Ann McPherson was an outstanding GP, health communicator, champion of the NHS and patient advocate. She was able to do all this whilst at the same time being a devoted wife, mother and grandmother. She was modest, caring, humane, generous, had a very good sense of humour and an enormous capacity for friendship.
Ann was the only child of Max and Sadie Egelnick, secular British Jews, who became communists in response to the threat of fascism before the Second World War. Ann inherited from them a strong desire to fight injustice wherever she saw it and in the context of her medical career to do all that she could to improve the lot of patients. She retained left wing sympathies all her life.
Brought up in north London, she was educated at Copthall County Grammar School. She went to St George’s Hospital Medical School, where I first met her as a fellow medical student. She was an enormously attractive personality. She was well informed and confident in her views. She was very much at home in the conventional world of George’s, despite still being a member of the Communist Party at that time.
She graduated with distinction, top of her year, in 1968. Somewhat against the culture of George’s at that time, she decided to pursue a career in general practice. This led one of her professors to ask her why a bright student like her wanted to be a GP, but Ann knew what she was doing and where she would be able to do most to help patients. Her first house job was with Tom Pilkington [Munk’s Roll Vol.XII, web], from whom she learned evidence based medicine, always to listen to the patient and to have a healthy disregard for NHS administrators, advice that stood her in good stead over the years.
In 1968 Ann married the public health epidemiologist Klim McPherson. Professionally they had a shared interest in health matters and especially women’s health. In 1976 they moved to Oxford when Klim joined the department of community medicine. Ann completed her GP training, getting a distinction in the MRCGP examination. There were relatively few women in general practice at that time and it was difficult for them to get a partnership. We have to thank Ann and others like her for paving the way for women in general practice. In 1979 she joined the 19 Beaumont Street practice, where I was already a partner.
Ann became admired and respected by her consultant colleagues through her referrals. I cannot remember her ever getting an important diagnosis wrong. One story illustrating this is that of a woman who walked into her surgery with jaundice. Ann managed to pick up, in the confines of a 10 minute consultation, that the patient was very fond of broad beans and that she had been eating a lot of them after going to a ‘pick your own’. She suspected the patient had Glucose-6-phosphate dehydrogenase deficiency. The initially sceptical admitting registrar later had to ring back to say she was right. That case led to her attending the grand rounds at the John Radcliffe Hospital, where she delighted in putting the patient and GP point of view.
She was an excellent GP. She had everything – she was warm and open, she was a brilliant diagnostician, a great communicator and she was the patient’s friend and advocate. She was generous with her time. Patients never felt that they were rushed. She worked incredibly hard on their behalf. She was always picking up the phone to ring consultants or administrators if she felt one of her patients was not getting the care they needed. She did not mind patients ringing her at home and made sure they had her home phone number. She made follow up phone calls and visits to patients in the evening and at the weekend even when she was not on call. She never minded doing an extra surgery if we were short of appointments.
In addition to working almost full-time as a fully committed GP, Ann worked tirelessly to break down barriers between doctors and patients, and to explain illness to patients in simple everyday terms. She did this brilliantly through her books, articles and broadcasting.
She was a prolific medical writer, writing more than 30 books. With Aidan Macfarlane she wrote Mum – I feel funny!: a family guide to common ailments (London, Chatto & Windus, 1982), which answered children’s questions about health and illness. This led to The diary of a teenage health freak (Oxford, Oxford University Press, 1987), which used humour to answer in a matter of fact way those embarrassing medical questions that trouble teenagers. It topped W H Smith’s teenage book list, sold more than one million copies, was translated into 25 languages and was made into a television series. Other books for teenagers followed. Later they launched Teenage Health Freak (www.teenagehealthfreak.org), which provides an online question and answer service.
Ann did more than any other GP I can think of to improve women’s health care. Her book Women’s health (edited with Deborah Waller, Oxford, Oxford University Press) became the standard GP text on the subject.
