Head of Centre for Medical Informatics, Usher Institute
How did you find out about DDI?
I’m part of the Usher Institute where I led one of the centres. Some of the investment that’s coming to the university will fund a new building for us and I’m involved in the discussions about the design of that, which will be here on the Bio quarter campus. I have an understanding around what the university needs to deliver to go alongside this very large investment – we have a senior responsible officer whose based in cardiovascular science but co-located at the Usher Institute, Nick Mills, whose leading on delivering the DDI vision.
Tell us about your journey to where you are now – what sparked your interest in your work?
I originally trained in medicine and practised as a doctor for a several years. I was on my way to training to be a neurologist, which is what I am primarily, then as a junior doctor I became interested in common neurological diseases. I had a boss at the time who was researching strokes, which is one of the most common neurological disorders with a massive burden of disease. That seemed like a good area to be getting in to. I started doing work with him alongside my job in my spare time and I got a research fellowship and did a PhD. This is common among doctors – they practice for a few years then get a fellowship funding rather than going straight to postgraduate from undergraduate. I did a Masters in epidemiology at the London School and then did a PhD at Oxford, which they call a DPhil – they have to be different don’t they!
Wow, what a fascinating area of study! What next?
I carried on my clinical training for a bit then I came back to Edinburgh in about 2000 for a more senior fellowship which split my time 50/50 between clinical practice and research, largely on stroke epidemiology, building my own research study in Edinburgh. Around about 2006/7, I was coming to the end of my fellowship, which was meant to be 5 years but I had two babies along the way.
I then got involved with advising on how to capture stroke outcomes in a very large study called the UK Biobank. The CEO of that study is Rory Collins, who was my co-supervisor at Oxford. I started doing some work at Biobank, which is a large population-based study with half a million people in it, and one thing lead to another. They were looking for new senior people in the team to run the study. To cut a long story short, I applied for the role and got it and I’m still the Chief Scientist!
Tell us a bit more about what Biobank does
Biobank is very much a big data enterprise that collects all sorts of data, imaging data, large-scale questionnaire data, wearables data, lots of genotyping data. It’s become a huge treasure for the UK and a globally valued resource, so getting involved at this key stage in my career was a really great opportunity and allowed me to convert myself from being a neurologist to a big data population health person, which I’ve always been really interested in. On the back of that, I have acquired more health informatics and big data in health roles leading large research studies and large research enterprises which means my work as a doctor has sadly shrunk quite considerably so I was about 50:50, now my clinical commitments are down to sometimes half a day to a day and the rest of my time is spent delivering these large scale research projects.
What an amazing journey – tell us a bit more about your big data roles
I head up the university’s Centre for Medical Informatics, which is in the Usher Institute. In the centre, we have about 50 people. The research staff work on big data in tech projects – AI, machine learning, technical development work, population-based analyses and large-scale statistical genetics analyses.
I’m now involved with Health Data Research UK which is newish UK-wide institute involving 21 universities coalesced in to 6 centres and I lead the Scottish centre, Health Data Research UK Scotland, coordinated from Edinburgh but it involves Glasgow, Dundee, St Andrews, Strathclyde and Aberdeen. My three roles in large-scale big data have a common theme of linking large studies from records that are available from the NHS to translate in to knowledge and benefits for the population.
Not much then!
It’s been very fun and a bit stressful at times – I won’t pretend there hasn’t been times I haven’t thought ‘oh I just want to give this all up and go and live in Orkney’. I definitely make space in my life for family and fun.
Is there such a thing as a typical day for you?
No there isn’t!
I’m up about 6.00 – 6.30 and I do some work at my desk whilst eating breakfast, sorting my kids and planning the domestic day. I come in to the office in between 8.00-10.00 and arrive on the bus because I can do some work on the bus, check my emails (laughing). My day is quite heavily diarised, involving meetings with my project managers and clinical fellows conducting research and data analysts. I might go to a seminar – or give one or chair one!
Yesterday I had a rare day when I was in my office for a couple of hours, on my own, getting stuff done.
So what about your clinical work?
My clinical day is on a Wednesday, in the morning, leading the team, seeing new stroke patients and taking calls from GPs. There’s a number of consultants on the rota, I’m one of them. We work with a registrar, who is a more junior doctor, and a specialist stroke liaison nurse, who makes sure we are all doing the right thing. We see all the new referrals, from those who have been sent by their GPs to those brought in by emergency ambulance or been brought up from one of the hospital wards. We help confirm diagnosis and decide whether rapid treatment is needed. It’s the brain attack equivalent of a heart attack. Throughout the morning, there will be on-off calls from GPs wanting advice or if there’s a patient who they suspect has had a stroke, a milder event that may not need emergency treatment, a mini stroke or a transient ischemic attack (TIA). We give advice on what to do with them immediately and whether they need to come to an outpatient unit. At least one day a week I’m on the road, normally to London, where I have a Biobank meeting or give a talk or join a workshop at somewhere like the Medical Research Council, sometimes I chair committees. I go down on the sleeper – you can do a full day in London then – and sometimes I do a bit of work on the 17.00 or 18.00 train back or sometimes I just collapse and fall asleep.
