| Description | Prof PETER JOHNSTON interview at the Sir Duncan Rice Library, University of Aberdeen on Monday June 26th, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) PETER WILSON JOHNSTON, born on 17th May 1958, at Aberdeen Maternity Hospital. Retired officially at end of 2021, having already reduced his hours. [Continues working part time] as a Consultant Pathologist at NHS Grampian and also Associate Post-Graduate Dean with NHS Education for Scotland, and also has an honorary chair with the University of Aberdeen, so not really retired. Family background does not directly include any medics, though one of his father’s uncles was a Chest Physician in Inverness, and one of his father’s cousins was an Obstetrician and Gynaecologist who spent of a lot of time in the Forces. Went to school in the primary department of Ellon Academy from 1964-68, and from primary 6 to finishing secondary school went to Robert Gordon’s College in Aberdeen. Talks of interests at school; singing and the Music Club; Literary and Debating Society; biology and the Biology Club; music his main interest, talks of inspirational music teacher at Robert Gordon’s, Douglas Tees. (0:03:59) Thinks he was about 13 or 14 when he decided to study Medicine, influence of a friend of his parents, Edith Beveridge, a Consultant Anaesthetist in Aberdeen, explains. Studied Medicine at Aberdeen, applied for several other places; got acceptances from Glasgow and Newcastle, rejection from Edinburgh; explains choice of Aberdeen. Medical course was then five years, but took option of doing an intercalated degree in the middle, explains, including how his interest in Pathology first began. At end of his pre-registration House Officer year not sure what to do, opportunity to spend a year as a Lecturer in Pathology. Describes life as a medical undergraduate, remarkably carefree, enjoyed time at Medical School, explains. Talks about first encountering patients in summer term of his second year; recalls his first patient, talks of his enjoyment interacting with patients. (0:11:16) Talks about inspirational tutors and lecturers; Sandy Stalker, the Regius Professor of Pathology at the time; explains about the "Christmas PM"; mentions John Simpson, and Geoff Scott. Talks about the influences of these people on him choosing Pathology as a specialty; going forward in time, talks about doing education-based research in last ten years, did study around Perceived Organisational Support, showed significance of what influences doctors to be what they aspire to be. Clarifies that he went to Med School in 1976, and graduated in 1982; explains his intercalated year involved studying Pathology, which gave him degree of Bachelor of Medical Biology, explains it was mainly a research project. (0:15:07) On graduation became a pre-registration House Officer at Aberdeen Royal Infirmary; first job in General and Vascular Surgery, professorial unit which did not quite have a professor, because George Smith had just retired and Alex Eremin had not yet started. Worked with people like Jetmund Engeset, Tony Ah-See, and Jack Miller, a great bunch to work with, explains. Mentions colleagues from his class, Tricia Donaldson, and Christine Hoy, realise you are in group of people who just gel together. Nursing staff incredibly supportive; sad thing is that nowadays doctors and nurses don’t have the fun that we used to have; explains why he thinks this has happened, quality of the NHS working environment, needs a lot of work to make it better; thinks splitting the service away from the educational component was a huge mistake. Explains what he got to do in surgical terms as a House Officer. Did his second six months as a House Officer in Haematology and General Medicine. Importance of Audrey Dawson and John Rawles, and…(we took a pause in the recording at this point as Peter tried to remember the surname of Professor Stuart Douglas). Pays tribute to Audrey Dawson, inspirational, a brilliant clinician; John Rawles also brilliant, responsible for innovation of people doing thrombolysis in ambulances, explains. Tells anecdote about diagnostic skill of Prof Stuart Douglas. Really enjoyed these jobs, Haematology one of the inspirations for Peter doing Pathology later, explains, and comments on how things have moved on over forty years. (0:22:07) Explains how newly graduated doctors like him ended up in particular House Officer jobs. Talks about how he specialised in Pathology, opportunity to do temporary lecturer appointment in Pathology for one year; about a third of the way through that decided he liked it. Talks about how things have changed over forty years, and how young doctors now exercise professional autonomy. Explains in detail about what attracted him to Pathology; talks about how teaching of students has changed. Talks about Pathology being a very strong department when he first started there; big department, well organised and well run. (0:27:29) Talks about what the specialty of Pathology was like in Aberdeen in the 1980s, and challenges he and his colleagues faced. When Peter started it was rather a confirmatory specialty, lump taken out, Pathology said this is what it is; explains now it’s more about making diagnosis before anything else happens, diagnoses from smaller and smaller fragments as biopsies. Explains consequences, moved from