PhysioUpdate 25th October 2022

This time last year, PhysioUpdate published an exclusive interview with respiratory physiotherapist Rachael Moses as she prepared to become the first person in her profession to take the presidential reins at the British Thoracic Society (BTS).

The article received an unprecedented response from readers, who appreciated the significance of the role and Rachael's willingness to go beyond her own comfort zone within an organisation that had traditionally been led by physicians (though it is important to stress the multidisciplinary nature of the BTS and the influence that physiotherapists, among other disciplines, have had on its policies and procedures over the years). 

Now, as Rachael's term in office nears its end, she again found time during her dauntingly busy working schedule to answer a series of questions posed by PhysioUpdate editor Ian A McMillan.

What have you learned personally from being BTS president?

My first reflection is it wasn’t as scary as I thought. Whatever you want to call the feelings of the 'imposter phenomenon', they are most definitely there when you take up a role such as this one. Occupying a space that is new is always something that most of us will approach with slight fear of what is the unknown, but it also means we really care about what we are doing and why we are doing it. 

I learnt that in these spaces we need to bring our authentic self. Don't dwell too much on what others have done before us, concentrate more on what we can do with the time, platform and privilege the situation gives us in that role.

What are the main changes you have overseen?

The president's role is more about providing support, really modelling the values of BTS as a member organisation. Each president over the last 40 years has brought their own strengths into the role. Some really championed respiratory disease as a speciality, some took the opportunity to focus on their own clinical areas of expertise, while others showcased the society and all its achievements. 

For me – as the first non-medical president – I really wanted to focus on our BTS people as well as equity, diversity and inclusion. The last two years have been so challenging for the respiratory community I wanted to make sure people felt valued, cared for and part of a society where everyone feels like they belong.

Should other physiotherapists be inspired to seek prominent roles outside their comfort zones?

YES, YES, YES! It’s important to remember that we often create our own comfort zones and what our boundaries are. Yes, there are things that are barriers, lack of opportunities, person specifications that don’t include us – but sometimes we let our own misconceptions limit us. Taking those leaps of faith, challenging the status quo, asking 'Why not' when faced with the ‘Nos' and believing in our own strengths and capabilities is always my advice to others!

You had some disagreements over physios having 'consultant' in their job titles during the year. Tell us more

Working in a non-medical consultant role for the last seven years has been my career highlight for sure. The role is designed around a specific service, job description and person specification. There is strong governance in place to make sure I can work safely, autonomously and as part of a wider highly functional multidisciplinary team. 

The term consultant is not protected or specific to doctors but in the context of health care the term consultant is most often associated with medics – especially by patients. When doctors have not had the opportunity to work alongside non-medical consultants there can sometimes be a lack of understanding about why they have the title – for example, consultant respiratory physiotherapist – which is understandable.

But in my experience those doctors who have worked with people like me, understand why that title is used and that the safeguarding is in place to make sure patients, carers and professionals know the role and the clinical boundaries that come with it. What I will add is that I rarely take too much notice of the opinion of those who don’t know me or haven't worked with me in these situations.

As the first non-medical president, I really wanted to focus on our BTS people as well as equity, diversity and inclusion. The last two years have been so challenging for the respiratory community I wanted to make sure people felt valued, cared for and part of a society where everyone feels like they belong

Tell us a little about your 'day job' and how you manage having so many professional interests and demands on your time

I’m going to keep this short as I have what is known as a 'portfolio career'. I work two days a week in a clinical role (one in clinical practice and one as a national clinical advisor for respiratory in the Personalised Care Team, NHSE) and four days a week as head of clinical leadership development at the NHS Leadership Academy. 

As well as being president of the BTS, I co-chair two national groups and am a humanitarian aid worker (currently affiliated with Medical Aid for Palestinians) so my work life balance is not good BUT it’s something I navigate. These additional roles bring so many incredible memories and opportunities to support and help others, it's inspiring and motivating.

When do you hand over the presidential reins and do you think it will be emotional?

Professor Onn Min Kon is amazing and will do a fabulous job when he takes over in November at the Winter Meeting. I couldn’t have asked for anyone better to work with and for that reason I just feel very grateful.

What role will you play in the BTS in the future and what else is next?

I truly believe that after being afforded the privilege of roles such as these we need to create space for those coming through alongside us. I will always be an active member of the BTS and advocate for respiratory medicine but am not sure what my next formal role is, but I will certainly enjoy being the past president for the next 12 months and seeing who will be coming through as the next president elect in 2023.

The BTS is celebrating its 40th anniversary this year. To find out more about the society and its various advisory groups (including one focusing on pulmonary rehabilitation), visit: https://www.brit-thoracic.org.uk/about-us/committees-and-advisory-groups/

To read last year's PhysioUpdate Q&A with Rachael, visit: https://www.physioupdate.co.uk/news/rachael-moses-makes-history-as-the-first-physio-to-be-president-of-the-british-thoracic-society/

Professor Onn Min Kon takes over the BTS presidency from Rachael at the society's Winter Meeting in November. He is a consultant at St Mary’s Hospital in London, heads the tuberculosis service at Imperial College Healthcare NHS Trust and is also professor of respiratory medicine at the National Heart & Lung Institute of Imperial College London.

A multidisciplinary task force comprised of 96 experts from around the world – at least two of whom appear to be physiotherapists – has developed a set of recommendations on identifying and assessing the risk of falls among older people.

The World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative, which took three years to draw up, were published with some fanfare in last month’s edition of the journal Age and Ageing.

The task force’s remit was to weave a person-centred perspective into the guidelines by including the views of older adults with ‘lived experience’, as well as caregivers and other stakeholders. Another aim was to ’fill gaps’ left in existing falls guidelines and include recent developments in e-health. The task force hopes the guidelines will be relevant to practitioners in places with limited access to resources, such as low and middle-income countries

Dawn Skelton, a professor in ageing and health at the department of physiotherapy and paramedicine at Glasgow Caledonian University, helped to lead the task force’s working group on exercise.

Dublin-based physiotherapist and academic Grace O’Malley led a team that created up-to-date guidelines for health professionals working with children and adolescents who are obese.

Dr O’Malley said: ‘For the first time in Ireland we are seeing direct investment in healthcare services for child and adolescent obesity through the HSE’s [Health Service Executive] Obesity National Clinical Programme.’

She was commenting on the publication of the guidelines in an article in Frontiers in Nutrition earlier this month (12 October) for the RSCI University of Medicine and Health Sciences’ website.

Dr O’Malley, who is the principal investigator of the RCSI Obesity Research and Care Group, said the guidelines could provide a springboard for further research.