| Description | Prof ELIZABETH RUSSELL interview at the Sir Duncan Rice Library, University of Aberdeen on Monday January 9, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) ELIZABETH MARY RUSSELL, born 27th January 1936 in Preston, Lancashire. Retired in September 2001 as Professor of Social Medicine at the University of Aberdeen. There was one medic in her family, a couple of generations before in Ireland, but otherwise none. Father an Inspector of Taxes, worked in Liverpool, then came to Scotland at beginning of the Second World War because her mother wanted to be closer to her family. Educated at Troon Primary School, then in Marr College, Troon in Ayrshire, then Glasgow University. Growing up was keen on sport; tennis, rowing, hockey; family walking and cycling; and music, plays piano. Came into Medicine because she wanted to leave school at Fifth Year, explains. Studied at Glasgow University, then did post-graduate GP training in Lanarkshire, then came to Aberdeen. Started medical training at Glasgow in 1952. Describes life then as a medical student, exciting, very participatory, explains. Glasgow a commuting university, so she commuted daily from Troon for five years. But in her sixth year stayed in digs in Byres Road, explains why. (0:05:34) Recalls outstanding lecturer Alastair Currie, who went on to become professor of Pathology in Aberdeen. Had skill of knowing the names of just about all the students in every year he dealt with, recalls what happened when she dropped a knitting needle during one of his lectures. Graduated in 1958. spent first year doing House jobs in Glasgow, and at Hairmyres Hospital in East Kilbride. Then went on to her trainee year in Lanarkshire, her aim was to be a rural General Practitioner. Went to a rural practice in a place called Douglas Water, really exciting, part rural, part mining community; had digs with a miner and his wife. It had a Cottage Hospital, enabled her to do lots of things she wanted to do, explains. Goes back and recalls her first contact with patients while studying at Glasgow University. In those days did locums as students, or attachments; tells amusing story about her first patient. (0:09:31) Explains there was a split between the hospitals that medical students went to in Glasgow; the academics went to the Western General, the rest, including Elizabeth, to the Royal Infirmary; explains this enabled her to take a later train. Patients stayed in hospital longer in those days, Royal in a poor part of Glasgow, so she used to do a hairdressing ward round where she cut the hair of women patients, explains this allowed her to chat to them, important thing. Talks about her GP trainer in Douglas Water, George Burns. She was his first trainee, first thing he taught her was how to drive on ice, and how to clean a carburettor. Explains it was a rural practice, describes it; good relations with the AA (Automobile Association) who would take the prescriptions the practice had dispensed to the Red Moss Cafe, where patients would come to pick them up. (0:13:20) Clarifies nature of how the practice operated (there was confusion because Elizabeth initially calls it "a prescribing practice" when she actually meant "a dispensing practice"). Worked there for fifteen months. Would have loved to stay, but quite hard sometimes driving in the winter, and her trainer thought he would be better to have a male assistant partner, so she left. Her parents had moved to Aberdeen, so in Feb 1961 came to the city, very good weather, she thought it was a wonderful place. Mother one day announced she had found her a job, as a locum in Torphins, explains. Did it for about a year, then a male partner was employed; then for next three years did locums in Tarland, Aboyne, Peterhead, then back to Aberdeen. Really got to know the people of the North-east; but had to get the matron in Aboyne and Torphins to translate what the patients were saying, gives amusing examples. (0:17:58) Recalls that doing locums and then getting replaced by a male doctor was a typical experience for a woman doctor in those days; worse in hospitals than in practices; justification was that women were not strong enough to do it, not because of their medical skills, but because of their gender. Her year was one quarter women, did analysis later, only two went on to consultant posts; neither married, and the women who did get married were only working part time. That was the pattern, and it’s still the pattern. In 1964 Elizabeth decided to go abroad; went to the City Hospital in Aberdeen to do a refresher course. May 1964 there was the typhoid outbreak in Aberdeen; city short of senior staff, explains; so she spent a year there, following up all the typhoid patients to make sure there weren’t any carriers. City Hospital was at that time the infectious hospital, recalls first patients arriving, two students. Resident at the time was Dick Hardie. They were the only two on that weekend, Dick Hardie had experience of typhoid from being in the Army and thought he recognised the symptoms. An amazing experience, but really an organisational experience for her; explains in detail. (0:23:24) Talks of issue at beginning of outbreak of whether staff should be vaccinated, explains. Mentions controversy over publicity approach at the time by then Medical Officer of Health, Ian MacQueen; alludes to his relationship with STV (Scottish Television). (Summariser’s note: at the time the local independent television station for the North of Scotland was called Grampian Television, who started operations