| Description | Mr ROBERT JEFFREY interview at the Sir Duncan Rice Library, University of Aberdeen on Monday 28th August, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) ROBERT RANKINE JEFFREY, born on the 4th May, 1954 in Edinburgh. Retired in July 2014 as a Consultant in Cardiothoracic Surgery at Aberdeen Royal Infirmary, since 1989. No medics in his family, father was a pharmacist, mother had been a bank teller. Was encouraged into Medicine by his parents, explains. Went to Daniel Stewart’s College in Edinburgh from Primary One to Senior Five, left at end of Fifth Year and went straight into First Year of Medicine, explains. Talks in more detail about his choice to do Medicine, including doing First Aid. Applied to do Medicine in Edinburgh, Glasgow and Aberdeen, explains why he ended up in Edinburgh. Talks about what life was like as a medical undergraduate in Edinburgh, including embarrassing encounter at a party with Prof Forest of Surgery, who Rob later worked for. (0:05:26) Asked about being only seventeen years old when he started studying for Medicine, his views on that now, believes Medicine should be a post-graduate subject, explains. Did an intercalated year, taking an Honours degree in Pharmacology, but predominantly in Physiology, probably explains specialty he ended up in; met his wife in Pharmacology, got married in his final year at university. Recalls first encounters with patients, had great young Registrars as teachers, explains, a lot of elderly patients in medical wards at that time, tells anecdote about one patient lapsing back into Gaelic when he was developing a chest infection. Inspirational teachers included a man who ended up as Director of Cancer Research UK [later clarified this was a registrar named Dr Gordon McVie who ended up as CEO]. (0:09:18) Explains in detail when and why he decided he wanted to be a Surgeon. On completion of degree had to do six months Surgery and six months Medicine. In Surgery he worked for two of the most opposing people you can imagine; one was Mr James W.W. Thompson, a hunting fishing and shooting man; the other was Mr Tom McNair, a quiet, confident Queen’s Surgeon. Both great to work for, explains in detail; tells an anecdote about an in theatre conversation, which included an anaesthetist called Dr Alistair Mathieson. Explains at that point he was still thinking about being a Physician, but within two weeks of doing his six months as a Physician he decided against it, explains why he went for Surgery. Went to work in Accident and Emergency (A&E), then did an SHO (Senior House Officer) post in Vascular Surgery, explains this gave him time to study Anatomy for his Part One (this refers to exams for gaining FRCSEd - Fellowship of the Royal College of Surgeons of Edinburgh), which he passed at first attempt. Then did some A&E for nine months, really enjoyed it, then did a year at the Vascular Unit in Edinburgh, good fun [later added: Again, two outstanding inspirational teachers, Mr B Nolan and Mr A McL Jenkins]. Explains that when he graduated the only surgical specialties really were Urology, Neurosurgery and Orthopaedics [later added Cardiothoracic]; otherwise General Surgeons did the lot! Only in the last ten to fifteen years have you seen super-specialty, tells anecdote about this. Did his last six months on the Surgical Registrar rotation in Kirkcaldy; had to decide what he did next, explains. Went to a Cardiothoracic Clinic in Kirkcaldy run by Mr Philip Walbaum, the about to retire senior Thoracic surgeon in Edinburgh; explains how this led to him getting a job in cardiothoracic, Walbaum an outstanding thoracic surgeon. (0:15:09) Explains what Cardiothoracic Surgery encompasses, anything from the neck to the diaphragm. Explains in detail why he pursued Surgery as a career; refers again to his degree in Pharmacology, which was basically Physiology; liked the idea of cardiovascular physiology. Worked for Dr Alex Ungar, an outstanding physiologist, very encouraging. Talks about how he came to spend time at the University of Colorado, at suggestion of Philip Walbaum, opportunity to go to Denver on an exchange Fellowship. There he worked In Professor Alden Harken's unit, whose father Dwight Harkin was a real pioneer of cardiac surgery in the States, explains. Principally worked with Mr Michael Johnston, a thoracic surgeon. Rob did a year out there doing research on methods of treating lung cancer, using perfusion techniques that were relevant to cardiac surgery. His American colleagues tried to persuade him to stay in the States, explains the reasons he decided not to. Went back to Edinburgh and then got the Cardiothoracic Senior Registrar job in Liverpool, at Broadgreen Hospital. That was in