February 2017 | Issue 28
Helen Smith: championing family medicine

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By Nicole Lim, Assistant Director, Communications & External Relations

“Medicine is not a nice career for a lady.” This piece of advice from her school career counsellor made the then teenage Helen Smith more determined than ever to turn her love of biology and problem solving into a career in medicine.

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Introducing LKCMedicine's first Professor of Family Medicine & Primary Care

Some four decades on, LKCMedicine’s first Professor of Family Medicine & Primary Care has shaped her career in medicine taking on challenges others would have walked away from.

Reflecting on this, Prof Smith said, “I thrive on change and I like developing new initiatives”, both of which became hallmarks of her professional career.

Having grown up in England’s Midlands, Prof Smith enrolled at the University of Nottingham’s newly opened medical school as a student in its sixth cohort.

“We were a relatively small year, did a lot of our learning in groups of eight and had fantastic opportunities on the wards because there were not that many students but a lot of patients. When you meet patients, you really start to learn,” said Prof Smith, who sees many things she valued at Nottingham here at LKCMedicine such as the systems-based teaching blocks.

As part of her medical undergraduate studies she had the opportunity to do an intercalated degree, for which she chose to focus on Community Medicine, and completed her studies in 1981. Knowing that her interest did not lie in a specific disease, Prof Smith decided to pursue a medical career that focused on the person. She considered specialising in healthcare of the elderly, but romance intervened and set her on a different path.

Prof Smith said, “I found out that had I pursued healthcare in the elderly, I would have been posted to a job in the north of England while my husband worked in Oxford, and that didn’t seem a particularly good start to our marriage.”

Sticking with her desire for a more holistic specialty, she trained in public health medicine. After a whirlwind of postings that covered five different regions in the UK (including a spell studying and lecturing at the London School of Hygiene and Tropical Medicine), her husband’s work took the young family of four to Canada. A respiratory physician, he was studying the asthma that cedar workers developed from working in the saw mills.

Whilst based in Vancouver, Prof Smith worked at the University of British Columbia’s Centre for Health Services & Policy Research, undertaking a study of inappropriate paediatric hospital admissions, work which would later form the basis of her doctorate degree.

After two years in Canada, the family (now with three children) returned to the UK, where she accepted the position of director of public health in Burton-upon-Trent, a deprived area in the Midlands. While the position was a great challenge for Prof Smith, she realised that it would not leave her with time to continue seeing patients, something she had done throughout her career.

“So I did something that people advised me not to do, which was to go and train in general practice. This allowed me to combine the epidemiology and management skills I acquired in public health with clinical work and academia. So it was a good move for me, but it was unconventional,” said Prof Smith.

Having previously completed a wide variety of clinical postings, she was able to complete her second specialisation with a ‘top-up’ training year. With this, Prof Smith, who sees herself as a generalist in her personal and professional interests, found a perfect fit.

“As a general practitioner, you have the potential to help people in a variety of ways, and sometimes that’s not with heroics or diagnostic acumen, but rather by being the patient’s advocate,” said Prof Smith.

For example, it may be writing to the housing board to get people rehoused rather than continuing to prescribe medication for the distress caused by noisy neighbours. “Family medicine is about problem resolution in partnership with the patient, be that problem a benign self-limiting disease or multiple chronic disorders,” said Prof Smith.

With her dual accreditation in hand and a fourth child, the family of six found themselves in Southampton, where both Prof Smith and her husband were appointed by the university. Prof Smith spent 50 per cent of her time at the university and 50 per cent of her time in clinical practice.

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“As a general practitioner, you have the potential to help people in a variety of ways, and sometimes that’s not with heroics or diagnostic acumen, but rather by being the patient’s advocate,” - Prof Smith.

As well as establishing links between the faculty of medicine and other faculties at the university, Prof Smith’s main task was to establish a primary care research network that would stimulate practitioners’ interest in research, increase their research skills, disseminate research and encourage an evidence-based approach to practice, something that had not been done before in the UK.

“It was enormously exciting and I was very lucky in that a handful of GPs, who were already doing their own research, came on board to help launch the network,” said Prof Smith.

The network, which involved GPs, practice nurses and managers, grew to number more than 300 practices and the research it generated on nurse triage services was eventually used as the basis for a national service called NHS Direct, a nurse-led medical helpline set up in 1998.

Initially, the network projects were small and often descriptive studies, arising from questions encountered by its members in their clinical practice. For example, what was discussed between a practice nurse and a patient during blood taking or could venepuncture be delegated to a non-clinician, or how did GPs out-of-hours care responsibilities affect them?

“The latter study was a simple one-page questionnaire, but the GPs wrote all over the questionnaire, including the margins, telling us about how difficult it could be,” said Prof Smith of the study that led to a major change in out-of-hours care across the UK.

As the skills and confidence of the network members grew, they began to design robust, large-scale trials. One study examined whether elderly patients should be given a Vitamin D injection to reduce the risk of fractures when they come for their winter flu jab.

“Most of us expected that the injection would benefit patients, but the evidence showed otherwise, emphasising the need for research in primary care, if we are to provide a high-quality clinical service,” said Prof Smith.

After more than a decade at Southampton, Prof Smith was ready for a new challenge. A new medical school was being set up and she applied. “There were five of us appointed in 2003 to develop the Brighton & Sussex Medical School,” said Prof Smith.

With very wide responsibilities, Prof Smith set up the Division of Primary Care & Public Health, established a student support system, recruited more than 100 general practices to teach and once again developed a research network in primary care. In parallel, Prof Smith was appointed as the British Royal College of General Practitioners’ Clinical Champion for Allergy.

The most memorable moment from her time at Brighton, though, was seeing the inaugural cohort graduate. “I felt very proud and confident of future healthcare seeing them walk across the stage at the graduation ceremony,” said Prof Smith, in whose heart that group of students would always hold a special place.

The 10-year anniversary of the medical school also holds special significance for her. She organised the over-sized celebratory extravaganza (OSCE), where old and current students, faculty and staff participated in a series of fun ‘examination’ stations; for example, the microbiology examination was identifying microbes knitted by the medical school’s needle-worker-in-residence and student support coordinator; the ENT station was wine tasting.

After more than a decade in Brighton, it was a chance remark to a headhunter who had approached her with a UK-based position that brought Prof Smith to Singapore’s youngest medical school in 2016.
As the School’s first Professor of Family Medicine & Primary Care, Prof Smith is co-leading a new Centre for Primary Health Care Research & Innovation with the National Healthcare Group Polyclinics CEO Associate Professor Chong Phui-Nah, and will create a network of GPs to drive evidence generation in primary care as well as widen access to existing evidence.

She’s also working very closely with the College of Family Physicians on a number of academic initiatives, including academic writing workshops and mentorship. Her personal research will focus on asthma and atopic disorders and evaluation of innovative approaches to patient care, including psychological  interventions.