Ann’s passion for good care under the NHS is illustrated by her reaction to a dirty ward when she went in for her own breast cancer surgery. There was no bed for her, so she was asked to wait in the patients’ room, which was filthy, as were the toilets. Most of us would have been too wrapped up in our own impending surgery to do anything, but Ann got out her camera and started to take photographs. She then marched up to the chief executive’s office, which she noted was clean, carpeted and had flowers on the table. The chief executive was not there (I suspect he may have been hiding), so she marched his deputy down to the ward so he could see for himself. Ann never minded ruffling a few feathers if that is what it took. I am pleased to say the cleanliness of the John Radcliffe has improved since then.
Ann’s diagnosis with breast cancer 16 years ago and Andrew Herxheimer’s replacement knee operation made them realise that, although as doctors they knew a great deal about their medical problems, they still had many questions they could not answer. This led them to set up DIPEx – Database of Individual Patient Experience, a charity, which became Healthtalkonline (www.healthtalkonline.org) and Youthhealthtalk (www.youthhealthtalk.org). Patients and relatives were interviewed and video-recorded about their experience of disease, these videos being put on the website so that patients, health professionals and others can inform themselves about the various diseases. It has become a great success, with 60 diseases covered. Ann became adept at raising money, but she always refused drug company sponsorship. She also managed to persuade celebrities to introduce sites – it was difficult to say no to Ann.
When my daughter Alice, aged 18, developed a lump in her leg, Ann was the first person we turned to. She agreed the lump was worrying and helped us to plan what to do next. A few days later I rang Ann from the hospital with the bad news that Alice had a rhabdomyosarcoma. Ann was at work but she dropped everything to come to the hospital to support us. That was the sort of thing she did, nothing was too much trouble.
Ann supported us throughout Alice’s illness. She was an especially good friend to Alice. She used to take her out to afternoon tea (Ann was a great believer in treats), where they would chat about everything, but also about the grim reality of cancer treatment and prognosis. Alice loved those meetings.
Out of those conversations came the germ of the idea for Youthhealthtalk’s teenage cancer pages. That was typical of Ann, she could always see the bigger picture. She was always looking for ways of turning personal experience into something that would help patients in general, help them to understand and learn to live with their illnesses. And she had the drive and determination to see it through.
Looking at the section on teenage cancer on Youthhealthtalk the other day, I was again struck by how brilliant it is, how good it is in dealing in a matter of fact way with the realities of a young person with cancer.
Four years ago, Ann developed a second cancer, pancreatic cancer. Although her clinical acumen led to early diagnosis, and in spite of a Whipple’s operation, the cancer recurred two years ago. Ann retired from general practice but continued to work more or less full-time almost to the very end.
In the light of her terminal illness, Ann campaigned for a change in the law on assisted dying. She wrote an article in the British Medical Journal in July 2009 (Brit.med.J., 2009 339 2827), in which she said made the case for patients to be able to choose assisted death, which she saw as a logical extension of good palliative care. This led her to help establish Healthcare Professionals for Assisted Dying (HPAD). She knew that it was too late to change the law for herself, but as always she selflessly campaigned on the behalf of others.
In spite of excellent palliative care from her GP and Sobell House, Ann had a very difficult last month. There is no doubt she would have chosen an assisted death, had the law allowed it.
Shortly before she died she was awarded the BMJ group’s communicator of the year award. One cannot think of a more appropriate recipient.
She leaves a legacy of work that will benefit patients for the foreseeable future. She has left the DIPEx and Teenage Health Freak websites in good hands, along with the idea of the proposed Oxford Health Experiences Institute. She was survived by her husband Klim, her children (Sam, Tess and Beth) and five grandchildren (Josie, Sonny, Saskia, Lissie and Alma). Another grandchild, Theo, was born after her death.
Neil MacLennan
[The Guardian 30 May 2011; The Daily Telegraph 1 June 2011; The Times 1 June 2011; The Independent 10 June 2011; Brit.med.J., 2011 342 3424]