‘Is dòcha gum bi e na dhotair’
“Maybe he’ll be a doctor”, said my grandfather. I was three years old at the time and he was ninety-four.
An t-Àrd-ollamh Iain MacGillIosa, OBS, FRSE, Àrd-ollamh Urramach ann an Dotaireachd Teaghlaich, Co-stiùiriche Iomairt Tròcair na Cruinne, Oilthigh Dhùn Èideann.
Professor John Gillies OBE FRSE, Honorary Professor of General Practice, Co-Director, Global Compassion initiative, University of Edinburgh
Dr John Gillies is an Edinburgh graduate who has worked in Malawi and as a general practitioner in rural Scotland, latterly in Selkirk for 16 years. He has been an undergraduate tutor, a GP educational supervisor and a training programme director with NHS Education Scotland. He was Chair of the Royal College of GPs in Scotland from 2010 to 2014 and deputy director of the Scottish School of Primary Care from 2015-2019. www.sspc.ac.uk He is an Honorary Professor of General Practice at the University of Edinburgh and the University of St Andrews. In 2019, he chaired a group for the Scottish Board for Academic Medicine which produced recommendations on increasing undergraduate exposure of medical students in Scotland to general practice.
John is from North Uist Western Isles Scotland, proud of his Gàidhlig roots, language, and heritage. He co-directs the Compassion Initiative within the Global Health Academy, which works across disciplines to use the growing evidence for compassion in workplaces including healthcare. He is on the editorial board for a book of poetry for new doctors, “Tools of the Trade”, gifted to all new doctors in Scotland, published jointly by Scottish Poetry Library and Polygon Press in June 2022. He keeps fit — and tries to keep sane– by cycling and walking in the Scottish Borders, Western Isles and beyond.
Watch the video of the interview below or on Youtube or listen to the podcast on Spotify and all the major platforms
Hello, I’m Domhnall MacAuley and welcome to MedicsVoices.com, where we talk to the key opinion leaders in health and medicine around the world today we’re in Scotland and I’m talking to John Gillies. Fáilte go MedicsVoices.
John Gillies: Mòran taing airson cuiridh agallamh a dhèanamh le MedicsVoices. Many thanks for the invitation to do an interview to Medics Voices. But, I suppose we’d better do this in English
DMacA: You were born on the Gaelic speaking Hebridean island of North Uist…
JG: I was born on Lochmaddy, the Isle of North Uist, which at that time, was predominantly Gaelic speaking. So Scots Gaelic was my first language. And, I learned English more or less when I went to school where the teachers weren’t allowed to teach in Gaelic, and didn’t allow us to speak Gaelic as part of the minoritisation of language that you see all across the world. It was a world apart. We had no electricity. There was no electricity there until 1969. So when we moved to the mainland when I was eight, it was my first exposure to the new technology where I was able press a switch at the wall and the light on the ceiling came on- my first experience of electricity and technology. It was a very traditional community and everyone worked together. My grandparents were crofters, small farmers, my mother was a nurse, and my father worked in the post office as a clerical officer. He got promotion, which is why we moved. So, I’m the first person in my family to go to university.
DMacA: Where did the interest in medicine come from?
JG: It’s hard to say what goes into making these decisions especially when, like me, there was no background of medicine in the family to guide you, or to put you off, because both things happen, of course, in medical families. I think it has a lot do with my family’s experience of ill health. Nearly all my father’s family, including my father, had tuberculosis at some stage. One of my father’s sisters died from what was probably miliary tuberculosis before the availability of triple therapy in the 1940s. My father had TB in the 1950s but at that time, luckily, it was curable, but I remember him going away in the boat to a sanatorium in Stornoway for three months, and coming back better. So, there was that sort of background. My mother was a nurse and so I remember her going into hospitals and coming back and talking about patients. So, this family background probably had a big effect on me. And the idealism of youth. When you leave school and you want to make the world a better place, I think that’s part of it too.
“I realized then that what we were doing in medicine used science but it was not really science in the sense that a pharmacologist or a biochemist would know.”
DMacA: You went to Edinburgh. Tell us about your time at medical school in Edinburgh…
JG: It was quite a shock. By that time my father was head postmaster and we were living in Glenrothes, in Fife. The school system was fantastic and at that time we had very good science teachers and I think that also played a part in guiding me towards the sciences and medicine. I went to Edinburgh, I think, because it was the closest university to where we lived. What struck me first of all was that many of the students in Edinburgh then were from Edinburgh and they’d been to Edinburgh Public Schools. I actually thought they were all English because that accent was so completely different, both to my Gaelic island accent and the accent of the people in Fife. That took a bit of adjusting and, luckily there was a very active Highland Society there which I became part of. I really only became seriously interested in medicine properly when the clinical years started. I did an honours degree in pharmacology, and that was interesting because doing an intercalated year teaches you that medicine is not science. We had a very rigorous pharmacology tutor called Professor Bernard Ginsborg and we did critical analysis of papers. I realized then that what we were doing in medicine used science but it was not really science in the sense that a pharmacologist or a biochemist would know. But when we got to the clinical years and we began to see patients I then became much more interested in the business of medicine. I stayed on in Edinburgh and I think I had decided I wanted to be a hospital physician. I did my MRCP and then things changed, of course.
