We're continuing from with the regional position, yes, so John Bell had established this actually excellent and specialist clinic,
which was superb for managing difficult lupus, scleroderma, peggies to see the best heart patients in Boston living and involved in that, John Lennon.
And by that stage would have retired. But he did. He started it was his clinic.
Yeah, that's what I was thinking. So I knew him. Peggy, pigheaded lupus work.
That's right. I used to work in his clinic as well. That's quite right.
So did he have a sort of skin clinic? Well, it was lupus patients.
Yes. Right. OK, but but I used to once I started officially there, John Berman set it up as an official multidisciplinary clinic.
Then I would bring across the lupus patients from the dermatology part.
The difficult ones would go to that clinic.
So while I was in St. Mandaville, I was still doing that clinic that the lupus visual system basically systemic,
the destroyed ones with systemic problems, the simple, straightforward descriptions one would leave in the dermatology.
Yes, but these patients do it on a systemic disease.
Yes. Right. Because that had been your experience. They said, yes, I tried.
I sort of forgot my career. Oh, yes. So that had continued all the way through.
And I was John Ballerini who got that guy officially. So that was a great length to continue when I was in state Mandela.
So when I came back to Oxford, that clinic obviously continued and I was doing a set up.
I'd set up a big tumour clinic in Stoke Mandeville where I,
I divided up the clinic so that instead of seeing a mix of patients, all the tumour patients were coming through on one day.
It was a much more efficient way of running it. So you could see with I had a registrar between us, we'd see three patients every 15 minutes.
So you would Ratliff's through screening and deciding who needed surgery, who didn't need surgery.
So when I came back to Oxford, I ensured that we had a tumour service established in Oxford for screening patients.
But it just does mean that your general clinics, you don't have any life relief.
You have patients who need a lot more time. So I was then dividing my service more and more into medical and tumour.
And so I set up a psoriasis clinic in Oxford.
Yes. Which I think was really important because you don't need a lot of time with chronic disease needs.
A lot of times these sorts of patients that are coming through to a hospital to secondary care are usually complex,
is and has raised has really changed hugely.
It's amazing. So what do you do for you given biologics, you switch to biologics?
Well, TANF and yes, yes, it's fantastic.
And that new ones coming out all the time. So people who have taken over from me have got more drugs than I had when I retired from the government.
And they were going to really work well, they do really well, but psoriasis finds a way around it.
So they will work for a time. They work in rheumatoid arthritis as well.
But I think the arthritis patients, they don't seem to get the breakthrough. Sorry. I'm sorry.
I first to help. Yes. So the management has changed enormously.
And what's very interesting is the way the patients cope.
So you may have somebody who's had chronic psoriasis,
plaque psoriasis for years and sort of coped and we've got quality of life indexes and you get them to fit it in.
And to your surprise, they say, well, you know, I'm alright, I'm coming.
I've got used to it. And yes, I get on with it. Then you can have psoriasis.
And if it starts to come back even a small bit, they can't cope at all.
It's so sudden I discovered what life's like without it. Yes. So yes, it's fantastic.
If you think back to what I was doing with Tarrant's when I started in dermatology, we were giving patients time to use it.
Yeah, it's hardly surprising people didn't use this stuff as often different from vitamin D.
Yes, yes. Yes. In what way? Well, well, the ultraviolet light that well it's Chess's where the T cells.
So I mean a local immunosuppressant has big effects on the skin.
Yes. And it does that separate from generating vitamin D in the skin.
Yes. Yes. They have many different effects as psoriasis, a terrible disease.
I was used to what we used to bring people in and we used to tell them they had to stay in until the psoriasis was cleared.
And if they didn't, it was their fault if it came back. But I never, you know, said that that was what they were told if they wanted to go higher.
And they were strongly discouraged when I started in dermatology, that's yes.
It's your responsibility to come in and stay and three weeks or more.
What was the success rate that was. That was different.
All right, sunlight and what is it?
Did you hear them? I did, cos they could people come in now for three or four weeks, my bad.
Well, they used to come into the sleigh. This is wonderful because. Tell me about that.
I mean, how many birds were there? Must've been I suppose it must've been about ten, something like that.
Was that in the dermatology invasion? Yes, yes. Yes.
And we had specialist nurses. We had ultraviolet light there and we had lovely grounds.
And that's, of course, where she was based. So we'd come and do our outpatient clinics in the John Atlas.
And I go back to the slide, you know, when the slide started.
But the end I wanted to finish Terenzio to be able to tell.
Yes, I said yes. So what is it finished in your time?
And yes, the new unit was built and opened when I was at State Medical.
Yes. Yes. Because the new parents are wonderful. Yes. Terence and Rodney raised fine and I raised the money for that.
And then I sat in the hospital, put in some money as well. But a lot of that was raised by that very personal unit.
Very, very good. So when did you get into structured teaching, as it were?
I mean, you've had this experience to do and then you said when you were teaching was.
Yes, I always loved teaching. That was one of the tools to get me back to also because I really miss not getting medical students instead of actually.
Yes. So I came back to Oxford and got thoroughly involved in medical student teaching.
Did you have the brief to do that or did you just get involved?
No, it's just something we all talked about this because I was particularly keen on teaching and I must have done well.
I don't think I have done any courses or anything. And then the interesting thing about coming back to Oxford was that I was no longer my own boss.
I had three other colleagues and something colleagues say, you can't say you're going to do this.
You've got to negotiate everything, which is fine. We all got on, but it's just not as quite as quickly.
It was a big hospital. You can't change things quickly. So I came back, for example.
It was nice. I know. Disease index. I've got a set up instatement.