the days when people worked very hard, explains this in terms of being almost permanently on call, but great experience; at work so much you knew exactly what was going on. Thinks new junior doctors have a miserable time in comparison, explains. (0:15:09) Explains about completing his higher surgical training in Liverpool; before the introduction of the FRCS cardiothoracic specialty exam, Edinburgh pioneered the specialty fellowship. Talks about (later) being on appointments committee, people being appointed having done 150 cases; when Rob was appointed as a consultant, quite young, he had personal experience of over 600; reflects on this, some aspects of training less good than they should be. Talks about coming to Aberdeen in 1989, wanted to get back north of the border, explains. Aberdeen had just got the funding to be the fourth cardiothoracic surgery unit in Scotland. Had previously been in Aberdeen on a couple of occasions for school swimming competitions. (0:22:46) Talks about his first impressions on coming to work in Aberdeen, and finding that the headmaster at Robert Gordon’s College, Mr George Allan, had once taught him Classics! Son and daughter both ended up going to Gordon’s. Explains what he was joining in Aberdeen; gives history from time in 1988 when Aberdeen became fourth cardiothoracic unit in Scotland. Mr John Cockburn and Mr Andrew Foote were surgeons there, explains about them, and how in those days cardiothoracic surgery was dominated by thoracic surgeons. Advertised for a third surgeon under the New Blood initiative, Rob was the one appointed. Understands that prior to this surgeons called Brunnen and Gower had done closed cardiac surgery (in Aberdeen), which did not involve bypass. Andrew Foote ("Footie") then came back to Aberdeen from the States; Sir Andrew Watt Kay came and said cardiac surgery should only be delivered in Edinburgh and Glasgow (Kay report commissioned by Scottish Office recommended concentrating cardiac surgery in the Central Belt Edinburgh and Glasgow). Footie continued to do it (cardiac surgery in Aberdeen) with support of Grampian Health Board, but not allowed to do valves. When John Cockburn came they were doing up to fifty cases a year, all they were allowed. Grampian Health Board then commissioned another report, thinks it was by Roy Weir, who said cardiac surgery should continue in Aberdeen, explains outcome in terms of operations. (0:27:29) Explains in detail about cardio-pulmonary bypass; open heart surgery, and closed heart surgery. Gives explanation for why Aberdeen was previously stopped from doing open heart surgery. Rob says he was made more than welcome when he arrived to take up the third consultant’s post in 1989; explains what he was doing, with his colleagues they quickly pushed up the number of operations. Biggest problem was getting access to intensive care beds, explains. One of the big developments during his time there was getting their own independent cardiac intensive care unit; talks of frustration towards end of his time there with overspill from adjacent General ITU (Intensive Therapy Unit). Talks about his teaching duties for Aberdeen University. (0:32:19) Open heart operation requires a big team, explains about this in detail. Recalls frightening operation on young man who had come off his motorbike at Stonehaven, and transected his aorta; mentions Joyce the theatre nurse, and Mr Jetmund Engeset the vascular surgeon offering to lend a hand; patient survived. Describes how unit grew, by time he left it was doing about 600 operations a year, potential to do 800, but recent problems, explains. Took on a fourth surgeon, built their own ITU, nurse staffing issues. Talks about reputation of the unit when he arrived, no recognised cardiothoracic surgical trainees; John Cockburn invited SAC (Surgical Accreditation Committee) to look at their facilities; Ms Deirdre Watson asked about operation Rob had just done; subsequently accredited for trainees, explains. With Rob’s support started a Scottish training programme, explains. (0:38:02) Talks about interaction with other specialties; general surgeons jealous of the Cardiac Unit developing a High Dependency Unit; but no nastiness, all co-operated. Talks about some nasty chest wall tumours dealt with by Orthopaedics, we used to get involved with Mr Tom Scotland, and subsequently Mr David Bodie. Talks about importance of Research; when Rob went to Liverpool he got very involved with minimising blood use during cardiac surgery, explains he did not like the idea of transfusing people, to extent that he got put on a list of people that Jehovah’s Witnesses will come to. Got appointed as Chairman of the Clinical Users Group for the Scottish Blood Transfusion