| Description | Dr KEN MCHARDY interview at the Sir Duncan Rice Library, University of Aberdeen on Monday June 5, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) KENNETH CHARLES MCHARDY, born at Fonthill Maternity Home, Aberdeen on 28th of May 1955. Retired at end of May 2015, had a few jobs, foremost a Consultant in Diabetes at NHS Grampian; also Associate Post-Graduate Dean with NHS Education for Scotland; also the Medical Specialty Deputy in the [Diabetes] Managed Clinical Network based at Woodend [later corrected to Summerfield House]; so had three different components to his salary. A couple of months after retiring, was re-hired mainly to do appraisals, explains; also helped with some fact-finding panels investigating cases of indiscipline. Did those two jobs till 2018; also back in Spring of 2017 doing two or three diabetes clinics a month, explains. When COVID came along registered to go back to work, explains what this involved him doing. Other major project he has been involved in relates to diabetes and medical history. Only official status he currently has is as an honorary Senior Lecturer in Medicine at Aberdeen University. (0:03:54) Describes family background, no medics in his family. Talks in detail about his mother and father. (0:06:45) Talks about his education. Started school in 1960 at Rosewood Infant School, there for a year; post-war baby boom, three primary schools in Kincorth at that time; in Ken’s school three classes of about 35 (all born in 1955), explains consequences. His second year of infant school held at back of the stage at Kirkhill Primary School, where he then spent primary three and four years. Because he was bright, was put forward for a bursary place at Robert Gordon’s College, explains. By time he was in primary four did another exam and was offered a place in primary five at Aberdeen Grammar School, which he took up, explains consequences, including isolation from his peer group in Kincorth. (0:11:40) Mixing with a much broader range of social backgrounds at Aberdeen Grammar School, explains in detail. Did well at school, academically and in sports, always played for school teams; played soccer, rugby, cricket. Music another interest, explains; but found sports and music were mutually exclusive options! (0:15:30) Transition to secondary school also at Aberdeen Grammar; renewed acquaintance with some members of his old primary school class whom he had left behind three years before, explains. Ken always in the top groups throughout school. In third year, hockey became an option, which he took up rather than rugby; also continued playing cricket. Also explains how he came to take up playing the bagpipes at school; his grandfather’s uncle had been a junior piper at Balmoral Castle. Played pipes throughout secondary school, and because the tutors came from the university, was also recruited to the university pipe band for two years before he left school. Explains why he did not join pipe band when he went to university. (0:20:41) He was doing well in Maths and Science, interesting relationship with English, explains; mentions his English teacher David Northcroft, whom he also played cricket alongside for a city club from 1970; recalls conversation they had on the evening of the day Ken sat his Higher English exam; came to realise in later years that he had quite a passion for English Language, explains. Talks about considering what he would do when he left school, clearly in Medicine or Biology area, explains in detail. Recalls influence of a 1960s TV serial called "The Human Jungle" in drawing him towards a medical career. (0:25:55) Talks about influence of evening sessions the university put on when he was in fourth or fifth year at school, with the different faculties presenting their wares. Decided he was going to do Medicine, explains his then rationale in detail. Can’t remember seriously considering a university other than Aberdeen for his studies. Explains importance of Aberdeen University bursary competition for high-achieving pupils at Aberdeen Grammar School. Medical School at the time was in process of reducing medical course from six to five years, explains consequences for himself; decided to stay for Sixth Year at school, sat bursary competition, got top place for Medical bursary, went on straight into Second Year of medical course. (0:33:45) Describes being a medical undergraduate at Aberdeen from 1973. Huge cultural shock, explains in detail. Meeting people from different backgrounds, grownups, meeting females, because with two brothers and attending boys’ school for nine years had had little exposure to females. Limited social life because of desire to succeed in studies. Main focus of his first year (second year of the medical course) was Anatomy, explains. Recalls the Professor of Anatomy, David Sinclair, telling anecdote to illustrate why it was really important for them all to study anatomy. Dissecting corpse for whole year. Struggled to read the formulae on the board in Biochemistry, realised he needed to go to optician