FEATURING: Rosamond Gruer (1927–2025) – Pioneering researcher, public health advocate, and artist

By Laurence Gruer | Honorary Professor of Public Health

Rosamond was born in Aberdeen, the daughter of Robert and Euphemia Beattie, a barman and a shirtmaker who both left school at 13.  In 1945, she won the Aberdeen Town Council Gold Medal for Mathematics and Science and a bursary to the Faculty of Medicine at Aberdeen University. In 1950, she graduated with honours in medicine, winning the Keith Gold Medal in Systematic and Clinical Surgery, the MacQuibban Prize in Surgery, and the Davidson Smith Prize in Diseases of Children. As a woman, she was not invited to the graduates’ dinner.

In 1951, she married another student in her year, Kenneth Gruer and two years later had the first of four children. In 1954, Kenneth became a GP in the Aberdeenshire village of Kemnay. Rosamond did not expect to work as a doctor again. She became a housewife and practice receptionist, finding the time to become an expert knitter and dressmaker and host increasingly elaborate dinner parties based on French cuisine. 

In 1964, Kenneth’s partner left the practice. When he failed to find a replacement, Rosamond reluctantly became his assistant, feeling untrained and out-of-touch and still expected to do most of the child-rearing and housework. But she grew in confidence, discovered she could cope and became his practice partner a year later.

In 1967, after Kenneth developed a chronic illness, they moved to Edinburgh in search of a more manageable life. Rosamond enrolled in the Diploma in Social Medicine at Usher (the then-equivalent of a Masters in Public Health) and soon discovered her passion for epidemiology and statistics. Inspired and encouraged by the legendary Professor Sir John Brotherston, she began a series of ground-breaking studies evaluating health services and medical care.

Her study of inpatient service utilisation in the Scottish Borders found that the existing haphazard method of recording patients’ place of residence hampered accurate analysis. She was one of the first to advocate using the newly introduced postal code as a solution.¹

Using geospatial analysis, she found that the further a patient lived from an outpatient clinic, the less likely they were to be referred there. She challenged the prevailing idea that it was more efficient to concentrate all specialist services in a small number of large district hospitals, demonstrating that the overall cost of to the community consultants travelling to peripheral clinics was invariably lower than the cost to the community of outpatients travelling to centralised services.²

Her study of medical and social care of the elderly in the Scottish Borders revealed a huge amount of unrecognised and unmet need. She concluded: “On reviewing the results of this study as a whole, there is one inescapable conclusion: the greatest need in the elderly population is money.”³  Her findings were politically unpalatable, and her report was suppressed. She also evaluated the Glasgow computerised ECG interpretation system, concluding “there was no evidence it was ready for general application in the health service.”⁴  Further studies focused on the diagnosis of abdominal pain⁵ and the provision of gastrointestinal endoscopy.⁶

She played a key role in establishing systematic surgical audit of general surgery in the Lothian Region. She led a five-year analysis – an “audit of clinical audit” – showing significant reductions in the number of re-operations and post-operative mortality for many but not all conditions. This enabled improvements to be prioritised and promoted rational service planning.⁷  Professor Gerry Fowkes later wrote: “Rosamond Gruer was almost unique in conducting major studies of high academic calibre in a health service setting.”⁸

As a research fellow, she quickly became involved in teaching and was appointed as a part-time senior lecturer in Community Medicine at the Usher Institute in 1977. She taught epidemiology and healthcare evaluation to medical students, trainees in community medicine, and clinicians. Well-prepared, articulate, and impeccably dressed, she was a popular lecturer. As a project supervisor, her formidable intellect and attention to detail left no room for sloppy thinking or clumsy writing. With her unique knowledge and skills in health service evaluation, she became increasingly involved in service planning and management.

In 1983, she became District Medical Officer for South Lothian District with responsibility for surgical services. At the time, senior surgeons were exclusively male. While many respected her logical thinking and clarity, a minority were resistant to change and openly sexist. A committee chairman once wrote to her “to apologise on behalf of the surgeons, for the very ill-chosen remarks at this evening’s meeting. Quite groundless and not shared by the others present.” 

In 1987, she decided she had endured enough occupational stress and retired after a career of only 23 years. The energy she had poured into her work was then transferred to her retirement projects. Over the next few years, she studied drawing and painting. From 1991, she concentrated on mastering screen printing and the use of photo editing software to prepare images. In 2001, Professor Raj Bhopal commissioned her to create a screen print to celebrate 100 years of academic public health at The University of Edinburgh. The complex, multicoloured work now resides in both the Usher Building and the Royal College of Physicians of Edinburgh.

Despite health problems in her later years, she remained a keen gardener and enthusiastic traveller - and was immaculately dressed right to the end. She leaves four children, eight grandchildren, and 13 great-grandchildren. 

References

¹ Gruer R. Hospital discharges in relation to area of residence. Brit J Preventive and Social Medicine 1970; 24: 124-8.

² Gruer R. Economics of out-patient care. Lancet 1971; 297: 390-4.

³ Gruer R. Needs of the Elderly in the Scottish Borders. Scottish Health Service Studies No 33. Scottish Home and Health Department, 1975. 

⁴ Gruer R. Evaluation of the Glasgow Computerised Electrocardiogram Interpretation System. Preliminary Report 1976 (unpublished).

⁵ Gruer R, Gunn AA, Ruxton AM. Medical audit in practice. BMJ 1977; 1: 957

⁶ Gruer R The rationalisation of gastro-intestinal fibrre-optic endoscopy services in Lothian Health Board. Health Bulletin 1987; 45: 234-245.

⁷ Gruer R, Gordon DS, Gunn AA, Ruckley CV. Audit of surgical audit. Lancet 1986; 1:23-6. doi: 10.1016/s0140-6736(86)91903-3.

⁸ Bhopal R, Last J (eds). Public Health: Past, Present and Future. Celebrating academic public health in Edinburgh, 1902-2002. Nuffield Trust 2004, p112.