royal College of Physicians, London 1988-97; married 1965 Elizabeth Wood (three sons); died London 7 March 1997.
Comments