and get glasses. Recalls Anatomy Viva examinations every three or four weeks, pretty good for keeping you focussed. (0:42:04) Asked about encountering patients for first time. Thinks nowadays that students are exposed to patients from their first year, but not the way in his time. Explains his was the last entire six-year class, about a quarter of them had entered straight into second year, which had degree exams in Anatomy and Biochemistry; in third year it was Physiology and Pharmacology, but in summer term in third year they started clinical practice and going to the wards. Talks about the challenge of this. Found the patients, even the very ill ones, were all co-operative and helpful; exceptional to find people who would challenge your right to be there as a student. Loved it, clear he was in the right place and this was what he wanted to be doing. Thinks in those days most of focus was on different medical disciplines and different ranges of diagnoses. Not as much focus as there should have been, and is now, on different types of communication skills, explains. Criticism that too much training is hospital based. Laments the fact that there are not many generalists left, because people have specialised too much. Their training was almost all hospital based, with a short GP block in final year. Refers to one of the tutorials he ran, in his retirement, for the Medical School was about giving telephone advice, explains. (0:47:43) Felt he should be inspired by professors, was always impressed by people who knew lots. Impressed with Doris Campbell, lectured in Physiology but was an Obstetrician, explains. Had some very good tutors when he started in clinical practice; Rowena Paton, Allison MacCuish, Brian Junor, people he remembers who were early clinical tutors. One of the senior clinical tutors was Bill Gauld, tells anecdote; impressed by his exceptionally broad knowledge of medical conditions. Tells another anecdote about Bill Gauld, illustrating his knowledge. Worked with many of these people in later years when he was specialising in diabetes, explains. (0:53:01) As his training progressed, was impressed by the academic department that in those days was called Therapeutics and Clinical Pharmacology. Mentions Jim Petrie, who eventually went on to become the President of the Royal College of Physicians in Edinburgh, was a leading light, explains his influence on Ken’s career, eventually led to Ken choosing his department to do his house job, which eventually led him to his specialty. In that department the main Endocrinologist worked, explains connection with Diabetes. Because Diabetes so prevalent has developed in many places into a specialty itself, explains. Impressed by Peter Bewsher, the endocrinologist, by Bill Walker, head of department, professor of Clinical Pharmacology and Therapeutics, and by young Jim Petrie. Worked with non-physician specialists, people like Hamish Sutherland at the Maternity Hospital. But some people you were not so impressed with, names no names! (0:56:22) Talks in detail what he did upon graduating in 1978, pre-registration house officer jobs in Aberdeen. But first explains that after passing and finishing written exams in fifth year of medical course, he did two what were then known as locum house officer jobs, under supervision. Included locum in Surgery at the Children’s Hospital, which included covering children’s casualty one night in four; speaks about this period of a month of locum house jobs being scary for him as an undergraduate, but also enjoyed it. So did most of a fortnight at Sick Kids and most of a fortnight in Ward 4 in Aberdeen Royal Infirmary, the ward of the Dept of Clinical Pharmacology and Therapeutics, mostly doing General Medicine duties. These were the two units that he went back to in his pre-registration year (after graduation), explains. Explains in detail how his hours on and off duty and on call worked. Explains also what happened when ward he was working on became the receiving ward for emergency admissions every eighth or ninth day. Talks about how they became possessive of their patients, taking responsibility and solving problems. Discovered patients do not have the grace or sense to have the correct set of symptoms or to only have one disease at a time! Comments on the era that grew up, where there are guidelines for everything, not taking this into account, when four different complicated things are happening at once; fears for future of the profession. (1:06:01) Even though describing these horrendous hours, could not wait to get back into the ward on Monday morning to find out what had happened. After six months decided future for him was in hospital medicine, explains he wanted to be a consultant physician. Explains about his six months surgery, and fact that in his day there were no surgical consultants for the Children’s Hospital, they all came from adult specialties. Talks about how this worked in detail, including lying in bed on call and watching to see which way the emergency blue lights went. Quite liked the