My weeks are very varied – I used to take clinical calls at the weekend but I don’t anymore. Some academics work very hard at the weekends. My weekends are definitely more about relaxing, spending time with family, going to the school football match or orchestra. That sort of thing.
What sorts of data sets do you work with and do you have a favourite analysis technique?
Ahh! The data set I work with most is the UK Biobank because I’m the Chief Scientist, which is made of lots of data sets. We are most familiar with the data sets from NHS that tell us about hospital appointments, diagnoses, all their healthcare journeys. We make our datasets available all over the world to researchers, about 10,000 of them. I don’t do the analyses myself anymore but I see the results and I direct the overall enterprise. I don’t suppose I have a favourite but there are some really innovative methods these days that are allowing us to see how diseases work, and those have a strong reliance on genetics. Genetic techniques that establish cause of disease are really useful, like mendelian randomisation, which combines genetic data about lifestyle, environmental factors, that really allow us to understand good and bad health.
As a woman in your line of work, would you recommend your role to women and girls? Do you find your work supportive of women?
That’s a really interesting question.
I don’t think being a woman has held me back in my career, maybe because I haven’t been particularly aware of it and I have been pretty lucky. I haven’t encountered a large amount of discrimination or inappropriate behaviours although I have worked in a male-dominated world. Increasingly at the university, there are opportunities for women and they have been pushing the equality agenda in a way that does work, it’s genuine and not a paper-based exercise. However, I’m more aware when I’m in the South, in London and Oxford, that I’m sitting in rooms full of men in grey suits. I generally get on with it and I think things are changing. I do push for simple solutions that help people to participate, that apply more to women than men, like the ability to take part in meetings remotely and make it hard to suddenly appear on the other end of the country. They tend to have more in the way of domestic responsibilities, more men can get on and rely on their wife or their support network. My senior male colleagues, who I have a lot of respect for, just haven’t recognised that. Everyone benefits from systems that mean we don’t have to travel for meetings or attend dinner. I’ve had small successes in that sense and is something I feel strongly about. There has been times where I’ve been asked to sit on an interview panel, board or committee and I haven’t been sure whether it’s because they have to achieve a gender balance – I prefer if people ask me because I have an asset or skill.
In terms of recommending the role to other people – there’s been times when I’ve pushed myself too hard, especially when the children were young, and coming back to work, always full-time. I won’t necessarily recommend that. People have to make the decision that’s right for them. It’s important to be kind to yourself. We have long careers these days, we live a long time, so you don’t need to do everything at the rate your full-time colleagues are and not taking time out to have a family for example. I might have worked 3 or 4 days a week to take the pressure off rather than feeling like I have to do everything at the same rate. There are more and more opportunities to allow people to slow down. I wouldn’t necessarily do it the way I’ve done it.
I have a pretty gender-balanced team so women and men are in all different types or roles and seniority. The Usher Institute is a nice place to work and is good for generating role models for women and for men that help the next generation. We don’t have enough ethnic diversity because of visa restrictions.
I would definitely recommend the role of being a clinical academic. It’s really hard work but really rewarding, never boring and allows you to have a lot of self-determination and control. I plan my own time. I am my own boss and in charge of my own destiny. It feels like I’m a proper professional and I have more freedom than doctors.
Who is your data science hero?
I don’t have just one – I have a lot of admiration for Andrew Morris, who is the head of Health Data Research UK. It comes from his fantastic capacity to make people feel valued and encourage people to work collaboratively, which is an incredibly valuable asset because data science is a team sport. I have a lot of time for my two fantastic project managers, who are women, who understand how to work with very diverse people and make things happen in the most remarkable way. I admire Rory Collins, the CEO of Biobank. He has vison and enormous tenacity and a capacity to make decisions that get things done. In terms of methods and so on, George Davey-Smith from the University of Bristol on mendelian randomisation. In his team, I have huge admiration for Debbie Lawla who has done a lot of work on using data that spans generations, looking at babies from the point of conception, to understand the evolution of diseases. Her work has been very influential.
What are you proud of in your career?
I am proud of how I’ve been able to do amazing research and not be confined entirely to neurology. Most academics stay firmly in their speciality. I’ve allowed myself to drift outside of my comfort zone and that’s made life really exciting. I hope that makes others realise that they don’t have to stay put, it’s quite refreshing to change direction and take on new challenges and build new perspectives.
What do you look forward to?
I look forward to being a voice for Scotland in the UK health data science melting pot and really make the very most of the great assets we have in Scotland and make sure they’re recognised and invested in.
I would definitely recommend the role of being a clinical academic. It’s hard work but really rewarding, never boring and allows you to have a lot of self-determination. I am my own boss and in charge of my own destiny.