Professor Trish Greenhalgh: Academic Career
My early career was in hospital medicine, specialising in diabetes and endocrinology – in which (after a short break to start a family) I gained an MD in 1995. My initial focus as an academic diabetologist had been the laboratory-based study of insulin pharmacokinetics during periods of metabolic stress. My interest later shifted to the patient’s lived experience of diabetes (the ‘illness narrative’), including the family, social and cultural context in which self-management occurs, and the organisation and delivery of services for monitoring and preventive care. Diabetes disproportionately affects people from minority ethnic and socio-economically deprived groups, and its prevalence increases with age. Those who are poor, elderly, immigrants and speak limited English are in multiple jeopardy. Improving outcomes for such individuals requires an interdisciplinary approach that incorporates biomedical, psychological, socio-cultural and organisational dimensions, as well as optimising health informatics to support both front-line patient care and secondary uses (audit and research). As my understanding of diabetes shifted from ‘a disease of the pancreas’ to ‘a system-wide condition in which social determinants of health loom large’, I became less interested in a single-specialty career and more interested in general practice. For 30 years I combined academic work (including the social science aspects of diabetes management) with part-time general practice. I’ve recently stepped down from clinical work to be full-time academic, though around half of my research and teaching includes NHS-linked projects.