handwork of surgery, but not the specialty that suited him, so decided he was going to be a physician. Was successful in applying for Medical Senior House Officer (SHO) position, based in Aberdeen. (1:11:02) Talks about when he decided to specialise in Diabetes. Had been exposed to a range of endocrine diseases during his training, which had included managing medical emergency cases with diabetes. Through his SHO jobs spent four months working at Ward 8 Woodend, mentions Lillian Murchison; diabetes, endocrinology and general medicine. Mentions other disciplines he worked in during this time, including two months in general adult psychiatry at Cornhill, made big difference to his lifetime experience of training in “somewhat ectopic specialties to medicine”. Been thrown out of the rotation now for thirty or more years, but really important to him. Explains how he came to do a locum instead of the second year of his SHO rotation, now a temporary lecturer and honorary registrar in Dept of Clinical Pharmacology and Therapeutics, and working in the endocrine team, closer than ever to Peter Bewsher, explains. During that year completed his MRCP (Member of the Royal College of Physicians) exams, had by then become a UK qualification, explains in detail. (1:17:12) Refers again to how his two-year appointment became one-year appointment. Explains how he came to do the Diabetes outpatient clinic, mentions John Stowers. Ken spent six months in 1981-82 doing diabetes outpatients, loved it. Talks at length about various issues associated with long term conditions’ management. (1:20:08). Sent to Raigmore Hospital in Inverness for six months, fantastic experience, explains in detail. Worked there with John Burton, who was the Renal physician. Allowed him to develop his diabetes skills, explains back then the diabetes clinic there was largely run by a GP with diabetes, no specialist consultant. Ken worked alongside Donald Pearson, a lecturer at the University of Aberdeen, who had been sent to Inverness, only senior registrar in medicine in Inverness, and his specialty was in diabetes. Ken came back to Aberdeen, did a year in Oncology and General Medicine at Woodend. Enjoyed the latter, worked with Dr Andrew Hutcheon for two six-month slots before moving back to in-patient diabetes at Foresterhill, where Lillian Murchison had moved and joined up with Mike Williams, to be one of Ken’s main mentors for many years. Explains what his work at that time involved, had about ten pieces of published research on his CV at that time; nothing exceptional then, but would be exceptional now. When John Stowers retired in March 1984, Donald Pearson replaced him [later clarified that Donald Pearson had come to the Diabetic clinic from Inverness in 1982, so was in Aberdeen for almost two years before being appointed as John Stowers’ replacement]. Donald Pearson had been going to do a research project at the Rowett Research Institute, did not need to do that now, so Ken got involved in negotiations with (Professor) Philip James, director at the Rowett. Led to him going to Edinburgh to be interviewed for a national funded Cruden Research Scholarship, gave him a full year of research work at the Rowett, into (role of insulin in) how you dispose of nutrients after a meal, explains. At the end of that year had another opportunity, successful in applying for one of the New Blood lectureships, explains affiliated to the Dept of Medicine but could continue Rowett research. Over several years completed his training in General Medicine, Diabetes and Endocrinology; also completed his big research project at the Rowett which meant by 1990 was able to take an MD degree, explains. (1:26:20) Also started training in how to train, another major interest that was evolving for him. By 1993 Ken had become half time assistant to the Postgraduate Dean, looking after the training for postgrad doctors in the North of Scotland. Also moved half time into a locum consultant post because Donald Pearson had taken up a management post which took half his time. By 1994 when Michael Williams, the third ever Aberdeen diabetologist, retired Ken competed for and was appointed to his post, and was then a tenured consultant in General Medicine and Diabetes with NHS Grampian. Explains what this involved him doing, including continuing an interest in Thyroid disease. Was given an opportunity to spend a month overseas. Largely due to work he had been doing in Diabetic Retinopathy with John Forrester, who was Professor of Ophthalmology in Aberdeen, he had contact in Perth in Western Australia. Ken sent there for a month to be an observer, wonderful experience, explains; mentions being well looked after by Tim Welborn, an English expatriate and diabetes consultant. Talks in detail about his experiences in Australia, comparisons with what he was used to back in Aberdeen; tells anecdote about being mistaken for a patient; talks in detail about treatment of diabetic feet by Tim Welborn. (1:33:39) Explains terms of his new contract were that he would still be