DMacA: You talked a moment ago about the idealism and the optimism of youth, and you next went to Africa. Tell us about that.
JG: It was my girlfriend at the time, who subsequently became my wife, whose parents were in the colonial era and were civil servants in Northern Rhodesia, which is now Zambia. She’d been back to Africa on an elective to, Tanzania, I think. So we had a look at that and I knew a few African people in Edinburgh as well, so I thought it would be interesting to go. But, Mary was probably one of the main factors. We both did the three-month course for the Diploma in Tropical Medicine and Hygiene at Liverpool. Jobs came up in Malawi in central Africa where I think our official title was ‘General Duties Medical Officers’. We ran a District General Hospital near the Mozambique border with a lot of very competent Malawi staff, clinical officers, and nurses. There was no medical school in Malawi at the time so all the doctors were either expats like us or Malawians who’d been to the UK or other countries and had come back. There is now a good medical school in Blantyre. It was a really interesting three years and we were both quite sorry to leave, but there were other factors which drew us home.
“… the core values of general practice at that time, which I think are still rather similar to today. Perhaps every decade you have to redefine them in the context of your structures, and the expectations, the technology, the therapeutics, and so on.”
DMacA: You then had this transition back to Scotland and a new career…
JG: One thing about working somewhere like Africa is that you become quite independent because you have to make decisions, sometimes without much support, although we did have excellent Malawian surgeons, obstetricians and physicians but, basically, we were nearly 100 miles from the nearest large hospital. Looking at the situation here, I thought it would be problematic to go back as a junior doctor. Also, I had decided by that stage that I didn’t really like hospitals and I didn’t want to spend the rest of my life in a large overheated, hospital environment.
A job came up as a trainee with Alastair Donald who was then Regional Advisor in Edinburgh and subsequently Chair and President of Royal College of General Practitioners. I had an excellent year with Alastair and his colleagues, some of whom I’m still in touch with in Leith and Edinburgh. After that, because besides medical school I had always lived and worked in rural areas, I’d begun to look for posts in rural Scotland. I went to Galloway for 11 years, on the A75 route to Stranraer and Northern Ireland. And the rest of my career, of 18 years, was in Selkirk in the Scottish Borders, where I still live.
DMacA: You’ve already given me a hint as to where drew your interest in the College and then in academic general practice. So, tell us how you got involved with the College.
JG: I did the exam, of course, when I was a GP trainee but, when I was in Galloway, we were working a pretty hard rota on a one in two, one in three rota, and we had a rural hospital to look after with the other doctors. There were no consultants, besides a surgeon, and we did some intrapartum obstetrics. It was only when I moved to Selkirk in 1996 that I became interested, became a member of the local faculty, and began to go to meetings and became interested in a few things such rural training – how do we train doctors for rural parts of Scotland and indeed the wider world. I published some work with the help of the College, and with Doctor Mairi Scott, who was chair of RCGP Scotland at the time, was a member of Council, and with encouragement from her ,the late Dr David Blaney and Dr Stuart Murray, we got some funding to do a project called the Essence of General Practice, which we eventually published with Stewart Mercer, Graham Watt, Mairi Scott and the International Futures Forum. It was an attempt to set out, I suppose, a kind of practical philosophy of the core values of general practice at that time, which I think are still rather similar to today. Perhaps every decade you have to redefine them in the context of your structures, and the expectations, the technology, the therapeutics, and so on. That was how I became interested so I’m very grateful, particularly to Mairi Scott, for introducing me to stimulating people within the college. After that I became Chair of the Royal College of General Practitioners in Scotland for four years, which was really interesting, and really challenging. But, but I don’t regret any of it.
“Certainly, there’s more evidence now for the importance of continuity, the clinical importance of continuity, in reducing mortality, morbidity, patient attendance and so on. And also, the concept of the expert generalist has come to the fore.”
DMacA: I was always impressed with your fresh new approach to the College, which was quite different to the establishment approach. And when I look at your work, you were way ahead of your time. You must look at some of the what’s happening now and think- we were there 15 years ago.