in 1961; Grampian was bought out by STV in 1997, and in 2006 was rebranded as STV). Explains how her experience of the typhoid outbreak influenced her decision to specialise in Public Health. Became a Scottish trainee in what was then called Medical Administration, because Scottish Chief Medical Officer John Brotherston believed public health planning should be part of and lead the NHS, not in local government (as it was till 1974); his dream (of integrated care), didn’t come off. Explains how "Health" then was intended to be about prevention not just treatment, explains. Defines Public Health; the science is epidemiology, explains. (0:28:59) Recounts her career from the mid-1960s to becoming a professor in 1991. Went to Edinburgh University to do her MSc (Master of Science degree). Two things happened that year. Had two brilliant tutors; one invented the concept of "The Iceberg of Disease", explains; the second was a sociologist who demonstrated very clearly all the reasons for people not seeking help, explains. Second thing that happened was her boss in Aberdeen asked her to look at a projection of the demand by nurse staffing on the resources in the health authority; explains this was first time she met the concept of rationing, limited resources, has stayed with her for rest of her career. Came back to Aberdeen in 1967, working in the health board; moved into data collection about the health of the population. Worked closely with the university, Elizabeth was the NHS side set up in what was then called the Dept of Community Medicine, explains. Began working with George Innes, who came from Psychiatry, and Roy Weir; with them set up the NHS Health Information Unit for the North-east. Worked with Tayside Health Board to develop what is now known as the CHI, the Community Health Index, explains in detail; gave clearer picture of how patients moved through the system. (0:35:04) Aberdeen was leading the way in this development; explains this was because of Aberdeen’s size; started in Psychiatry, mentions John Baldwin, who went to Oxford and set up the Oxford Records Linkage Study; so apart from Oxford, Aberdeen the only ones doing this at the beginning. Mentions Dugald Baird at the Aberdeen Maternity Hospital in the 1950s in terms of data banks; recounts her own experience of record-keeping there with knitting needles and punch cards. Talks about what has evolved from the use of information; particularly used in past two decades by management to see if hospitals are meeting the targets set by government, very different from the start when it was epidemiological. (0:38:28) Talks about Roy Weir becoming head of the department in 1969, set up a patient costing study, explains. George Smith, Professor of Surgery at the time, also involved; had worked in America and was quite used to costing patient care. Elizabeth was recruited along with Douglas Harper, who was a Surgical Registrar to see if they could cost patient care in Foresterhill. First patient-costing study in Britain, explains; in 1971 Senior Lecturer post became available at the university, Elizabeth appointed to it, to begin to develop interest in resource allocation and economics of care. Refers to article by York University about death trends in the UK, where they used the term "health economics". Elizabeth went to York for a few days to speak with them, and came back and said we have to do this; explains they set up a health economics project in 1974, recruited economist Gavin Mooney. At end of three years applied to the Scottish Office for funding and set up the Health Economics Research Unit in Aberdeen; still running. After a few years Gavin Mooney said I know we can find out about costs, I know nothing about value; patient outcomes. So worked with the Dept of Medicine, Jim Petrie in particular, applied for funding and got the Health Services Research Unit, also still running; basis for a lot of our activity since then. (0:43:26) Admits the biggest loss for her in dealing with data was lack of contact with patients, but explains this fitted with her leanings towards the bigger picture. Thinks the work of the two units she helped establish has been seminal in talking about what is now called Evidence-based Medicine. They were the forerunners of NICE, the National Institute of health Care Excellence in England, explains significance, great to have had a part in that. After that, she was part of the move to introduce health as a topic to the Medical School. Recounts difficulties she had in establishing a BSc course in Health Sciences. Took three goes with the Medical Curriculum committee to get a degree in Health. Introduced mature women, a whole cohort of different people working in health promotion, and working in and around the university in health research. Recalls when she became a Senior Lecturer in 1972, ten people in the department; eight medics, two statisticians. Later there were more non-medics than medics, explains importance of this to understanding of Health as opposed to Medicine. (0:48:29) Up till the 1980s was very much involved with the Health Services Research Unit. The units became part of the Faculty of Medicine, not part of Public Health, Elizabeth moved on to other things, explains. Went to a course in Minneapolis in 1981 on epidemiology and statistics; but that was the time of swingeing university cuts. So most of what she has done since then has been short term projects, and getting students involved in projects, explains. In 1980s and 90s spent a lot of time setting up the Office for Public