assistant to the Post Graduate Dean for one day a week, which became formalised to title of Postgraduate Tutor, explains. Went on later to become chair of the Scottish Postgraduate Tutors consortium for about a year. In 2002 the Deanery operation was becoming even bigger, explains; became Associate Postgraduate Dean, meant giving up some of his clinical work, which now took 60 per cent of his time, set Ken into a career pattern. (1:35:08) Explains in detail about Diabetes as a condition which has become increasingly prevalent throughout his career; told while training that Type 1 Diabetes affected one in three patients who got diabetes, Type 2 Diabetes affected two in three patients who got diabetes. Explains in detail about Diabetes and Insulin and Glucose. Prior to discovery of insulin, Type 1 diabetics would only live for months or at most a couple of years. Explains that Type 2 Diabetes is a different kettle of fish, predominant defect is insulin resistance; mostly presents as people get older and less physically active, explains this is mostly in people who are overweight, and incidence [or even better, prevalence] of this in the population is rising as well. Throughout Ken’s career, Type 2 has become by far the more prevalent condition. Typically now about eight-ninths Type 2 and one-ninth Type 1. (1:43:00) When insulin was discovered we could keep people alive with diabetes for a long time, but both types over long periods typically involve damage to small and large blood vessels. Talks about long term effects of diabetes, including effect on kidneys, increasing need for renal dialysis. Area Ken was involved in, diabetes affecting the eyes. For a long time diabetes was the commonest cause of blindness in the working age population in the UK. No longer the case, things have improved a bit. So mostly about helping people manage their condition, explains about this in detail. (1:47:30) Explains in detail how the treatment of diabetes was organised in Aberdeen. In 1926, only three years after discovery of insulin, Aberdeen appointed Alexander Lyall to be the first specialist not only in Diabetes, but also in Clinical Biochemistry, or whatever it was called at the time. Explains about this in context of general lack of clinical tests at that time. Edinburgh probably set up the first Diabetic clinic in 1924; R.D. Lawrence, Aberdeen graduate and diabetic patient saved by discovery of insulin, set one up in King’s (King’s College, London). Not many medical specialists in those days. Setting up of these diabetic clinics in Edinburgh, London and Aberdeen made clear the need for specialist services for long term complicated conditions like diabetes. Explains in detail what Alexander Lyall introduced, beginnings of increasingly multi-disciplinary teams. Meantime developing a clinical biochemistry service, which now processes hundreds of thousands of tests. Centenary of both departments is not far ahead of us. (1:50:51) When Ken started his first job in the Diabetic clinic in 1981, John Stowers was the head of department; had been there by that stage for almost twenty years. He was also a great believer in clinics, explains. Describes in detail how the clinic system worked. This also involved maternity clinic, as Prof Stowers had developed an important interest in pregnancy, and was a co-founder of the Diabetes Pregnancy Study Group, a European organisation (European Association for the Study of Diabetes). Held four five-yearly worldwide symposia on this in Aberdeen, three during Stowers time, and one when Donald Pearson took over. After you had done your clinics, you were round the hospitals, including the maternity hospital most days, explains. Mentions that Dr Lyall started evening clinics for working people which, possibly because of blackouts, were moved during the War to Sunday mornings; trying to normalise the condition, explains. By Ken’s time had an evening clinic to do twice a month. Explains in detail how clinic was staffed, including nurses, and diabetes health visitors. Developing this service became a major part of Ken’s career, explains. (1:56:21) Asked about changes he saw throughout his career in treatment and management of diabetes, and whether these were all positive; definitely not! Qualifies answer. Established a register of diabetes patients in 2002, because setting up a Grampian diabetes retinal screening service, explains how this worked. Had 10,500 diabetic patients then. By the time Ken retired in 2015 this had increased by 152%, very nearly 30,000 patients [over 26,000 then; over 31,000 now]. Reasons were increased age, less physical activity and more overweight people. Also separate factor, more pro-active medicine, people being screened and tested for things, the whole Quality Outcomes Framework (QOF) incentivised practices to do many tests etc. Led to discovering more diabetes; so increase partly societal, partly medical pro-active thing. (1:59:50) When Ken started just about everyone with diabetes was sent to the clinic, and diabetes was largely not looked after any