Lives of the fellows

David John Dickson

b.15 May 1943 d.20 October 2017
MB ChB St And(1969) DObst RCOG(1971) DA(1972) MRCP UK(1977) MRCGP(1979) FRCP Glasg(1990) FRCP(1999)

John Dickson’s influence on medical practice went far beyond the boundaries of the North Yorkshire market town where he first worked as a general practitioner. As co-founder and leader for many years of the Primary Care Rheumatology Society, John put his clinical skills, drive and leadership at the service of patients with common, disabling and neglected musculoskeletal diseases. With his unbridled capacity to embrace new ideas that might improve the lives of these patients, he was the most respected teacher of primary care rheumatology of his generation.

John was born at home on 15 May 1943 in Guisborough, when the last wartime bomb was being dropped on nearby Middlesbrough. He was the second of four children. His father, David Clark Dickson, was a surgeon born in Lochgelly in Fife and his mother, Betty Dickson née Wood, came from a Sheffield steel-making family. He was educated at Terrington and Durham schools, but his teenage years were not easy. His mother, father and a younger brother all died before he went to university, disrupting his education and placing a great deal of family responsibility on his young shoulders. As a result, he did not leave school until he was 20.

He studied medicine at St Andrews University and qualified in 1969. His first jobs were in Sedgefield, County Durham and Dundee, followed by posts in obstetrics in Plymouth and anaesthetics in York. He was awarded an American Heart Association scholarship in 1972 for one year in Youngstown, Ohio, which he enjoyed but was too homesick to stay permanently in the United States. He worked as a medical registrar in York before joining a semi-rural general practice in Northallerton in 1976. His interest in rheumatology and musculoskeletal medicine grew as he realised how great a part of a GP’s workload they formed.

In 1986, he co-founded the Primary Care Rheumatology Society with the aim of encouraging and educating doctors and other healthcare professionals in musculoskeletal medicine and associated research. Through the Society, John nurtured a generation of GPs with special interests in musculoskeletal medicine. After 20 years in general practice, John retired to give more time to musculoskeletal medicine. He helped set up primary care clinics in the Teesside area with small teams of physiotherapists, a podiatrist and pain nurse. This was an early beacon of the sort of multidisciplinary service that has since spread widely across the NHS.

John led the Primary Care Rheumatology Society to develop an early distance-learning course (‘Joint ability’), and then to a collaboration with the University of Bath that produced the diploma in primary care rheumatology. Between 1998 and 2008 this was the academic qualification for aspiring musculoskeletal clinicians, many of whom went on to lead the delivery of these services in their local community. He co-authored two books with a Glasgow GP, Gillian Hosie, (Managing osteoarthritis in primary care Oxford, Blackwell Science, 2000 and Osteoarthritis: your questions answered Edinburgh, Churchill Livingstone, 2003) and a third with an academic rheumatologist, Gabriel Panayi (Churchill’s in clinical practice series: arthritis, 1e Churchill Livingstone, 2004). He was a member of the Arthritis Research Campaign’s education sub-committee and GP editor for their publications In Practice and Hands On from 2002 to 2006.

Early relations with other professional organisations such as the Royal College of General Practitioners were not always smooth, but John’s 2013 certificate of commendation showed the high regard in which he was eventually held by the College. He was always ready to challenge established dogma, often persuading secondary care colleagues, quite bluntly, that they needed to understand primary care in order to do their jobs properly. As a result, many professors and society presidents benefitted from wise advice given Yorkshire-style, even if they hadn’t asked for it and always followed with John’s twinkle-eyed observation ‘not bad for a GP?’

John’s foresight and knack for encouraging and facilitating others influenced the growth of primary care musculoskeletal research in the UK. He helped the Society forge productive collaborations with academic research units in London, Manchester and elsewhere. He encouraged and persuaded Primary Care Rheumatology Society members to take part in time-consuming studies that delivered seminal published research on the course of common musculoskeletal conditions, such as shoulder pain, in primary care. He sought other opportunities to lead primary care research engagement in the new era of evidence-based medicine, notably national guideline development and trials of new physiotherapy treatments. He was involved in many trials, the last one being HERO (Hydroxychloroquine Effectiveness in Reducing symptoms of hand Osteoarthritis). He was an adviser for the North of England Back Pain Pathway Development Group (recently approved by NICE), and clinical adviser and GP clinical lead for NICE osteoarthritis management guidelines from 2006 to 2008.

Behind these achievements was a man with enthusiasm, drive and personal charm who ensured things got done and a doctor who treated each patient as an individual. As a teacher, friend and mentor, he recognised and nurtured other people’s talents and was always keen to pass on his knowledge and enthusiasm. He was an enthusiast in his personal life too. At Durham, he set a new school record for the two-mile cross-country race, which has never been broken. He played rugby at Durham School and St Andrews, and later focused his interests on shooting and the countryside. He was a school governor in Northallerton for many years. He travelled widely to places such as Chile and China, especially enjoying safaris in South Africa with friends. After the loss of close family members when young, his own family was always important to him – his wife, Christine (née Thompson), and his son Alastair and daughter Gail and their families. His biggest regret was not living long enough to see his two grandchildren grow up.

An award and medal were set up in John’s name to be given annually for the person who has contributed the most towards the Primary Care Rheumatology Society’s aims. John was able to nominate the first recipient, a physiotherapist. The presentation was made by Christine and Alastair at the Society’s annual conference the week after his death.

Christine Dickson
Alastair Dickson
Peter Croft
Peter Lanyon

[BMJ 2018 360 1304 www.bmj.com/content/360/bmj.k1304 – accessed 21 April 2018]

(Volume XII, page web)

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