A tribute to Dame Margaret Turner-Warwick, former president of the Royal College of Physicians, who died peacefully on Monday 21 August 2017 following several weeks of exemplary care in the Brompton Hospital, where she had practised as a physician for most of her brilliant career.
It is a well known fact that Dame Margaret Turner-Warwick was the first woman president of the Royal College of Physicians, but it would be a travesty if history records that fact above all others. She herself said ‘I had no wish to be any kind of feminist pioneer or curiosity. That would have got in the way, gender has no place in medicine.’
Margaret was a reforming president, a challenging president, and a collaborative president. She was an energetic and engaging presence - improving patient care was a driving force and a touchstone against which medical, professional, managerial and political initiatives would be measured.
She was elected president in 1989, following a brilliant academic and clinical career as a world authority in respiratory medicine, including the publication of over 200 papers and at one stage being the only woman in the country holding an established chair in medicine following the retirement of Dame Sheila Sherlock.
While others will be more qualified to comment on these extraordinary achievements, I will concentrate on Margaret’s activities as president of this college. Many of the initiatives she began while in post have continued to this day, and have been expanded and developed during successive presidencies, including my own.
Margaret arrived at a time when the workforce crisis in medicine was becoming particularly acute, and there was already a serious shortfall of 50% in every subspecialty. She had the foresight to create a Manpower Unit (now our Medical Workforce Unit) to collect reliable and detailed national data on the workforce and workload, to give the RCP the evidence to drive consultant expansion.
1989 was also the year of the infamous white paper Working for patients, heralding major reforms of the NHS under Margaret Thatcher, introducing the purchaser/provider split, GP fundholding and Trust hospitals. The RCP, working with the other medical Royal Colleges, raised serious concerns and questions on key elements of medicine missing from the proposals - how education and training programmes would be handled, and clinical research supported in an internal market. Pilot schemes were suggested, and Margaret’s disappointment with the government’s stonewalling response was a catalyst for her major internal reforms that were needed to improve the RCP’s relations with its own fellows and members, patients and patient representative groups, and to have more influence with government and stakeholders. In 1991 she gathered together representatives from the larger charities involved in patient support, a group that continued to meet and later became the catalyst for development of the RCP’s Patient Involvement Unit, now the Patient and Carer Network.
A new management structure, closer and formalised working relationships with specialty societies, more democratic election processes for college posts, and greater transparency in RCP decision-making all followed, enabling better handling of the pressures put on medicine by new developments - in medical ethics, evaluation of treatments, patient expectations, professionalism, communication and confidentiality in the electronic age, and the impact of increased litigation. By creating new underpinning structures, the RCP was better able to consider, analyse and respond to these new challenges.
Margaret was deeply embedded in the wider clinical, academic and medico-political networks that exist to this day and support collaborative working between the RCP and other medical organisations, but her focus always came back to the key question ‘What do patients want?’
Margaret remained a friend to the college and a major force in medicine long after demitting the RCP and throughout her ‘retirement’. I was very grateful for her personal notes, and regular private advice, sent to comment on and help hone RCP policy. Always thoughtful, wise and germane – our last formal correspondence was about the lease on our building in Regent’s Park, so she definitely had our future at heart.
I benefitted personally from her understanding, and support for the ups and downs of RCP presidential life, and accurate and honest insights about issues like junior doctors, women in medicine, and dealing effectively with other colleges, and government ministers. One of my favourite moments was at UCL, when Margaret, her daughter Lynne Turner-Stokes and granddaughter Tabitha, attended for Tabitha’s graduation – it was so inspiring to see three generations of pioneering medical women.
To her humility in the light of her extraordinary achievements was added a warmth and personal charm – one of the highlights of my own presidency was her 90th birthday party with the RCP’s senior officers, where she held the whole room spellbound with her witty and insightful anecdotes. Members of Margaret’s close knit family were also present on that occasion. Family was incredibly important to her - her husband Richard, daughters Gillian and Lynne and her wider family were a source of great support, love and happiness, and despite the demands of her career she was always available for them and considered time at home very precious.
Remarkably, she found time for a raft of interests outside medicine, including music – she loved music, particularly sacred and chamber music of the eighteenth century, played the violin, was a keen gardener and her watercolours were turned into Christmas cards and often featured in the RCP’s Annual Art Exhibition.
The RCP is shortly launching a new exhibition on women in medicine, for which we gathered all three living female presidents a few months ago for a photograph. That was the last time I saw Margaret, and with typical candour she was clear that she did not support special pleading for medical ladies, but was happy to have her photo taken anyway!
The RCP was greatly enhanced and rendered more effective by her presidency, we are in her debt and we will miss her very much, but it is fitting that the last words should be Margaret’s own. Taken from Living Medicine, her account of her amazing career and achievements, this quote about doctors embodies Margaret’s core philosophy:
If they can ensure that their professional integrity in the selfless care of patients is sacrosanct then all will be well for the future of medicine. However, if doctors allow their commitment to patients to be pushed into second place by political or managerial diktats, or more personal factors, then medicine will be at risk of losing its soul. In the end, the future of medicine will depend on those who really care for patients.
Professor Jane Dacre, president of the Royal College of Physicians