Peter Cross talks to Joseph Spitzer, an orthodox Jewish general practitioner and writer

London is sometimes described as a collection of villages. The metropolitan sprawl, a transient and multicultural population, can make this difficult to accept. But general practitioner and author Joe Spitzer makes a convincing case for being a village GP. "I look at this practice as a village practice," he says, "In spite of the fact that we are stuck in the middle of northeast London [in Stamford Hill] it is different from most other practices in the area. We have a very low turnover. It is a stable community, not just our Jewish community; even our Afro-Caribbean community has been here since the 1960s. Many practices in east London have a 30% annual turnover. The concept of the old village GP living, drinking, and worshipping with his patients is something I am comfortable with. A lot of my close friends are patients. If you go back a generation or two this was the normal model of general practice.

Villiage GP: Joseph Spitzer

"We are an unusual practice," he continues. "We still do our own out of hours. We use a deputising service for message handling and locums during the Sabbath. Our call out rate is low. Frivolous calls are rare. Patients know they are going to get my partner or myself. It's an old fashioned approach, but we are happy with it for the time being."

Joseph Spitzer was born and brought up near his modern surgery in northeast London, in the heart of the largest Hassidic Jewish community in Europe. He studied medicine at King's College. He enjoyed all his jobs in London and Sunderland yet always knew he wanted to go into general practice. In 1986 he started a singlehanded practice from a flat, with his wife as practice manager. It was soon bursting at the seams, so larger premises were sought and found.

In 1996, prompted by a pamphlet that his practice nurse had written, Joe published a booklet. A gem with the somewhat off-putting title: A Guide to the Orthodox Jewish Way of Life for Health Care Professionals.¹ "It was," recalls Joe, "the sort of thing a new registrar, houseman, or nurse could read in one night at the beginning of a job, giving them some insight, teaching them a little bit about etiquette and how to handle themselves, preventing social embarrassment. It was a concise book without much background detail." Expanded second and third editions followed. The booklet was a great success. Apart from handouts for people working in hospitals, nothing like this had been written before. Joe became increasingly involved in multicultural medicine. A talk he gave at an evening on religion and medicine that was held at the Royal Society of Medicine led to an approach from Radcliffe Medical Press and a commission for the recently published Caring for Jewish Patients.²

"I saw that as a challenge and actually enjoyed writing it. It is very different from the original book: it is expanded; it encompasses all aspects of the Jewish community. My original booklet was just about the orthodox community. This one has got lots more background and fills in some of the gaps. After my original book was published, I had many emails and phone calls, people saying this is fascinating, full of facts, but we would like more explanation of the reasons why. So this gave me an opportunity to fill in the gaps. It has got many case histories and lots of interesting quotes from classical Jewish literature."

Joe Spitzer writes well. He persuades and never hectors. An insider's grasp of detail is matched by an outsider's objectivity. More impressively, his text transcends the subject matter, making readers contemplate ethical issues relating to all patients, not just Jewish ones.

He laughs when asked what he will do next. He has more ideas for future books: "I've been thinking a lot about this since it went off to the publishers. I suppose I've built up an expertise looking after the local orthodox Jewish community. I've been looking at their future health needs, and I think there needs to be forward planning. A lot of orthodox Jewish patients feel that they can relate best to someone from their own culture.

Hassidic Jews

"Our list is closed. We can't take on any more patients, yet I am inundated daily by people saying 'Can't we join your list?' 'My son in law doesn't speak English, only Yiddish, and needs to be registered with a doctor who understands his cultural background.' I think this problem needs addressing. The Hassidic community of northeast London is growing rapidly (the birth rate is high and few move away); people want healthcare provision tailored to their needs, and there aren't the resources available. I would like to spend some time, possibly taking prolonged study leave, and look at these issues. Look how they have been solved elsewhere in the world. The other thing that has caught my interest is about Jewish patients' culturally specific behaviour and use of linguistic nuances in a consultation. No one has looked at this. I went through the literature, and I think I am the first person to think about putting this into writing."

Having said this, Joe is keen to agree that he would be reluctant to work exclusively with the orthodox Jewish community. As far as he is concerned it would be divisive. He loves the cultural diversity. "This is one of the rich parts of living in this part of London. Not just the variety of clinical conditions that you see wandering through the door but the variety of types of patients.

"The sign of a lively GP is that at the end of each surgery there are questions. Every day I come across great mysteries of medicine that demand research. I think you have to keep a lively mind to be a GP and never get bored. The thing that keeps you lively and interested in general practice is looking at the patients as people. General practice is not about diseases but about people who have diseases."

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