Intended for healthcare professionals


Calm under pressure: the stroke physician

BMJ 2023; 383 doi: (Published 10 October 2023) Cite this as: BMJ 2023;383:p2123
  1. Kathy Oxtoby
  1. The BMJ

Mark Barber talks to Kathy Oxtoby about the variety in stroke medicine and teaching “the old fashioned way”

Geriatrician and stroke physician Mark Barber is passionate about helping patients who have had a stroke.

Describing the sudden and potentially devastating impact of stroke, he reflects on how a patient can go from being well to very unwell in a matter of minutes. “Lots of other conditions build up over months, even years, and patients may have time to come to terms with what’s happening to them,” he says. “With stroke, unfortunately, it happens like the flick of a switch. And the sudden loss of health can feel like a bereavement.”

As stroke lead clinician at NHS Lanarkshire, one of Barber’s goals is to help stroke patients achieve some kind of normalcy. “As a doctor working in this type of acute care you can make a real difference. People make some amazing recoveries—it’s so satisfying to see,” he says.

He emphasises that those recoveries are a team effort, and that working as part of a team is one of the reasons stroke medicine appeals to him. “Professionals like stroke nurses and therapists are the people that really make a difference and it’s a privilege to work with them.”

He loves that his subspecialty involves a mixture of both making potentially life changing treatment decisions in just a few minutes and seeing a patient through long term rehabilitation care.

Barber divides his time between University Hospitals Monklands in Airdrie, North Lanarkshire, and looking after the stroke service at Western Isles Hospital, Stornoway, which has a small rural population. As well as clinical work, his career has encompassed research, teaching, and leadership, and it’s this variety that makes him look forward to work. “I miss it when I’m not there,” he says.

Barber says he fell into medicine because he was good at science. “I didn’t have a vocational desire to become a doctor. But I did some voluntary work at the local hospital near Ayr where I grew up, and thought, ‘This is for me’.”

After graduating from Glasgow Medical School in 1991, he worked for several years in a variety of different specialties before choosing geriatric medicine—“one of the last bastions of general medicine.”

“I wanted to be able to do general medicine and I enjoyed caring for older people,” he says.

During his five years of registrar training, he met two of the main role models of his career. Peter Langhorne, emeritus professor of stroke care at the University of Glasgow, prompted Barber’s interest in stroke medicine and research. “He has an international reputation, but is relaxed, humble, and kind,” says Barber. He was inspired by the professor to take two years out of training to do a research fellowship, at the end of which he decided to become a stroke physician.

His other role model was Bill Reid, his educational supervisor at the old Glasgow Southern General Hospital. “A successful teacher and trainer, he encouraged self-directed learning, which allowed me to develop as a clinician, and also prepared me to be a trainer,” he says.

His appointment as a consultant at University Hospitals Monklands—a relatively small hospital—in 2006, proved the right move, giving him opportunities that may not have been available to him at a larger NHS board. “I was able to make changes as a relatively junior consultant, and to carve out extra niches,” he says.

Within a year of his appointment, he became the lead clinician for stroke for the NHS board, and from 2007 to 2017 he was hospital subdean and responsible for all undergraduates who came to the hospital. He has also been chair of the Scottish Stroke Care audit, working one session a week monitoring the quality of stroke care across Scotland.

One of his great successes has been his role as educational supervisor, and several of his trainees have since become consultant colleagues. “One of the nice things about appointing consultants that you’ve trained is that to a certain extent they tend to be mirrors of yourself, and so you do things in a similar way,” he says.

He enjoys teaching on ward rounds, “passing on knowledge and encouraging learning about medicine the old fashioned way.” He also supports senior trainees, who he considers to be both colleagues and friends, and says he learns as much from them as they do from him. They call him by his first name. “I don’t like ‘professor’ or ‘doctor’—it creates an artificial barrier,” he says.

To relax outside of work he enjoys walking, Munro bagging (climbing as many of Scotland’s biggest mountains as possible), geocaching (where participants use a global positioning system receiver or mobile device to hide and seek containers), cycling, and narrow boat holidays.

At the hospital he likes to keep things on an even keel, to help manage the pressures of working in such a fast paced area of medicine. “It’s a strength in medicine to be just a little bit relaxed. If you’re calm in an emergency hopefully everybody else is then a bit less stressed as well.”

Nominated by Clayton Micallef

“Professor Barber has shaped my registrar training. He has been my educational supervisor and a role model for me for three years. In a time when training and supervision can seem like an exercise in ticking off competencies on e-portfolios, he has provided supervision that considers other aspects in my life—he had even offered to help me and my family move house.

“When I approached him during busy periods he always listened to and valued what I had to say, and made it feel like he had all the time in the world. He is passionate about stroke medicine, has an excellent manner with his patients, a great sense of humour, and is incredibly humble.”

  • Clayton Micallef is a specialty trainee year 7 in stroke medicine and geriatric medicine at University Hospital Monklands, Airdrie.