more by Primary Care, because there was a specialist service looking after it. But explains there were exceptions, and how these were viewed. Notes that in 13 years they had five times as many people with diabetes [later corrected this to two and a half times as many people], so just as well that they were involved in revolution of re-equipping primary care to look after patients. Explains in detail what he saw as the deficiency of the old way of doing things, which aimed to give patients autonomy but then criticised them if they did not adopt all the recommendations. Not an easy disease to live with. Evolution of a method that could overlook your diabetic control for the past three months; glycosylated haemoglobin, when he started he would have loved to have that number, but says that later it became a tyranny because too many consultations were dominated by this bloody number, instead of listening to the patients, explains. Ken says he felt like a bit of a heretic because while he was trying to uphold these best national standards, to try to contextualise it for the patient in front of him, was difficult, a challenge. Never believed that when you had a patient with poor diabetic control that it was automatically the clinician’s fault. Had to aspire not to the best national average, but to aspire to the best you could work on with your patient that they could achieve and still have a tolerable life. There were many revolutions for treatment resources and also self-monitoring resources for diabetes, explains significance of this in treating real world diabetes. Explains 5 to 2 ratio means currently more than 5% of the population have diabetes. Round about the time he retired, at the age of 65 it was of the order of 1 in 9 women and 1 in 6 men have a known diagnosis of diabetes. Need to have solutions to apply to that. (2:05:50) Speaks about how the technologies of treating diabetes changed throughout his career. These have been enormous, have made modern practice almost unrecognisable from where it was. First and most basic one, pioneered in Scotland, the use of Informatics, explains this involves using computer systems to collect, collate and share data, for about twenty years now has led to annual report of the Scottish Diabetes Survey. A lot of more personally relevant technologies; change from glass to plastic syringes, explains. Explains why when he started diabetes registrars needed to have two Biros (Biro - type of cheap ballpoint ink pen); a blue one to write units of insulin, and a red one to write marks on the syringe. Worse, back then there were three strengths of insulin produced, explains difficulties this caused. In about 1983 or 1984 U-100 insulin came in, all insulin now same strength, explains this meant he could dispense with his red Biro. Also explains about insulin-resistance causing the more recent production of double-strength insulin. Other change that came in about time Ken was starting was change from urine monitoring to blood monitoring, explains in detail. (2:10:28) Bigger emphasis on self-monitoring, explains how this worked and what some patients did; tells anecdote about how one lecturer pointed out a serial number in a patient’s monitoring book that had last been issued fourteen years before! Then finger-pricking devices came in, explains. Then insulin pens became prevalent, instead of using a syringe. Another thing earlier on was the change from animal insulin, which was mainly extracted from the pancreas of pigs, but in 1981 or 82 when Ken was starting there was a trial at the maternity clinic of human insulin, explains how this was developed. And issues that this raised; hypoglycaemia a big bugbear. (2:14:59) Testing important for measuring in relation to low glucose. First big debate was whether awareness of hypoglycaemia was diminished by using human insulin. Explains in detail about significance of blood sugar levels in relation to perception of hypoglycaemia. Became progressively aware, and important for clinical practice, that if people are just above "too low" they become less able to tell the difference when it becomes "really too low". Explains about quick and slow insulin, and mixing. Then advent of human insulin as 1980s progressed. And what all this involved in terms of injecting. Finding the right balance was a challenge. Explains that in the 1990s new synthetic insulins were introduced that were not human, they were modified insulin molecules to make them work, allegedly, better; explains. Quick-acting stuff from about 1996 was modified, explains in detail. Delay in acting even using human insulin when injected under the skin, might need to inject half an hour before meal, inconvenient. So in mid-1990s brought out insulin analogues, different to human insulin, which could be injected at the time you started eating. (2:20:03) Talks in detail about insulin pumps, which came about quite early in Ken’s diabetes existence; fraught with problems, explains in detail. Insulin inhalers, never did well. Oral insulin, not likely to work, explains. Insulin