Well, I've got my own disease index, so I could actually sort out what I was seeing every year, how many patients I've seen.
I could pull information. There was nothing in Oxford University and a computer that yes, there was no nothing.
Chris Bunch had set up something and each department I think was doing their own thing and there was no coherent possible policy.
And and I found it. If you knew you couldn't actually evaluate what you were doing, extraordinary things.
I found it extremely frustrating, but that's the way it was.
And then sometime into the second year, I suppose it must have been this letter came round to everybody.
They were looking for a new director of clinical studies. And that's when things.
So you volunteered? Yes. Yes. Well, I volunteered.
Yes. I wrote say I was interested to a position that wasn't in the competition.
I think they interviewed a number of people. The interview was extremely informal.
I have no idea how it was really working. It was all Davit. Well, yes.
And a cup of coffee. And how much would it cost him before I hadn't come across him as a student because he arrived.
Yeah. After I left and I knew him,
um I better when I've been doing my research because there was a time I looked at while I had applied for a welcome fellowship and didn't get it.
So David was involved with that. I didn't know because I was running.
It was John Bell. Right. There were those David is there's probably a pair of them because John was very much involved, I suspect.
And tell me about the indirect evidence that as well,
I hadn't realised quite what a challenge it is going to be because the quality assurance, secure assurance,
certainty were coming in to look at Oxford and Oxford really hadn't engaged with
what the other medical schools had done is that had Salford and Cambridge.
I think to some extent I thought that they would probably not participate in this process at all
and then realised I probably had to participate in it and this was going to be a big mistake.
So I only had eighteen months to get the place turned around, fit for purpose place as viewed by an outsider who is doing the quality assessment.
The James, you know, know the GFC had come in separately,
the Q&A where the great and the good from other medical schools basically come the correlates with, you know, positive health.
I mean, who is running the key? I don't know who runs the cure.
It is I suppose it's I don't know if you can look at it, but the people on the teams are.
Individuals from other medical schools were trained up as inspectors and they all dermatologists, so none of this is medical schools.
This is this is the whole. So you would have a team of eight people coming in, inspecting the school and staying for five days.
And there was a room. In fact, it's the committee room only the first on the academic corridor that was filled with files of information.
And they needed to look at the curriculum. They need to look at how things were taught, how things were assessed,
how we support students, what resources we propose, but nothing, even a curriculum.
The good stuff. So that was the problem and I had no idea, I said I'd become director to see what it was.
Nineteen ninety something. Well, look it up. Yeah, I think it was 1998.
I started in 1999 and the QCA were coming in in May 2002.
Yorkhill consultant Cordy's heads together. I did.
I told them I'd put them on the bus going on and on the ringroad while the inspection team was here.
They wouldn't play. We could bring about change because actually the inspection team were coming in.
So yes, people realised that actually they were going to have to do something. And was that beneficial?
I think it was, yes. I think Oxford it was a very good medical school, but it had drifted a bit.
And there were there was feedback, I think, from the medical students who were less than happy with the quality of teaching they were getting.
And David, I think, recognised that there were there were problems and things needed changing.
The GMC had been in and Oxford wasn't actually measuring up to what they expected,
although there was a tension between what the GMC wanted and the type of education Oxford provides.
And I think the GMC had moved moved away from the views I had then,
because the GMC at that stage were very much pushing integration and clinical clinical being introduced early.
Yes. Separation between the two parties, special study modules so that students would have opportunities to pursue humanities,
do other things like Oxford had not moved at all.
And so there was quite a lot of moving needed. But we still retained what we believed was the best in Oxford and were able to justify what we did.
And we don't have anything to do with the surgeons. Or was it just the research?
No, no, no, no. Saho Medicare for those of us. Yes, it was that because the physicians are good, as we all know, that was challenging.
I was challenging. I have some interesting discussions with the surgeons.
Yes, but but I've learnt, you know, the right things to do because it was hugely difficult.
It's hugely difficult. I actually had to ring Peter Morris in Australia because stuff wasn't being delivered.
He was at a conference in Australia and I explained that the tape was coming in and whatever it was a month or two months,
and I still hadn't had the information back from the surgeons. And please, could you do something about it?
Which he did. And then the hands appeared.
The stuff that Quicknet, which is a good thing, she's she's very good, but has his clinical lecturer at that stage wasn't delivering anything.
Right. So there were challenges, but we got there and people pulled together.
It was amazing. And we got a curriculum. There was a curriculum committee, you know, which have been running for years under Graham Evans.
Oh, yes, there were all these papers and they had not made any decisions about anything.
And in fact, the feeling was that if things were written down, the medical students wouldn't learn anything else.
I mean, I'm sure I would want to know unless they just kept me away from it.
But I'm not sure that ever had anything to do with agreement.
When this committee wanted to have the way I was pulled out, these other papers, what I was trying to sort out what this committee had achieved.
Well, that's another story. But there was a strong feeling that nothing should be prescribed.
The medical student should find that way and they will be OK if they were pretty much I.
It's OK. And that's another thing. I misremembered then.
But their assessments were not a huge problem. The exams are completely idiosyncratic.
The exams in year five, which is when they're doing that, various specialities, like everybody was doing slightly different things on the fire exams.
If you pull them off, it's dysphonia medicine.
Saiva exams, heavy emphasis on tropical medicine, predictable questions challenge your space of the curriculum, not exam at all.
There was no blueprint of questions, nothing else.
The amazing discourse emerged within the exams to the finals.
You know, it wasn't just that, but the people who were sat in exams were not necessarily teaching.
That was the other thing. So, you know, they were just examining the things that they thought were important to the.