being at the end of the patient hospital journey to being pre-hospital and defining what the disease is, enabling appropriate treatment. Gives example from his own interest in Lymphomas, better classification of disease means others have been able to develop treatments that result in much better survival and cure rates across the last forty years. Gives examples of childhood leukaemias; was 15-20% survival rate for five years; in uncomplicated child with good genetics now looking at cure rate of 95-98%. Another example, diffuse large B-Cell Lymphoma, the most common adult high-grade lymphoma; in early part of this century cure rate overall 30%, now cure rate 50%, but 80% cure rate in a population under the age of 60. Really exciting to have been part of that, explains. (0:32:15) Talks about the staffing and reputation of the Pathology Dept in the 1980s. Staffing not too bad, reputation very high, explains. Talks about just before his time, Aberdeen graduate Professor [Andrew] Wylie who ended up going from Edinburgh to Cambridge; that team with Alastair Currie was the group who discovered Apoptosis, programmed cell death, explains importance; Sandy Stalker was a so-called Clotter, interested in disseminated intravascular coagulation, hugely important clinical phenomenon, explains; Angus Thomson was looking at agents that modulate immunotherapy and immune responses, explains. Explains many people came and went through the department; Eric Walker, then a Senior Lecturer, went to Leicester, came back as professor; Wilson Horne went to Newcastle. Peter became a Consultant Pathologist in 1995, an honorary post, explains in detail; refers to introduction by the General Medical Council in 1993 of initiative called Tomorrow’s Doctors, which reduced time spent on studying various subjects. Peter’s job was to create an Anatomy course aligned to Clinical Medicine, explains this involved curtailing about 450 hours [later corrected to about 400 hours] of tuition down to about 100 hours. (0:37:13) Explains in detail why it was not an easy appointment, starting with the comments and attitude of the head of department. But very supportive people in the department; Margaret Moir, the bequest administrator, just fantastic; Mike Moore, a senior lecturer; Mary Cotter, Professor of Physiology, she and Peter basically ran First Year Medicine for the five years he was there. Coincided with research he had done before, round about Endothelial Cell Permeability, explains in detail the challenges he faced, including dealing with students who had been caught in the middle of the changes to the Medical Course. [Peter wanted to ensure the programmes in medicine and science were being well delivered.] But he was completely deluged with stuff to do, running a clinical post; also had a wife and two young children. Ultimatum time came, said to the university if they wanted him to do this then they needed to invest in Anatomy, explains; university said they could not do that, offered him academic promotion, which he refused because he would still be working in the same circumstances. So he quit, and has worked for the NHS ever since; realised his strengths were more in education than in doing blue skies research. Went back to doing Pathology, then developed his post-graduate interest while still continuing teaching a lot, explains; a pivotal moment in his career. (0:43:29) Explains there is still very little Anatomy on the course for medical undergraduates; Physiology also much reduced. Thinks we suffer for that, explains; still relying on the model of Tomorrow’s Doctors. If he had his own way they would be teaching more basic Science in general, explains his ambition was to thread it more through the clinical years. Talks about what the response was. Today’s medical graduates a different beast to what Peter and his contemporaries were, explains; uncertainty and concern; perception; how we mitigate risk. Explains in detail about this. Talks about lessons learned in treating COVID. Peter and his cohort were taught to be autonomous individuals who practised medicine; we now teach doctors to be employees who are governed by processes, explains. (0:50:33) Talks in detail about how the specialty of Pathology has changed in the forty years he has been involved with it; Technology the big change in that time; Immunocytochemistry or Immunohistochemistry, using the science of antibody, antigen reactions; helps understand how Cells work; helps classify diseases. Helps develop targets, allowing the pharmaceutical industry to develop drugs against specific disease processes. The second big component is the growth of Molecular Biology and molecular techniques, explains this can be used to explore the Genome, and the benefits of this. All this allows us to detect particularly cancers, earlier. (0:55:39) The corollary to this is considerably increased workload, explains in detail; when he started most pathology reports fitted into a quarter of an A4 page, nowadays many go on to several pages. Refers to study they did about 2012; showed in specific sets of cases that over ten-year intervals from 1991 the amount of information in pathology reports doubled each time. But have not seen a fourfold increase in the workforce over that time, explains. Because of the complexity of where we’ve gone, we’ve had to become more