Thinking Aloud with Dr Ralph Abraham

Thinking Aloud with Dr Ralph Abraham, founder of London Medical and the London Diabetes Centre

I spent my childhood in Mumbai, and we had a family friend who was a wonderful gynaecologist-he delivered me, in fact. He was from a very old-style German family-educated, academic.

He loved classical music, which was a rarity in India in those days. I saw him as a role model in many ways. He’s the reason I am the person I am.

At Oxford, I was blessed with a wonderful tutor in biochemistry. His was a very old, Athenian way of teaching: almost one-to-one. Throughout my medical career, I have learnt greatly from doctors, on individual cases. That kind of learning, where you define and solve a specific problem, teaches you how to think-much more so than big lectures. You cannot be a good doctor without being a thinking doctor.

I specialise in diabetes, endocrinology, cholesterol and obesity-I’m a little off the peg. There are super-specialists I can use if a patient has a rare or difficult condition, but recognising the need for them is often the key-and you have to have a grounding in everything to do that. We are losing that in British medicine: the generalist has slowly been edged out.

Sugar permeates the body: your brain, your eyes, your salivary glands, your heart, your kidneys. Diabetes patients commonly get osteoporosis. Diabetes patients get stressed and depressed. So should I have a clinical psychologist here? Of course. Medicine is all about interconnectedness. We’ve made that the heart and soul of our operation.

As a student, I had a big map of the metabolic pathways up on my wall. It was like a map of the world-it was huge. It included the Krebs cycle, which shows how we produce energy. It was a very new theory at the time. We sometimes fail to recognise just how quickly medicine has developed.

I act as a champion for diabetes patients. If I see a young child with type one diabetes I say, “Don’t let it stop you.” You have to surmount the disease, and in doing so you will bring out characteristics you never knew you had, which will serve you wonderfully well in life. The world is full of disabled people who achieve much more than people ever thought they could.

There’s an enthusiasm now for tackling diabetes that was lacking in the past. It was the Cinderella of medicine. It was considered depressing and hard work.

Now, it’s a major focus.

The gut is where it’s going to be for the next five years, all the big medical discoveries. That’s exciting.

Our job is to translate the needs of a patient to the available science. That’s what the art of medicine is, in a nutshell.

Obesity is driving not just diabetes, but sleep apnoea, orthopaedic problems, cancer, thrombosis. Our society promotes calorie excess, and it has to be changed. We need many different approaches: social, company-driven, tax-driven. You’ve got to encourage people to think differently. When people make a choice themselves, it’s more successful than Big Brother telling them to do it.

Initially, I’d have loved to be on Harley Street or Wimpole Street. But being tucked away off Marylebone High Street turned out to be really popular with patients. They come in here with their bags from Daunt Books. I say: “You haven’t really come to see me, have you!” They reply: “Well, I thought I’d pop in while I was here, then I’m going for lunch.”