| Description | Dr DONNIE ROSS interview on Friday July 7th, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) DONALD GEORGE ROSS, born in Lonmay, Aberdeenshire on 6th June 1944. Retired as Medical Director, and Director of Medical Informatics, in September or October of 2003; working for Grampian Health Board, but then describes various titles of the organisation at that time, and the hospitals he was responsible for. His maternal grandfather was a farmer, explains he was a strong character and intelligent. Paternal grandparents sprang from Aberdonians who had gone to work in Wales and the West Country as shipwrights and ships’ carpenters; grandfather in Cardiff was a tailor. No medics in Donnie’s family background. [Donnie later recalled that he did actually have a fairly illustrious medical forebear, his great uncle Prof Robert Cruickshank, who succeeded Alexander Fleming in the Chair of Bacteriology at Edinburgh University] But his mother’s sister was married to one of the Downie twins, explains; Alan Downie became Professor of Bacteriology in Liverpool, and Richard or Ricky was a GP in Sheffield, strong influences on Donnie. Education was at the primary school at St Combs, then the primary school at Sandhaven, explains. Then sent to secondary school at Fraserburgh Academy. Then in 1957 came to Aberdeen, where his father worked in Customs and Excise, and Donnie went to Aberdeen Grammar School. (0:05:29) Describes interests at school, including Music and Art. Difficult to say when he decided to study Medicine, explains, including his interest in Anatomy. Describes process of shifting his focus to patients, talks about this also in context of him becoming a junior doctor; in Queen Mary’s Hospital in Sidcup. Talks about process of becoming self reliant. (0:11:02) Talks about going to Aberdeen University to study Medicine in 1961. Work was hard, teachers demanding, but great latitude of behaviour outside lecture rooms, explains what his Class was like; doing this interview 56 years to the day from when he qualified. Recalls interactions with patients as an undergraduate, including comments on his very youthful appearance; compares how interactions were then with how they are conducted now. (0:16:44) Recalls tutors and lecturers who most influenced him; Anatomy professor R.D. Lockhart; Johnny Mackenzie taught us Development and Embryology, died later after accident with an elk; many of these people austere and stern; when it came to Clinical studies Mike Williams was one of our great teachers; Professor of Medicine, can’t recall name [later recalled it was HW Fullerton], feared. Got to know surgeons better; Prof Smith, innovative; Bill Michie, one of originators of thyroid surgery in Aberdeen, explains he built up service till later ruined by Grampian Health Board, who got rid of Prof Krukowski, explains. Orthopaedic surgeon; Alex Adam, hugely respected, big hands which could do subtle things on tiny tendons and bones of children. All these surgeons had been in the War (World War Two), had very military way of doing things, explains. (0:22:16) Recalls Martin Nichols the neurosurgeon, massively intelligent, explains how he dealt with his arthritis (this was during Donnie’s time as an Anaesthetist), fascinating listening to his chats with David White the Consultant Anaesthetist, recalls what might happen if things went badly. Donnie recalls time after he graduated in 1967, pre-registration jobs, late in applying, describes what happened when he spoke to the Medical Superintendent at the time, Sandy Michie, brother of Bill Michie the surgeon. So he applied for jobs in the London area, first to come up was one at Queen Mary’s Hospital in Sidcup, later found it was the place where Plastic Surgery was more or less invented for war wounds, explains, including how anaesthetists there worked out how to keep airways clear [developed new techniques and instrumentation for keeping airways clear during radical head and neck surgery]. Donnie started there in Orthopaedics, explains, including him sometimes [when off duty] being the Medical Officer at Brands Hatch, the racing circuit. (0:27:43) Had to do a medical [pre-registration] job, but explains because his colleague Ian Dalziel wanted him to do surgery, he spent a year in General Surgery, so did an unusually protracted pre- registration career, explains. Enjoyed surgery, explains. In A&E (Accident and Emergency) would have to do a whole lot of things with minimal experience, explains. Became an A&E Casualty Officer, better rota, explains; gave him time to be a flamenco guitar player in a Chinese restaurant. Came home one Christmas, met with friends including Gordon and Doreen Aitken, who were in Anaesthetics. Suggested he might like to apply for a job in Anaesthetics. Went to see Dr Rollason; started job in Aberdeen in September or October 1969. Doreen [subsequently clarified that this Doreen is not the Doreen Aitken mentioned above] subsequently became his wife. More supervision in Anaesthetics till they saw you could cope with unexpected stuff. (0:32:36) Donnie was youngest member of the department. Dr Rollason asked him if he would like to go and do a locum in Shetland. Went to work there unsupervised in 1970. Ronnie Cumming was the surgeon there at the Gilbert Bain Hospital in Lerwick. Explains what happened when he first arrived - despite Dr Rollason assuring him that it would all be routine cases, they had put aside