specialist, or sub-specialist; explains that for much of his career he did everything that came through the door, but about 2010 they started to sub-specialise, explains in detail. (1:00:05) Talks about becoming a Consultant in Cellular Pathology for NHS Grampian in 2000, significance of various titles in the specialty, including difference between Scotland and England. Leaving university meant he did not spend hours and hours teaching medical students, became more focused on diagnostic work, was able to go back to Cytology, explains. Began to develop his interest in Haematopathology, explains; interest in Bone Marrow Pathology, explains; Lymphomas, senior colleague Douglas Thompson, incredibly supportive, taught Peter all he knew about lymphoma pathology, pays tribute to him, tells anecdote. (1:04:13) Explains his interest in Education and why it has been so important to him; came from a family of teachers, his mother and her sister and her aunts were teachers. Peter started teaching when he was a pre-registration House Officer, explains in detail. Going to Pathology gave him opportunity to develop that, explains he ended up doing a lot of tutorials with another junior member of the department in the 1980s, Louise Smart; explains what they did; devised online tutorials with the late Neil Hamilton; among the first to have any computer-based learning in the Faculty of Medicine. Peter also explains about being given the opportunity to run pathology courses; and also the system lectures across the hospital. Also used to do Post Mortem teaching every lunchtime, live from the mortuary on a closed circuit TV system, explains; the students loved it, unfortunately lost when they went to the new system-based course in Tomorrow’s Doctors. Explains the educational things he was involved in when he went to the Anatomy job. Talks about OSCEs (Objective Structured Clinical Examinations), he developed a practical one around Anatomy at that stage, explains, no one doing anything like that in the UK. Was told he was doing a good job, no one had said that about his research. (1:09:43) After his epiphany about his future in the university, he decided maybe he should be doing more teaching; opportunity came up to do some post-graduate work, became involved in what was then the beginnings of NHS Education for Scotland, started as a Post-graduate Tutor in 2001, developed, became an Associate Dean around 2007; explains in detail, became Chair of the Diagnostic Specialty Training Board; mentions Modernising Medical Careers, career structure of doctors changed; gave it up in 2021. In 2007 [later corrected to 2014] became an Associate Dean for Research, position which he still has, explains, including his other roles. It was out of the beginning of that Deanery work, when Modernising Medical Careers happened, that he found he and his fellow Associate Deans did not know what to advise trainees on their next career move; thought they better do some work on this. Duncan Henderson in Edinburgh, another Associate Dean; he and Peter decided to start a research project on this, from which came the Scottish Medical Careers Cohort Study, explains this introduced him to another long-term collaborator, Jennifer Cleland; she later became the John Simpson Chair of Medical Education Research in the university; she’s now in Singapore, but they continue to collaborate. (1:13:37) They suddenly began to realise that how people make choices about medical careers is not straightforward, explains they began to develop a research strategy in NES (NHS Education for Scotland); mentions Murray Lough, recently retired GP in Airdrie, but was an Assistant Director of General Practice in the West of Scotland. He was given task by then Head of NHS Education for Scotland, Malcolm Wright, to organise research; Murray and Peter collaborated with a whole lot of other people across NES to create the research strategy, only now beginning to be reviewed after being the policy for fifteen years. Mike Watson, Director of Medicine, helped hugely in promoting that research organisation, which became the Scottish Medical Education Research Consortium (SMERC), a collaboration of the five medical schools in Scotland with NES, explains; has involved working with the Health Services Research Unit at Aberdeen University, Diane Skåtun; explains in detail what they discovered about career choices. (1:18:29) Thinks the environment has deteriorated over the last twenty years, with the segregation of what we do for service, and the teaching educational part of what happens in the NHS in general, explains why it is not surprising that we have an unhappy, discomfited workforce; mentions lack of investment in NHS, contrasts this with oil industry in Aberdeen; political malaise in the UK. Explains in detail why he thinks commitment to education and training is currently under threat. (1:22:16) Talks about honour of becoming a professor in 2016. Assesses Aberdeen’s place in the field of Pathology; city has a gravitational pull because of the size of the place, but thinks the North of Scotland is rather underfunded, need a loud voice to enable investment in all services, and particularly in the diagnostic pathology services. Nationally we probably punch above our weight; we’ve had from Aberdeen a couple of Vice Presidents of the Royal College of Pathologists (one of Peter’s current roles!), the next President is currently a Consultant in Clinical Biochemistry in Aberdeen, Bernie Croal; Aberdeen bred a lot of professors of Pathology through the old academic system, known around the world as a centre (for Pathology); talks about what Aberdeen needs to do to keep on an equal footing. (1:27:18) Talks about what he feels he has achieved in his career. Feels he has been able to make a contribution, whether that has any value, Time will tell; recounts many of the things he has done. Talks about how hard it is to effect change. As a junior doctor thinks he must have been a bit of a nightmare, because he was always asking hard questions, explains; BMA (British Medical Association) roles. Feels he has grown up to be a bit of a thorn in people’s flesh, at least that’s what he hopes. Would not have done anything different in terms of Medicine; don’t necessarily advise people that it’s an encouraging career to go into now, hopes that might change in twenty years, less oppressive, more freedom, enjoyment and camaraderie than currently. Talks more on his relation to his job, feeling he can’t give up but the job will never be finished. Feels lucky, talks about his family, great colleagues to work with, generally enjoys what he’s doing very much, successful. (At this point the interview came to what might have been its ending, but we then had a discussion about other things Peter wanted to include in it, and we then started recording again) (1:33:58) Talks about his work with the Royal College of Pathologists, of which he is currently Vice President; curriculum and curriculum design for a number of years, up till 2015 or 2016, although continued till more recently in another capacity. Also became an education adviser in the General Medical Council, explains, has continued in that role for about ten years. Because of what he was doing as the College’s Specialty Training Board Chair, was invited to become part of the Scotland Regional Council of the College, and became its chair in 2017. Enabled him to become a trustee of the College Board and also a Council member. Mentions the start of COVID, was able to work with the Scottish Academy of Medical Royal Colleges and Faculties, and put forward the role of Pathology in that context. Talks in detail of how he has promoted Pathology, and how the specialty fits with the Patient Journey; every patient interacts with pathology services; about 95% of hospital admissions, and about 75% in the community have some sort of lab involvement, so we are in there all over the place, and nobody sees us. Talks about being encouraged to put himself up as a Vice President in 2020, been Vice President for Professionalism in the College since, talks about what this has involved him doing. Talks more about promoting Pathology. His College role ends in November. (1:42:18) Talks about the PhD which he did in the late 1980s, and finished in 1991. Did it in Pathology, he was keen to do research, interested in Endothelial Cell Permeability, explains his PhD was focussed around changes in this associated with pregnancy. About quantifying Immunocytochemistry at an electron microscopic level, explains. Able to use it to look at Oxygen toxicity. Says this research has not attracted a great deal of interest, but some of the techniques used have interested one of the new appointments to the department. Pays tribute to the help he got from Alistair McKinnon, the chief biomedical scientist in Electron Microscopy in the department, and Lynne Doverty, who eventually ended up as the Lab Manager in the department, and to John Simpson his PhD supervisor. Reflects on that part of his life, opportunity to work with interesting people, notably Fiona Knox, who was an Anaesthetist, now retired and an artist in the city. The PhD gave him the meal ticket to get his next job, explains about this and voices criticism of the way the NHS developed. (1:47:44) Talks about the importance of Forensic Pathology; the popular concept of what a pathologist is. Peter did not initially want to have anything to do with it, but when as part of his rota he was required to do it he found he enjoyed it, explains. Enjoyed working with Grampian Police, as the service was called then, a lot of fun. Senior Lecturer in Forensic Pathology at the time was Bill Hendry, describes him, an exceptionally good pathologist. Describes Bill Hendry’s approach, along with another of Peter’s great teachers Philip Best, who was the Neuropathologist in the department. They both fundamentally influenced the way Peter practises Pathology today, explains. Refers to his involvement with the Piper Alpha oil platform disaster in 1988. He was one of the four pathologists involved in carrying out the post mortem on the remains from the sea, and then later from the accommodation module. Talks in detail about the experience; working with people like Rhona Flin, they published a paper together about fifteen years ago on safety in pathology, still an on-going interest, explains; need in Pathology to think more holistically about safety, explains. Worked in the field for about eight to ten years, moved on because he did not want to spend his career working only with the dead, did not enjoy his interactions with the legal process. (ENDS 1:56:18)
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