Lives of the fellows

Anthony Philip Hopkins

b.15 October 1937 d.6 March 1997
BSc Lond(1957) MRCS LRCP(1960) MB BS(1961) MRCP(1963) MD(1969) FRCP(1976) FACP(1991) FFPHM(1992)

Anthony Hopkins died suddenly of a cardiac arrest during a tense discussion on clinical effectiveness. Within minutes British medicine lost a most unusual and controversial figure. Out of the blue, at 59, Anthony was dead. A light which had shone brightly for too few people, and had been misinterpreted by others, was suddenly extinguished. To his friends he seemed on the threshold of a new era, in the fields of neurology, public health and clinical effectiveness. This slightly gaunt figure, with a lifelong ambling gait, a shock of dark hair, piercing brown eyes and a slight stoop was unmistakable. For many he was not easy man, particularly when a combination of his intellectual crispness and caustic turn of phrase clashed with his colleagues. It is hard to capture this complex resolute soul.

Born in Poole, Dorset, Anthony was the son of building contractor, Gerald Hopkins. Educated at Sherborne, near his home, he studied medicine at Guy’s, where he developed an interest in disorders of peripheral nerves. He continued, in clinical neurology, at the National Hospital, Queen Square, where he had trained under Roger Gilliatt [Munk’s Roll, Vol.IX, p.195], whose dual qualities, a reputation for academic accuracy, combined sometimes with an acerbic tongue, were both from time to time reflected in Anthony’s own manner. He was widely expected to be appointed as a consultant neurologist at Queen Square, but the expected advance did not materialise, marking a watershed in his intellectual interests. Rather than continue to probe the expected realities within a nerve fibre, he examined issues and instances of dissonance between expectation and reality, both at a physiological and a wide, publicly based, but clinical level.

His appointment as consultant neurologist at St Bartholomews Hospital in 1972 was itself controversial. Bart’s was a hospital which had then the reputation of appointing its own, but was, with some difficulty, attempting to assimilate talent trained elsewhere. At 35 he was thought too young, and too inexperienced clinically. Once installed, Anthony generated one of the most congenial and effective neuroscience departments in the country. In clinical practice, he was before his time in many developments. He had established hub-and-spoke relations between the Bart’s department and five district general hospitals some fifteen years before it became a term used by the NHS executive and others. He realized immediately not only the improvement in clinical practice which followed and the quality of consultant staff this recruited, but its necessity for survival if specialized units were to remain within the changing NHS. It was noted, however, that Anthony remained very much at the centre of the wheel.

Major clinical research projects flourished in diverse fields as he established a neurological department. With Richard Greenwood he carried out tests studying changes in the reflexes in subjects falling from a height. A perceptive (and quite unconnected) study on the everyday problem of headaches followed. Collaborating with sociologists, rather than doctors, he measured the extent of the problem, pointing out the cost of 1600 people per 100,000 consulting a doctor for headache each year, while less than 10 had any serious disease. Several studies on the epidemiology of epilepsy followed. Finally, with Elizabeth Davies, he turned to patients with gliomas, recording in meticulous detail the care which this unfortunate group of patients and their families actually receive.

Each of these studies compared and contrasted the perceptions of doctors and their patients. Each was unusual, interesting and always returned to the theme of the difference between expectation and reality. The dissonance which this, in turn, provoked, even around the time of his death, is well illustrated by the indignant correspondence, roundly defended, which followed his last study on gliomas.

While an acknowledged clinical opinion, medicine at the bedside was not his forte. He was able to acknowledge this to those close to him, confessing his impatience and irritation. It was however in his writing about clinical events that he portrayed his softer side, and one of deep human understanding. The reader has the unusual feeling that Anthony the author is talking and guiding one through a difficult field. "This short chapter will I hope dispel some of the anxieties that seem to confront many medical students and young physicians when first confronted with neurological disease. The details of neuroanatomy and neurophysiology seem to be vaguely remembered as being more troublesome than other specialities. These recollections are a foundation for future unease in the setting of clinical neurology…..The message for those engaged in clinical diagnosis is Keep it Simple". Clinical neurology; a modern approach, published by the Oxford University Press in 1993, is an example of economy of style, readability and clinical wisdom. Though well reviewed, sadly it sold few copies.

His mid-consultant career was marred by some disappointment. He failed to be appointed to the chair of medicine at Bart's, and later as dean of the medical school, both indications that he was looking for a role as a leader in the profession. In an unusual move for a clinician in a then flourishing hospital, he left Bart’s in 1988. He was invited to take over as director of the research unit of the Royal College of Physicians from Sir Cyril Clarke, a post where he was to develop his interests in health economics, clinical effectiveness, audit and outcome. He did so with energy and an enlightened approach. 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". On the Chief Medical Officer’s working group on the health of the nation, whilst he had little regard for the document itself, he realized that continuing criticism simply emphasised the role of doctors as victims of change. Numerous other appointments followed, from working with the Chief Economist on quality and effectiveness measures, the Patients Association and the National Consumer Council, through Royal College committees, the editorial boards of six journals and the King’s Fund central committee. If these were not enough, and it is difficult to grasp how, in addition he managed to be the main author of ten major publications in the year before his death.

Those who respected his intellect and liked his style found a lifelong ally, and one who was ready to understand professional anxieties, and to encourage unusual career moves. Anthony was suspicious of the present trend of increasing dogged specialization and questioned both the value and the effect of cloning specialists, which he argued would have to carry out progressively mundane work as their numbers increased.

In the weeks before he died he was proposed as one of eight candidates for the presidency of the Royal College of Physicians. Whether he would have succeeded must remain conjecture, but holders of the post would do well to heed his understanding of that savage arena between government, health care and the medical profession itself.

He met his wife Elizabeth while he was working at the Salpêtrière and they were married in 1965. They had three sons, Felix, Nicholas and Edward.

Charles Clarke

[, 1997,314,1133; The Independent, 19 Mar 1997; The Guardian, 14 Apr 1997; The Times, 4 Apr 1997]

(Volume X, page 224)

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