all the difficult cases for "the Anaesthetist from Aberdeen"! Recalls his first case there, young woman with asthma requiring a tonsillectomy. Everything on the operating list was very varied. Recalls other cases, their challenges to him as an anaesthetist, and his interaction with Ronnie Cumming over a gastric tube. Recalls how attitude to him had changed when he returned to Aberdeen. (0:38:25) Confirms he was a Senior House Officer (SHO) at the time. After a couple of years would start on FFARCS - Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons. But explains that anaesthetists did not like being subservient to surgeons, and so developed their own college, the [Royal] College of Anaesthetists. Digresses on the subject of surgeons, [whose mythology has] been around for hundreds of years, while anaesthetists have been around for thousands of years, as shamans. Explains in detail the importance of anaesthetists; dynamic pharmacology, understanding the physiology of heart and lungs. So when he was a Registrar began studying for the fearsome exam, mentions Bertie Dundas; anaesthetists are scientists, explains; the Gas Laws; Relaxants; knowing how drugs interact. (0:43:07) Challenge of exam which not many people passed [during the 1960s.] Talks about the new [more] intellectual anaesthetists who started joining the department after the War, not always liked, explains. In his opinion there were [still a few] people in the department whose attitude to anaesthesia and patients was not of the standard that could be reached in a serious (professional) department. And that he should do something about it, not popular opinion, mostly kept it to himself, there were people who did not like him. Passed the final FFARCS on the second attempt in 1973. Was then a Senior Registrar, explains about then and now. Talks about the size of the Department in those days, about ten or twelve consultants, maybe five SHOs, three or four Registrars, and two Senior Registrars - the pre-Consultant level. Also a number of non-consultant permanent staff, explains. (0:47:27) Talks about going to work in Canada in 1976; Charles Janeway Child Health Centre in Newfoundland; very good Anaesthetics department there run by Charles Urquhart Henderson, explains things they shared in common. Very good experience, but very demanding, explains, including challenge of having to anaesthetise neonates. Had the good fortune to have had training from Edith Beveridge and Mike Tunstall and Wynne Parry and George Robertson, many of whom trained in paediatric anaesthesia in London, masters of the art, of great benefit to Donnie. Returned to Aberdeen in 1977 to take up a Consultant’s post; job a mixture of thoracic anaesthesia, and ophthalmic anaesthesia; also did on call, which included obstetrics and paediatric at the time. Worked for Grampian Health Board, but did teaching of students for the university, explains. (0:52:17) Talks about being a Consultant back in his old department giving him a degree of autonomy, but could still ask for advice. Exhilarating and demanding, had a personal relationship with the surgeons, explains. Worked with Alan Davidson; sessions with Andrew Foote; John Cockburn in Thoracic; Charlie Coburn in Eyes (Ophthalmology), younger colleagues including P.K. Ray. As time went on changed his mix of jobs, explains went part-time so he could do research [unpaid. Inter alia] did research on the design and construction of lung ventilators, [and on applications of computing in] anaesthesia. Formed relationships with people in the [University of Aberdeen] Computing Science Dept, Terry Rourke [in the UoA Computing Centre] and others, no professor at that time, Derek Sleeman came later. Did a few sessions of private practice, not his cup of tea, explains, including what he saw as poor standards in private nursing homes at the time. In research he worked with Henry Manson produced machines, tried them on rats then humans; rats needed a licence! Explains relationship with the Ethical Committee; compares then and now. Pays tribute to Mike Tunstall, the doyenne of obstetric and paediatric anaesthesia in Aberdeen, who was prone to be inventive, can’t do that these days. (0:57:38) Explains in detail the role of the Anaesthetist in the Surgical team, addressing the preconception that exists to this day that the anaesthetist is not very important, or not even a proper doctor. Anaesthetist’s job is partly to keep the Surgeon happy but not necessarily do exactly what they want. You are there to defend the patient, if necessary against the Surgeon, explains. (1:02:46) Talks about element of understanding, of science and "black boxery", explains in detail about anaesthetists forming mental models all the time, anticipating what will happen next; difficulty of maintaining constant presence of mind through two hours of nothing much happening, the answer is to draw, explains this is his private opinion! Talks about the ventilator, and what can go wrong; tension pneumothorax; no such thing as routine. (1:06:47) Talks about how anaesthetics have changed over the years, and about the ratio of general to local anaesthetics. Been retired for twenty years, but things were beginning to change during my time, explains in detail. First anaesthetics were terrible; Chloroform given to Queen Victoria; Cocaine into spinal canal; spinal and epidural anaesthesia, distinct, explains, hanging drop test; epidural anaesthesia converted