The Day of the GP is Over - 23 January 2004

Opening my morning mail (why do I say morning mail? - there's no other) I find a letter from a lady in Massachusetts who is about to write a biography of the late, incomparable cartoonist, Charles Addams.

Maybe you remember the Addams Family on television?

Anyway, as I riffled through my data bank of memories that lie packed and so far fairly intact behind that bruised forehead, I look up and out as usual at the rolling park and I'm almost blinded by the ice blue sky, the blazing sun and the landscape of snow and chuckle at this deceptive picture, since the temperature outside is 18 degrees - 14 below freezing - and no place for yours truly to patter into.

The chuckle was a tap root into a famous cartoon by Charles Addams.

First let me tap your memory of him and his cartoon family. A butler - the spitting image of Boris Karloff as the Frankenstein monster, his boss - a long, thin, weedy young woman with mean slit eyes, long black hair and a black soul like the two villainous cross-eyed little kids on the floor cooking up the neighbour's cat for Thanksgiving dinner.

The famous cartoon I recalled after glancing at snowbound Central Park was a simple drawing of a slightly surprised skier whizzing downhill and looking backwards after passing a tree.

The marks of his track ran parallel, coming towards the tree, but then curved out around the tree and met again on the down side.

He had evidently successfully skied through the tree and was as surprised as we were.

Charles Addams was of my generation. He was a very tall (I guess about six three or four) shambling, a rumply-faced man with a five o'clock shadow and hair as black as any of his characters.

He was also, like many writers of horrid things, extraordinarily gentle.

My most vivid memory of him, to which our lady biographer is very welcome, was of one time - there were many times - when my wife and I had driven over to the south shore of Long Island on a Saturday evening to party with a magazine editor who was a friend we had in common.

While the party dawdled and chatted out on the hot terrace, Charlie and I went into the shady indoors.

He was, at the time, much in love with a rather stunning movie actress - not present. It had been going on for some time but after two failed marriages he was not about to embark on a stormy third.

We sat down with our drinks and I remember saying: "So, Charlie: how's your love life?"

He sipped and paused and slowly shook his head. In his high, squeaky voice he said: "You know, Alistair, the trouble with women is they always want a permanent relationship."

A short story but a poignant one to many men who are coasting along in a very agreeable relationship but don't like to hear any mention of wedding bells.

A day or two after the lady biographer's letter, I had an even more touching reminder of Charlie Addams and an unforgettable cartoon of which I hope to get a laser copy.

It must be 30-odd years ago. The scene: a small bedroom. Present: two middle-aged women, one whispering behind her palm to the other.

A bed containing evidently a husband bandaged from head to foot, both arms, only his eyes are visible. Clearly, as old American gentlemen used to say, not a well man.

On the other side of his bed is an extraordinary figure - a witchdoctor, half naked and tattooed to the waist, face painted like a leopard, hair curled and tied in a high knotted rope, smoke coming out of his nostrils and ears. He has one knee bent in some sort of ritual dance.

The wife across the bed is whispering to her alarmed friend: "At least he makes house calls."

That punch line gave a comic twist to, even 30-odd years ago, a new sad fact of life, the fact simply that not long after the Second World War doctors ceased to make house calls.

I'm talking about the cities and specifically New York but I'm reliably told that the comfortable habit has spread to small towns.

Why I wonder? It can only be because in the past 50 years or so the rapid spread of specialisation means that what used to be called in Britain "the GP" is over.

Here is an American dictionary definition of "general practitioner": A physician whose practice covers a wide variety of medical problems in patients of all ages.

A note says: "mainly Brit" - British.

And, when you think of it now, what a marvellously accomplished being he must have been, able without timidity to face everything from cancer and diabetes to in-growing toenails.

In this country even the word doctor is going out.

On all printed forms - hospital entrance, health insurance, reimbursement bills and so on - the phrase is "primary care physician".

And he's always called himself here, not a GP but an internist - a practitioner of everything to do with the internal organs that can be treated without surgery. That leaves a lot to other doctors.

I very rarely see my primary physician because seven years ago within half an hour of a diagnosis he sent me off to a heart specialist whom I see all the time.

You go to the primary man once a year for your annual check up and call him when you feel ill. He thereupon sets a date for you to call on him - not I've just figured, since the 1960s, has a doctor called on me. You totter off to him.

If your symptoms alarm him he sends an ambulance, puts you into hospital, where about four or five specialists can attend to you.

Cost of ambulance and two splendid paramedics to whisk you five blocks away: $750 - £500.

Thank the Lord, as I regularly do, I'm over 65, when the blessed national system takes over and pays 90%.

I said that these medical memories, especially about the disappearance of house calls, were triggered by the request for a tale or two about Charles Addams.

But the subsequent recital was due to a telephone call, only two days ago - an astounding, a unique call in my lifetime.

It was from a doctor, a specialist. I had set a date with her and then cancelled three times because of the Arctic weather, even a sniff of which the heart man will not allow.

Well the call from this much-pestered doctor. She asked me if it would be all right for her to come to me here at my apartment to take care of me.

After I'd been revived from the fainting fit, I fell into a Gershwin response, I said it would be wonderful, marvellous, that you should care for me. And so she did.

So how about the Iowa caucus, next Tuesday's New Hampshire primary, the president's State of the Union address? I assume they've all been reported to you and I will add only a passing thought or two.

Unless you're an enthusiastic fan of quantum physics I will not try to define a caucus for you, an incredibly complicated method of testing the presidential choice of the active Democrats in one state. The result is the same as in any primary: a winner.

For two weeks before the caucus all the famous columnists, the TV and magazine pundits, went to Iowa and talked and talked and finally decided that Iowa would be a very tight four-man race.

Dead wrong. Veteran pundits - the older wiseacres - had cautioned us all that the likeliest winner was the veteran congressman Mr Richard Gephardt: 26 years in the House and leader of the Democrats in the House.

He came in a dismal fourth, with 11% of the vote.

So unlike the other runners who flew off to New Hampshire, he flew the same night home to Missouri and announced he was through with politics for life.

So you will understand why I'm making no predictions about New Hampshire, which is a tiny state, about the size of Wales, and has next November four electoral votes - 270 is what you need to win.

And it's so well watched because New Hampshire is the first primary and has a habit not of picking the man who will eventually be president but of killing off candidates who seem to be in the polls very likely contenders.

In 2000 the valiant naval hero John McCain handsomely defeated George W Bush but you know who won in November.

The president's State of the Union address used to be a fair, often blunt, account of where the country stood in both foreign and domestic policy.

In the last 20 years, I'd say, it's become a visionary description of how close the country has come to Utopia.

Mr Bush's speech was no exception. It was a hymn to the greatness and goodness of America. He used the word America 60 times.

No mention of Bin Laden, the Taleban, balancing the budget, the country's huge debt, nor ever the two words that many people here and abroad think are together the root cause of both the invasion of Iraq and the worldwide war on terrorism.

Those words are Israel and Palestine.

Mr Bush gave us no bad news. His address could very aptly have been recited against a muted chorus of Onward Christian Soldiers.

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