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Interview
64 Margaret McKiddie
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Consultant with a Special Interest in DiabetesBorn in Kirriemuir, Angus in 1939.
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Overview:
Dr. Margaret McKiddie worked in Glasgow and Dundee before becoming a consultant at Gloucestershire Royal Hospital in 1973. The hospital was too small to employ someone specialising solely in diabetes, but all patients with diabetes were referred to her and her official title was Consultant Physician with a Special Interest in Diabetes. She had to teach everything to the newly-diagnosed herself until a specialist diabetic nurse was appointed in 1989, who made a `huge amazing difference` to her working life. She retired in 1998 and in 2002 she became the British National Endurance Riding Champion.
Please note that Overview relates to date of recording Wednesday, May 16, 2007
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1 She enjoyed her whole career, but gained most satisfaction from looking after pregnant women with diabetes, because 'that was a sort of challenging situation'. [ 63 secs ] |  | 2 She dislikes the dominance of management and government targets in today’s health service. When she arrived in Gloucester in 1973, the hospital was split between two sites and there were only two managers – one for each site. So how did they manage? [ 53 secs ] | |
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| 01 Father encouraged Medicine. Aged 17, went to Queen’s College, Dundee, part of St. Andrew’s University. Diabetes in final firm – stayed on as house officer. Heard Philip Randle lecture on fatty acids. | |
| | 02 Qualified 1962. House jobs, Dundee. Paediatrics, Manchester. Scholarship for 6 months obstetrics. 1964 - SHO in diabetes, Glasgow. Big clinic. Astute consultant – Alec Imrie… | |
| 03 …I learnt from him. Helped registrar Keith Buchanan with insulin assay. He was promoted. I became registrar until 1969.
Clinic patients saw same doctor - friends. Imrie diagnosed instinctively. Now unnecessary tests. | |
| | 04 Clinic had types 1 and 2. No specialist nurse. Chiropodist. 3 insulin strengths caused mistakes. Urine testing – Clinitest. Type 2s – Metformin & Chlorpropamide – caused hypos. Blood test results after patient left. | |
| | 05 1960s research – paper to BDA – oral glucose tolerance tests on 200 people. Presented more papers – small BDA meetings more fun than now. Helped career. | |
| | 06 Research facilitated by access to patients & university & no restriction on hours. Keith did other work for MD – let me use insulin assay for my MD. Helped get consultant’s job. | |
| 07 Junior doctor had own patients - satisfying.
1969 – back to Dundee as Senior Registrar. General medicine, but special interest in diabetes. No diabetic nurse. Chiropodist. Not huge clinics – GPs did more follow-up. | |
| 08 Still talked re carbohydrate portions. Didn’t realise fat harmful.
Hard to get consultant’s job – discrimination against women. Got Gloucester job – experience in big diabetic clinics. | |
| | 09 Before 1973, clinical pathologist ran clinic. After I came, 3 of us - general medicine. I did partly diabetes. Hospital on 2 sites at first. Girl given bicarb for diabetic ketosis nearly died. | |
| | 10 30% of my ward patients diabetic. ITU when new hospital opened. As got more consultants, I specialised more in diabetes. I educated diabetics on wards – no specialist nurse until 1989. Enjoyed care of pregnant diabetics. | |
| | 11 Changes for pregnant diabetics 1973-98: need for tight control. Self-testing of blood sugar & HbA1 helped. Teenagers motivated. | |
| | 12 Urine test results falsified. HbA1c revealed truth! How much to warn re complications? On diabetic holiday, one boy thought he’d die early. | |
| | 13 Was no retinopathy treatment. I did clinic in eye department. Renal dialysis not offered to diabetics at first. Less coronary artery disease - less fat in diet. Less vascular disease in legs. No major advance re neuropathy. | |
| 14 At first, just SHO & I did clinic. Then GP assistants. More GPs started own clinics. Diabetic specialist nurse from 1989 – life-changing.
Nurses now more like doctors. Need basic skills. | |
| | 15 NHS changes – more managers, more targets. 100 % bed occupancy leaves no time to clean. At first only 2 managers, now lots. 1993 meeting re mission statement. | |
| 16 Medicine now less instinctive, more tests. Patients are numbers, targets. I enjoyed relationships. Doctors too rushed now.
Got proper diabetic clinic in early 90s. | |
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