Health in Scotland, explains. Would have seen herself then as both an academic and NHS person; but not an academic at heart, explains; opportunistic career. Deeply believed in applied research, but Aberdeen regarded as sub-optimum then by its peers, explains what happened. (0:53:07) Recounts how she divided her time between academic and NHS responsibilities; was not formalised then, as it is now, explains. In 1990 Roy Weir left to become Chief Scientist at the Scottish Office, chair was vacant. Was then the Chair of Social Medicine, and that was what Elizabeth was appointed to, explains about this, and why the term "Medicine" was eventually dropped from the title. Describes the variety of names the department was known by; also amazing combinations of names across the UK; department no longer exists. Confirms she was the first female professor in the Medical Faculty. There were only two other female professors at Aberdeen at the time, including Betty Fraser in the Dept of Psychology. (0:58:34) Describes what the Dept of Social Medicine was like when she took over as professor. Began to look at how you defined an outcome, began to look at things more from the patients’ perspective. That has continued across the UK and the world, patients have an identity they did not have before, as human beings, explains what this means. Refers back to the people she went to visit in York in 1971, leader was Alan Williams, man who developed the QALY, Quality-adjusted Life Year, explains. Refers to Mandy Ryan, leader of the Health Services Research Unit, who has developed the Discrete Choice Experience, still of huge interest. Speaks of the challenges she faced on taking up the Chair of Social Medicine; money, resources, recruiting staff; explains about latter, particularly in context of Aberdeen attracting people. (1:03:54) Explains that when she took over the department was strong, and was providing about two-thirds of the income of the Faculty. It was felt these resources would be better in the Faculty as a whole, and so the units moved into the Faculty. Same thing happened when they set up an Epidemiology Group, that was moved into the Faculty; Public Health was subservient to the greater good of the Faculty, explains. Effect on Social Medicine was that they had to often work with students, explains. Moved more back toward the epidemiology, refers to Cairns Smith and Corrie Black who took over running the new developments from the 1980s onwards, Elizabeth was much more involved nationally than locally at that time, explains. Professional life as a professor not much different from before, was not a hierarchical department, but added enormous amount of admin. Concedes that taking the chair did have an effect on her professional relationships, explains about battles for resources with other departments, sometimes blatant, sometimes possibly sexist. (1:09:45) Explains why her chair of Social Medicine was abolished when she retired in 2001. Explains why she thinks Social Medicine will come back; refers again to John Brotherston, explains his importance (he believed that an integrated NHS should be led by public health planning, which would help to move it towards prevention, previously public health was in local government); talks of going to Middleton Hall south of Edinburgh for debates, led to the Cogwheel Report which affected whole of the NHS in Scotland (including some integration of hospital and general practice). Explains what happened to the department after she retired; approves the direction of Prof of Public Health Corrie Black, explains. When she left Cairns Smith took over as head of department, but later took early retirement because of his unhappiness at the removal of departments at the university. Assesses the contribution of the department and Aberdeen to the development of Public Health. (1:14:39) Agrees that the specialisation has been developing for a long time in Aberdeen, explains this in context of the 1921 study involving health visitors; picked up by Lawrence Whalley, the Professor of Mental Health, still following through on that work. Aberdeen strong in the field of cohort studies at a practical level, and first in the field of record linkage till Oxford took over, because they put more effort into it. Addresses her legacy, with reference to the written history. The thing she is most proud of is the BSc in Health Sciences, explains why; first students, half were school leavers, half were mature women, explains what happened, tells anecdote about mother and son. Course now scattered around a lot of other subjects, can’t do it any more at Aberdeen. (1:20:21) Talks in detail about the importance of Ethics to her, how she taught medical ethics to First Year undergraduates, explains. Chaired for a while the Aberdeen Medical Group, wrong name, because it was interdisciplinary and for students who were interested in ethical issues; wonderful discussions over the years, explains. Care of the elderly, worked with philosophers and the Philosophy Dept, Eric Matthews, did series of discussions on this with other Nordic countries, explains. Gives her assessment of the NHS now, in early 2023; far too hospital-focussed, explains. It has become so specialised that finding a generalist is extremely difficult, explains consequences of this, including GPs having to spend so much of their time doing admin. Long term solution is not to provide more hospital beds, explains why; talks of concept of the virtual hospital. (ENDS 1:26:22)
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