Maternity Hospital some time in 1974 from place of screaming to nice quiet happy place, one of the things Mike Tunstall did. Local anaesthesia sometimes combined with general anaesthesia, in some ways safer but does lead to some instability of blood pressure, explains. Can do almost anything under local anaesthetic, including operations to the head and neck, explains from personal experience. (1:11:23) Local anaesthesia went out of fashion when the volatile agents came in, explains these were Chloroform, followed by Ether, followed by Vinyl Chloride, followed by Halothane, followed by Isofluorine, followed by dry cleaning agent Trichloroethylene. These were succeeded by better things for causing unconsciousness, explains. Then Curare came in in the 1940s, has to be administered intravenously or subcutaneously; explains its benefits, as well as risk of patient being left paralysed but aware of pain; gives example from his own experience with a Hypoxic dental anaesthetic. Relaxants became better and better, explains; now fast-acting and disappear rapidly, explains. (1:16:13) Soon after Curare-type drugs we began to use Analgesics, Opioids, Opiates. Pancuronium introduced in the early 1970s, much superior; then better more short-acting drugs for relaxation. Then very powerful Analgesic drugs, Morphine-like analogues, explains; naturally-occurring opioids called Endorphins, first described by Professor Hans Kosterlitz and his colleague Hughes, tells anecdote about Prof Kosterlitz. Explains about Endorphins having a natural target in the body; can hit those receptor sites with opioids called Fentanyl and Alfentanil and similar agents, explains. Recalls another eye operation he had with an agent to make you sleep called Propofol; talks about care he took over choosing his anaesthetist; rapid recovery, explains. (1:21:49) Talks about significance of his Consultant title in April 1992; inception of the Griffiths Report followed by Margaret Thatcher’s (then Prime Minister) reorganisations and so-called reforms, set up of Hospital trusts, explains in detail; mentions Marion Hall, doyenne of Obstetricians; more micro-managing from afar; Scottish government moves for centralisation in the Central Belt; comments on mortality figures. (1:25:39) Talks about in August 1992 also becoming Clinical Director of Anaesthesia, ITU & Hyperbaric Medicine. Thinks they had an annual budget in the department of about £20m; lot of people, lot of salaries, many for nurses. Donnie was using, even then, computers; explains; rotas; medical equipment committee; explains his role and challenges as Director. With the assistance of Christine Leith, who became the trainee Business Manager, Donnie was able to establish techniques and procedures, explains. But not a popular thing, explains in detail about existing management set up involving the hospital Consultants. Donnie developed understanding of how the dynamics of groups work, explains in detail. (1:32:13) How largish group of people behave under stress changes depending on the topic being discussed; 21 or so is about the maximum operable size; believes this relates to extended human family groups, explains in context of tribes in the Mesolithic. Talks about GPs not liking hospital consultants, and maybe vice versa; talks about his experience of this. (1:37:19) He was involved in transforming a small department into a very big one, explains in detail; effect of H2 blockers like Omeprazole. Made case for more consultants. Mentions ITU (Intensive Therapy Unit); also HDUs (High Dependency Units); explains. (At this point we took a short comfort break) Talks about in April 1996 becoming Medical Director, Aberdeen Royal Hospitals NHS Trust, responsible for all acute services in the region, explains; including dealing with a vast number of changes coming from the Scottish Home and Health Department; working with chief executive Alan Cumming; dealing with heads of departments; six to twelve meetings a day. (1:41:59) He also dealt with the legal cases, explains; including his position regarding the doctors and claims; and defending them at board meetings; gives examples. Explains why he took the job up. Continued his interest in computers, explains. (1:46:16) Refers to Scottish Audit of Surgical Mortality (SASM), explains in detail; "good" surgeons, and "bad" surgeons. Felt it was his duty to go and see patients who were unhappy, explains. Confirms he could not continue practising as an Anaesthetist as a result of his managerial duties, explains in detail. After he retired it was probably four years before he got back to normal thinking, explains. (1:52:36) Talks about becoming in 1999 the Medical Director, Grampian University Hospitals NHS Trust, just a change in title, except for last two years when he became Director of Informatics; explains this emerged from his interest in computing [later added for clarification: electronic medical records]. In 1980s he worked on a mainframe, then got a large desktop computer; began to develop programs for making patient records; threaded sequential files, open-ended memory system. Then tried to interest the Scottish Home and Health Dept (SHHD), arrogant, not interested. A period when local enthusiasts would form their own departmental system. Then got in cahoots with Dr Pradeep Ramayya who had come to Aberdeen to be a Registrar. Together they developed a system for putting into Intensive Care, taking data from devices