JG: What do modern philosophers say? The ancient Greeks are always stealing our ideas. The future is always in the past. Looking at some of the core values that we looked at in the Essence project, were things like, continuity of care and a generalist approach. (Distilling the essence of general practice: a learning journey in progress. So this was between 2007 and 2010. I think these issues of continuity and a generalist approach, a focus on the patient not just the disease, have come to the fore more recently. Certainly, there’s more evidence now for the importance of continuity, the clinical importance of continuity, in reducing mortality, morbidity, patient attendance and so on. And also, the concept of the expert generalist has come to the fore. That was all there within the “Essence” work that, Stewart Mercer, Graham Watt, Mairi and I did between 2005 and 2010. After that, Martin Marshall set up the Commission for Generalism when he was with the Health Foundation. But it’s interesting, that despite all, we are still at the stage in the NHS, certainly in Scotland, where there are still far more specialists and super specialists appointed than generalists. The numbers of these specialists and super specialists, all of whom I’m sure are doing a wonderful job, has grown remarkably and the number of GPs has stayed static. So, despite all the work that the College and other organizations have done, it hasn’t always translated into action in terms of where the funding goes. Funding for general practice has dropped, in percentage terms recently, rather than risen. So there is a message perhaps for the College about how it actually makes things happen. We’re sometimes quite good at talking evidence and theory but lack the practical effects. And, I think that if I have a disappointment at the end of my career, it is that the translation into spending more money in general practice hasn’t really happened, despite there being lots of evidence that it will provide better care and save resources for any health system.
DMacA: Let’s take a little diversion for a moment to talk about the breadth of your interests because, way back, you did an MA in Ethics and Law.
JG: I was fortunate that when I came back to Selkirk, and I was doing some work with NHS Education Scotland which was organized into local deaneries, I met Professor Kenneth Boyd who was Professor of Medical Ethics in Edinburgh, who’s actually a theologian rather than a doctor. And I became very interested in ethics because, one of the things we realized quite quickly, certainly in general practice, is that the facts don’t always tell you what to do, the evidence doesn’t always give you a clear path forward. And we need ways of sorting out what’s the best course of action. So, I did this Master’s in Keele and really enjoyed that; interesting colleagues, interesting teachers. It was quite an undertaking and perhaps if I’d realized what a big undertaking it was, I might not have done it. But one can be wise to these things after the event and I was very grateful for the support of Mary my wife, who was also a GP. She took up the some of the slack in the practice when I wasn’t there. Out of that came an Occasional Paper that I published on the consultation in general practice, which is still available “Getting it right in the consultation: Hippocrates’ problem; Aristotle’s answer” RCGP. Occasional Paper No 86.
It was basically an argument for the doctor patient relationship, a broader approach to that consultation taking into account the patient, her family, her culture, her community and so on. An holistic approach- it’s called different things at different times. It involves using an imagination model; imagination, empathy and compassion, as well as the hard clinical skills which you need. That time has shaped my practice ever since. And I’ve published a little in the various journals, including a review of the textbook of Practical Ethics in General Practice. and a chapter in the Handbook of Primary Care Ethics by Andrew Papanikitas and John Spicer, which was published a couple of years ago. So it’s been an abiding interest of mine.
“The medical humanities give us different ways of seeing of patients and different ways of seeing the world, and good poems provide a kind of intensity of gaze as well, appeal to the emotions and the intellect.”
DMacA: And you clearly have an interest in the arts, because you were involved in an initiative on poems from general practice.
JG: Yes, “Tools of the Trade- Poems for Doctors.” It wasn’t my initiative to start with, but it happened when I was Chair of RCGP Scotland, and one of our colleagues in Hawick, a GP called Pat Manson, had this idea of using poetry in teaching humanities at both undergraduate and postgraduate level. One of his partners, Lesley Morrison, suggested after he died that, we could put together a poetry book for new doctors in Scotland. https://pmc.ncbi.nlm.nih.gov/articles/PMC3722811/ (To read more about this see: Richard Smith: A Book of Poems for medical Graduates)
Robyn Marsack and the Scottish Poetry Library were very supportive of the idea and, with the help of Chris Kenny, the Chief Executive, the MDDUS has funded the last 3 or 4 editions and Polygon press publish it. In the new edition we have poems in Scots, English, and a couple in Scottish Gaelic of course, we have poems translated from the famous Bengali poet and Nobel Prize winner Rabindranath Tagore provided by one of the editors Noy Basu a GP in Glasgow, and we’ve a poem by the partially sighted poet Nuala Watt who talks about engaging with the medical profession. Sam Tongue from the Scottish Poetry Library has been hugely helpful in making this happen. It’s a very hard initiative to assess what has this achieved- it’s very hard to measure that sort of thing but it is really popular with some graduates. But, as they say- not all that is measured is important. Not all that is important can be measured- but, there is no doubt, through anecdotes, that this has a significant effect on some people. The medical humanities give us different ways of seeing of patients and different ways of seeing the world, and good poems provide a kind of intensity of gaze as well, appeal to the emotions and the intellect. So, I think they can really enhance our understanding of our patients and the world our patients live in.