pumps came back into vogue around the Millennium, explains in detail, including issues with them, and managing expectations of patients. (2:25:23) Quite soon now pumps available with a closed loop system, both a testing limb and an insulin administration limb, explains difficulties in achieving this. Other things, talks about pancreas transplant having some success, combined kidney-pancreas transplants, issue of rejection. Islet cell transplants, explains, issues. So big hope is using stem cells, explains. Continuous glucose monitoring, mentions former UK Prime Minister Theresa May. (2:30:05) Talks about his commitment to education and how it relates to the treatment of diabetes. Really been the be-all and end-all of his existence, explains in detail. Spent many thousands of hours of a career trying to understand and negotiate with patients, explains. Interested in process of education, helping other people understand things at school and university, unofficially. Later in career, helping patients to understand; managing complicated situations, and keeping the patient on board. Says he taught forty years of medical students, sure that he taught upwards of thirty years of them very badly, but hopefully by the end beginning to get the hang of what they needed to know. All his training was unofficial till he joined the Deanery service, although as soon as he graduated he was doing bedside teaching of medical students. After a year or two was doing lectures, teaching at RGU (Robert Gordon University) (at the time still under its former name Robert Gordon’s Institute of Technology - RGIT), nurses and occupational therapists, and latterly dieticians and pharmacologists. Says in his clinical practice became clear what he was doing with patients was not managing their condition, but managing them and their life and their personality, explains. More and more motivated in education. Twenty-two years in the Deanery mostly spent doing administration tasks, involved through that in doing various national inspection systems, explains. (2:37:12) Talks about his frustration in the many years spent on a national diabetes education advisory group, a sub group of the Scottish Diabetes Group, explains in detail. Ran courses for General Practitioners. In 1999, set up a diabetes scholarship programme for GPs, explains he resisted attempts to make this for all junior staff. That course was in its seventeenth year when he retired, explains about the messages he was giving the more than 150 GPs who had attended. Major course he did in later years was about helping mainly Practice Nurses to help diabetes patients to help themselves, explains in detail about what course involved. (2:44:39) All about getting people to speak and collaborate. Gives other examples of what the course involved; comments on the modern system where the nurse may have to tick 52 boxes in meeting a patient for ten minutes; some nurses almost in tears between need to do this and meeting the patient’s actual needs. Talks about another thing, ran course he undertook in his last few years for teaching and education for diabetes healthcare professionals, explains about this course in detail, and the challenges it posed to those taking part. (2:50:52) Talks about his contribution to the field of diabetes research. Ken involved fairly early on with the Dept of Ophthalmology, and the build up to automated retinal screening, explains in detail. Allowed the development of their first Medical Ophthalmologist, Ken heavily involved in training. Subsequently supported another trainee who stayed in diabetes, now honorary university Professor Sam Philip, who did his major research work on automated image analysis. Ken says this is probably the area that he contributed to that has made the biggest impact on service delivery, explains. Even in retirement, Ken was involved in writing up a project, now published, interface between education and diabetes, explains. From 2006 involved in setting up Practice Outreach programme; (2:56:23) Explains background starting in 1998 when he had to take on the service in the new Kincardine Community Hospital, which served five practices; involved him doing diabetic clinic about once a month in Stonehaven. Persuaded management that he should spend half of that day meeting a practice team, explains. Started at Inverbervie, known for a time as the Inverbervie Experiment, explains how he would sit with the GP and the practice nurse and tell them anything new that was developing, and invite them to tell him about any problems they had. Explains how this approach developed. One of the last things he did was he was asked by his replacement as head of service to allocate a senior medic to every practice in Grampian. One of Ken’s former trainees, a consultant colleague just as Ken retired, went on to write up this project, and they co-authored a paper in Practical Diabetes, another important contribution. Explains the importance of consultants consulting. (ENDS 3:00:37)
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