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Trish Greenhalgh and Brian Hurwitz maintain my observations on medical training and the quotes from their 1998 book are out of date (Letters, THES, February 2). My point was about the balance of the curriculum and the culture that can pervade it. Of course there have been changes, but my research and other in-depth studies suggest continuing serious problems. Many inner-city GPs in my work - including recently qualified and those involved in medical education - were critical of the relative neglect of psychosocial perspectives and the emotional aspects of being a doctor. Simon Sinclair's recent Making Doctors also revealed a deep-seated cultural antipathy towards examining "internal mental events".

Linden West
University of Kent