And, one of the things I’ve realized is that, in any career where you try to have leadership, there are no solo climbers. You always need people around you and people hauling you up. If you’re hauling people up, people are hauling you up. I think that’s a really, really important point.
DMacA: You’re still involved with a number of initiatives at the University of Edinburgh…
JG: The main one that I’m involved in is the Global Compassion Initiative, which is not just a medical initiative, it’s a broader initiative across a whole university and sits within the Global Health Academy led by Professor Liz Grant. Its an attempt to raise the profile of compassion and stress and how important it is in the lives of us as social animals. People think compassion is something soft and cuddly and so on. But compassion is recognising discomfort, pain, distress, suffering, all of which we see as GPs, but also in the wider world, and taking some sort of action to address them. And it doesn’t have to be a world changing action. Sometimes it just has to be an acknowledgment that people are in distress, or taking some simple action to help them. What I tend to say is that none of us would be here without the compassion of our parents, particularly our mothers, in getting us through the first part of our lives. So, we’ve had various initiatives. We had a really interesting evening at the Edinburgh Futures Institute, in March, which I chaired, on compassion, relationship based care, and artificial intelligence, because we are now in this new world of artificial intelligence, with Stewart Mercer who Professor of Primary Care Multimorbidity, , Liz Grant and Paquita de Zulueta, another well-known GP from London. And also Shannon Vallor , who is a philosopher with a longstanding interest in technology and its effect on human beings and the world. I don’t know if we came to any clear conclusions, but the general feeling was that the potential advantages of artificial intelligence also had to be weighed against some of the potential disadvantages. Artificial intelligence is not human and what we have to try and develop in these very difficult times we live in are better relationships between human beings, which include compassionate and respectful relationships.
“One of the reasons I’m still interested is because of the language and culture, which is my culture, my language, but also because it still has a remarkable sense of community.”
Visit the website: Comann Eachdraidh Uibhist a Tuath North Uist Historical Society.
DMacA: Finally, let me bring you back to the very beginning, because you’re still involved very closely with the community in North Uist. Tell me about your current links.
JG: I still have family there. My sister and her husband and my niece still live there. Indeed, I’m going up next week. I’m a trustee of an organization called Comann Eachdraidh Uibhist a Tuath North Uist Historical Society, which is involved not just with history. We’ve done a project recently on- what contributes to well-being in an island community- with a small grant from the British Science Association which comes originally from Wellcome. One of the reasons I’m still interested is because of the language and culture, which is my culture, my language, but also because it still has a remarkable sense of community. For people in these quite isolated places, life only works if you work as a community. The crofting communities work because they help one another at harvest time, at lambing and so on. And, one of the senses I have from my childhood is of that community, of being able to go into people’s houses without knocking, and things like that. That’s changed a bit but I think there’s still something to be learned from that, and I still find it very refreshing to go back there and also, it’s just such a beautiful place. The beaches are fantastic. You can get what they call – Sìde nan seachd siantan- seven sorts of weather in one day. That’s also refreshing in the very physical sense. So it’s still very important to me.
DMacA: You’ve talked about community and the island community. But of course, we have our own community within family medicine in which you’ve played a major part. We don’t often get the chance to thank those who have been a great inspiration so it’s a great pleasure for me to talk to you today because, what you don’t realise, is that you’ve been a terrific inspiration to me throughout your days in general practice and in the College. Thank you very much indeed.
For further information see:
https://www.researchgate.net/profile/John_Gillies4
Major initiatives and projects:
Home page of the Global Compassion Initiative, Global Health Academy
https://www.ed.ac.uk/global-health/compassion
Report on increasing undergraduate medical education in general practice in Scotland 2019
https://www.gov.scot/news/growing-the-next-generation-of-gps/
Tools of the Trade: poems for new doctors. Distributed gratis to all graduating docs in Scotland since 2014.
https://birlinn.co.uk/product/tools-of-the-trade-2/
Some key papers:
An Aristotelian philosophy of the GP consultations
https://pmc.ncbi.nlm.nih.gov/articles/PMC2560886/
A shorter more user friendly version!
https://pmc.ncbi.nlm.nih.gov/articles/PMC1570505/
Distilling the essence of general practice; a learning journey in progress
https://bjgp.org/content/59/562/e167
SSPC briefing paper: remote and rural general practice in Scotland: descriptors and challenges