to build up an electronic patient record. Got a grant from Aberdeen Hospitals in the 1980s to do work on this, got four early PCs (Personal Computers) installed on a Local Area Network in the burgeoning Intensive Care unit. It was called ABICUS. Pradeep gave up his Anaesthetist’s job to learn Assembler, and create ABICUS (Aberdeen Intensive Care Unit System). They published it in medical journals, other people became interested. Then went on to form relationships with the Computing Science Department and the Department of Psychology; explains importance of the latter. Aim to create an electronic patient record with its obvious advantages, explains. (1:59:39) Ultimately it happened, but ABICUS was not it. So when Donnie became Director he set up a job where Dr Ramayya would have computing sessions in Anaesthesia in addition to his Anaesthetic sessions, so he was able to do that within Aberdeen Royal Infirmary and be paid for that relevant work. Continued their work, Donnie gave lectures and presentations at many conferences abroad about Computing in Anaesthesia, Computing in Intensive Care, [Artificial Intelligence in Medicine.] Dr Ramayya then went to work at the Golden Jubilee Hospital in Clydebank as an anaesthetist, but also part-time computing, Started a firm with premises in that building, people in Hyderabad doing coding, Donnie became a director of that firm, AxSys Technology (Aberdeen Systems). Dr Ramayya began to sell the software all over the world. Donnie gave up his directorship of the company because as Medical Director he could not be part of a company that was trying to sell to the NHS. Company later sold to a big American company. But says they were not very open to new ideas (in Scotland). (2:03:33) Has served on a great many committees at university and national level, as well as being a member of various medical societies. Says it is difficult to say what have been his most significant roles. Wanted to successfully bridge the gap between consultants and management, explains, CEO had an accountancy background, Chairman came from the Paper Industry. Donnie did not think they had insight into the ethos of the health system. Donnie says their first thought was about reputation, not about the well-being long term of the service to the patients. [Later Donnie wrote that the last two sentences were "a bit unfair, as many of these people, during my time at least, were very well-intentioned - particularly Alec Cumming, who in nearly every case did an excellent job under the circumstances."] (Donnie felt on reflection that no purpose would be served by making adverse comments on individuals, when in reality the fault lay primarily in the system) Thinks his work with the Equipment committee was significant, explains; tiny budget, Mike Nieman of Medical Physics enormously helpful, explains; to build up a case for development where it was necessary Donnie built up a relationship with HERU (the Health Economics Research Unit) and HSRU (the Health Services Research Unit), superb institutions dwelling within the Medical School at Aberdeen. Explains about developing methods of Option Appraisal [with Mandy Ryan.] (2:09:35) Talks about his chairing of GHAT (Grampian Hospitals Art Trust), thinks that was important, looking at the idea of a healing environment, explains; mentions Norman Matheson, whose idea it was originally, and Arthur Watson of Peacock Printmakers and the Scottish Sculpture Workshop; Donnie’s own inroads into painting, explains; organised Wood Group exhibitions in Phase One (of Aberdeen Royal Infirmary), doing all this while he was a Consultant Anaesthetist, and soon Director of Anaesthetics; after he retired was able to go into Art World in greater detail, chaired GHAT for ten years. (2:12:52) Talks about, after his retirement in 2003, his role as an occasional adviser on Telemedicine to NHS Grampian; explains about Telemedicine, consulting with patients by video and audio at home or in a doctor’s surgery; or in those days there was a special studio at ARI, explains, including difficulties; explains things have moved on now, gives personal examples. Talks about him sending his own ECG (Electrocardiogram) readings to China to be analysed by AI (Artificial Intelligence), explains, he is a living example of Telemedicine; mentions Mary Joan Macleod, Consultant in the Hypertension Clinic. Proper application of technology to Medicine. (2:17:47) Doing interview in the week in which the National Health Service passed its 75th anniversary. Donnie thinks he started working in it when it was still only 18 years old. Thinks what is happening in America is a disaster, unfortunately thinks the government trying to make as many things American as they possibly can. Thinks the NHS does work, and is not falling over, explains. Comments on money spent on Track and Trace, mentions Dido (Dido Harding, who ran the government’s COVID-19 test-and-trace programme in England); asks why more money cannot be spent on making sure the populace has better health care? Lists other things that are needed, including Workforce Planning, which he did himself, explains. NHS a political football, explains what he believes it needs. Lists what he thinks is wrong with it. Explains concept of Reserve. (2:23:27) Talks about the other things he does; artworks and sculptures. Ends with a joke about him being born on D-Day. (ENDS 2:27:03)
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