Kumar and Clark: the interview

Debashis Singh meets two authors with an innovative approach to medical teaching

"She'll be late. She's always late," said Mike Clark as we sat in the bar at St Bartholomew's Hospital. He looked agitated. The stout gentleman with a flushed complexion who sat before me was the co-editor of a book - the hugely popular Clinical Medicine by Kumar and Clark.

First published in 1987, Clinical Medicine (better known as "Kumar and Clark") broke new ground as the first textbook to present medicine in an interesting, user friendly way. "Kumar and Clark" no longer refers to two gastrointestinal consultants but has become a brand name.

Parveen Kumar entered the bar, looking flustered from a ward round, clutching a mobile phone and a bag of crisps. She was a tall thin Indian woman with striking features, bursting with energy and eager to talk. Dr Clark on the other hand was more stoical and austere. They could not be more different, although they are both equally down to earth and abhor the pomposity prevalent in medicine.

It was entertaining to watch the two interact with each other - it was as though I was the marriage counsellor observing a couple on the verge of a bitter divorce. Throughout the interview they oscillated effortlessly from compliments to clashes. Dr Kumar described Dr Clark in a way a disciple would describe a mentor: "Mike has a great critical brain and amazing aptitude for remembering things. He can recall something that was in a journal years ago or that happened 10 or 20 years before - and still remember who did what. Mike is also very hard working while giving the appearance of doing nothing." In contrast Dr Clark describes Dr Kumar in a protective way, much as an exasperated husband would describe his fierce wife: "She is always late, despite the fact that she knows I do not like people being late. She gets herself involved in every conceivable thing and never gives anything up - she just adds it on. At the moment she is probably working 15 hour day - and that is a short day."

Their lives began poles apart. Mike Clark was born and grew up in Wales. "My parents never went to senior school, much less university - they didn't have the opportunities because if you were poor you couldn't go in those days. They wanted the exact opposite for me." At school he excelled at science and later embarked on a career in medicine, studying at St George's Medical School, London. "My sister always wanted to study medicine but never did, so I thought that was the thing for me to do."

Parveen Kumar, by contrast, grew up in India and went to an exclusive English public boarding school in the Himalayas. She came to England to study for her O levels, and her fascination with medicine led her to study at St Bartholomew's, where she was one of a very small number of women. While a house officer at Hammersmith, she met her husband, Dr David Leaver, who was her registrar at the time.

Clinical medicine was conceived in 1985 when the two were working together at Bart's. One day Dr Kumar received a letter from an editor asking her to write a chapter for his book. "I wrote back to say that I would be delighted to do it because I've always wanted to write a book on medicine.

Dr Clark inevitably saw the letter and said, "You're mad - why write a chapter for someone else's book when we have always been talking about writing the definitive book on medicine?" This was true - I wasn't very happy with the books around then. And he said something like 'Why don't we get on and do it together?' He continued: 'The books on offer then were completely old fashioned - no pictures, long, rather turgid prose - and even the bestseller only had about five illustrations in the whole book. A new book was definitely needed.' And so the process began. "I thought (rather naively) that we could get a few of the young, enthusiastic consultants at Bart's and have a book ready in a few months," said Dr Kumar with a smile. It was to take much longer.

They met whenever possible, mostly at weekends, working together paragraph by paragraph, chapter by chapter. "I used to get home at a quarter to seven in the evening. I had young kids, and they had to be sorted out. Mike would arrive at a quarter to eight, and we would work till about 11 00 pm when Mike and my husband would have a glass of whiskey." On Saturday mornings she would meet with Dr Clark at 10 30 am, and they would work until 6 00 pm. On Sundays they would begin work at 9 30 am and work through to about 5 00 pm.

The primary aim was to have an understandable text. "We could argue about one sentence for ages - the nuance, the way the sentence is worded is so important to the meaning that is transmitted," said Dr Kumar. The other time consuming task was making sure that everything was factually correct. "Every consultant has a speciality within their own speciality, so for any of us to write a chapter on our own specialty was a major task," said Dr Kumar. "Someone who is expert in one bit of cardiology may not know a lot about, for example, hypertension, which means that we had to ensure that everything in the book was right," continued Dr Clark. This was done by consulting the piles of journals and specialist texts (untidily spread over Dr Kumar's dining room floor), and asking advice. Two and a half years later the book was completed, a remarkable feat, considering that the average length of time for the gestation of a book is four years.

Dr Clark is careful to point out that Clinical Medicine is not simply an undergraduate textbook. "I do not believe you can distinguish between undergraduates and postgraduates - they are all students. It is meant to be a book for all people who want to know how medicine works, from all levels."

Dr Clark offers some advice. "Enjoy yourself as a student, don't work too hard. Pass your exams but don't do anything more than that because life doesn't really become serious until the first year after qualifying. And think about what you want to do, not only in the medical field, but more generally."

It is dusk, and we get ready to leave. When asked how she would like to be remembered, Parveen Kumar said : "If at all - which to me sounds a bit presumptuous - then as an educator. "What I love doing is taking medical students who are absolutely new and teaching them to relate what they see - the physical signs - to basic physiology and then building up their knowledge from there. If you do that, you never forget. It is much more interesting than saying 'this is clubbing' - what's the point in telling anyone that? It doesn't mean anything." She then turns to me as we leave, and says "Isn't medicine great fun? Aren't we lucky? Every patient is special, every patient teaches you something. As a doctor you meet the whole world."

Kumar P, Clark M. Clinical Medicine. 4th ed. Edinburgh: W B Saunders, 1998. (ISBN 072020192; price £32.95.)

Debashis Singh, fourth year medical student, University of Leicester


studentBMJ 1999;07:394-436 November ISSN 0966-6494