Margaret Roberts is the 2015 recipient of the British Geriatrics Society’s Marjory Warren Lifetime Achievement Award.
In this blog Ed Gillett, Communications Manager at the BGS, meets Margaret to discuss her career, the Society and her views on geriatric medicine.
Margaret Roberts’ career spans over 40 years as a doctor in the NHS: from 1980 until her retirement in 2014, she worked as as a Consultant Physician in Geriatric Medicine, latterly with a special interest in Stroke Medicine, based at the Victoria Infirmary in Glasgow. She’s also been an active contributor to the British Geriatrics Society at local and national levels throughout her career.
In the citation for her award nomination, submitted by BGS Scotland, Margaret’s energy, skills and enthusiasm are described as “essential to the medical advisory structure, NHS medical management, clinical effectiveness and governance, to medical education and to many professional bodies”.
Margaret’s career might present something of a paradox, then: although she’s worked within a single hospital for the entirety of her career, her influence has been felt across an uncommonly broad cross-section of services.
I ask Margaret what first prompted her interest in geriatric medicine. As many colleagues might recognise from their own experiences, it’s a personal connection which started everything off:
“When I first started my rotation, I was very keen to focus on Stroke medicine, but it didn’t quite work out that way. As an undergraduate in Birmingham I was impressed by the teaching in the Geriatric Medicine module, led by Dr Ronald Cape: when I moved to Glasgow, I carried on with the speciality. I was privileged to meet or work with people like Professor Ferguson Anderson, Francis Caird, John Dall, Bernard Isaacs and others, at a time of expansion and development in both the service and academic areas of the speciality. I was eventually able to focus on stroke medicine within that”
The evolution of geriatric medicine is a topic on which Margaret is well-versed. I ask her what’s changed most within the specialty over the course of her career, and she points to the increased focus on geriatricians working with and influencing other specialities, a spin-off of which has been less ageism, and more openness to medical intervention relevant to individual need.
I mention the increased focus on care which is patient-centred rather than shaped by institutional structures, and she politely corrects me:
“I’m not sure that’s quite right, to be honest; throughout my career, geriatricians have always been incredibly good at focusing on patients’ needs, and shaping their work around that. I think what’s changed is the stature of the specialty, and our ability to draw in other colleagues to work together to solve complex problems.”
One of the things which stands out from Margaret’s career is the number of new services she’s been involved in setting up at the Victoria Infirmary: a geriatric orthopaedic rehabilitation service in 1984, a stroke rehabilitation unit in 1993 and an acute stroke service in 1995, an integrated acute receiving service in 1997, run alongside General Medicine, a nurse-led rehabilitation unit in 2007, and in her role as Associate Medical Director influencing change in other services throughout the area. Are there any overarching lessons to take from developing such a broad range of services?
“I think the most important thing is the team around you. I’ve been very lucky to work in an environment where people are willing to try new approaches: obviously you need to have a clear plan in place, but having an environment where change is embraced is the most important thing. There will always be tricky things to work around, but as long as people understand what you’re aiming to achieve, and how to get there, I think that’s what makes it work”
I ask which of the services has been the greatest success, and she points to the integrated acute receiving service.
“We made sure that any frail older person included in the acute take was assigned to a specific geriatrician, who oversaw care throughout their stay. This targeted approach meant we could develop care pathways specific to their needs, interfacing with community services allowed us to turn patients around quickly and get them home providing more appropriate care outside the hospital; in others, where hospital admission was appropriate, we could take a holistic view of their needs, plan for longer term care and ensure rehabilitation was addressed. No service is perfect, though, and we’ve done a lot of work since to evolve the model gradually.”
That personal connection between a doctor and their patients is a key theme. When I ask Margaret what one change she’d make to geriatric medicine or to the NHS in general, she doesn’t opt for the obvious answers around funding or workforce planning, but hones in on the provision of care itself.
“I think the biggest change would be if we could ensure that every single patient, everywhere in the health service, was treated with dignity. It’s such a huge part of how people experience their care, and it has a massive impact on how we work together as professionals. If we could embed that sense of dignity across the health service, I think the changes resulting from that would be profound”
This approach serves to tie together the two apparently contradictory aspects of Margaret’s career, and underlines why her work has been so highly celebrated. Her work shows us that fostering excellence, whether that’s within a single hospital, a specific service, or even in one’s interactions with a single patient, has far-reaching ramifications, and can catalyse truly powerful change, both for patients and the staff who care for them.