Committee, explains. Talks in detail about achievements of the Cardiac unit, demonstrated we can deliver as good results as you can doing twice the number of cases [later clarified: …as other units performing twice the number of cases], explains Aberdeen had a consultant-based service that delivered good results. Recalls being the consultant on call on a Thursday evening when he got a call from Chris Blaiklock, then Director of Surgery, to say Dr Brunt would like you to come in, became clear it was to deal with the Queen Mother, explains in detail what happened. (0:44:40) Talks about issues he had to deal with while he was a consultant at the unit. At one period he was Assistant Clinical Director for Cardiac Services; found it difficult trying to be a manager and a surgeon at the same time. Later appointed Mr Hussein El Shafei, then two other colleagues, George Gibson and Keith Buchan; big increase in staffing. Does not consider himself to have been in charge of the unit; you can encourage surgeons, but not tell them what to do! Explains more about this; has his views about who managers should be, refers to recent case of nurse Lucy Letby. Talks in detail about the importance of teamwork in his specialty; a big team that has to communicate with each other. Current desire to break up teams in the health service, years ago management saw the way to make things happen was to disrupt the teams, to the detriment of patients, explains the consequences in detail. European working time directive, only 40 hour weeks, lack of junior doctors actually looking after patients. (0:49:32) Blames this on the formation of Trusts, rather than Health Boards, explains with example of how things were when he first came to Aberdeen, compared with now. Talks in detail of the work he has done with bodies at Scottish, UK and international level; the Royal College of Surgeons of Edinburgh; Hong Kong, Rob and Prof David Wheatley were the first examiners to go to Hong Kong to assess local surgical training, explains this has developed as an International Fellowship over the last five to ten years; Singapore connection, explains. Talks about how he sees his old unit now, problems with intensive care and COVID and staffing. Gives his views on the current state of the NHS; a political football, believes we have to take the NHS out of politics, explains in detail; problem of so much money now being spent on management; management have to be as accountable as the doctors. (0:55:32) But he is hopeful, explains. Has no problem with private health work, he did some himself, explains in detail; he believes there should be an integration between NHS and private, explains. Explains in detail the relationship between Cardiology and Cardiothoracic Surgery; cardiologists are the physicians. In last ten years interventional cardiology has absolutely blossomed, explains; stents, advantages and disadvantages. Can now replace the aortic valve through the groin; cardiac surgery in the elderly becoming more suitable to intervention, but don’t know what long term results are; issue of mitral valves. Talks about heart transplants, not done in Aberdeen. Talks about why Aberdeen became the fourth cardiac unit in Scotland, not Dundee; Sir Donald Douglas was then the professor in Dundee, had done some closed and open mitral valvotomy but with poor results, unlike Andrew Foote in Aberdeen who then had good results for coronaries; Dundee surgeons then tried to get the unit in Stracathro Hospital; thinks Aberdeen surgeons still do a clinic once a month in Dundee, also Inverness. Talks about issue of attempts to centralise services, not during his time there, but thinks it has again emerged; Hussein is having to do operations at the Golden Jubilee Hospital in Clydebank, explains issue is about staffing. (1:03:19) Talks about the campaign that was run to get funding in Aberdeen for the fourth cardiac unit in Scotland; very successful campaign run by Andrew Foote and John Cockburn, with support of the Dept of Medicine and the then professor of Medicine, explains. Talks in detail about Aberdeen as a medical centre, what it would be inappropriate to do, but we do the routine cardiac surgery well. Describes how he is the member of an exclusive dining club called the Aesculapian Dining Club; eleven surgeons and eleven physicians have dinner twice a year, explains. Also involved with the Harveian Society, celebration of William Harvey by the College of Physicians, explains in detail. Rob gave the Oration to William Harvey last year (at the Harveian Festival held at the Royal College of Physicians of Edinburgh). Explains significance of William Harvey. (ENDS 1:08:01)
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