Obituary - Dr Andrew Diamond

Andrew William Diamond had a tragic start to life, marred by the death of both parents during his early school years. His mother suffered from rapidly progressing multiple sclerosis, which caused her early death. His father was a general physician in Devon. He died suddenly after Diamond’s sixth birthday.

After leaving Aldenham School, he entered St Thomas’ Hospital Medical School, graduating in 1961. He specialised in anaesthesia and was appointed as a consultant in anaesthesia at Frenchay Hospital, Bristol, in 1968. He enjoyed a year working in Denmark before taking up his consultant post in Bristol.

He had considered a career in intensive care medicine, but his main interest was the control and management of pain. He was skilled in the use of regional anaesthetic blocks, following  his experience in Denmark. At the time, regional anaesthesia was uncommon in the UK, with very few patients being comfortable with the idea of being awake during their surgery.

The opposite was true in Denmark and the other Scandinavian countries, where patients were more concerned about the risks of having general anaesthesia. Diamond was soon identified as the doctor who could help patients suffering from intractable pain.

His interests remained broad, and in 1973, he published articles on prehospital intensive care for victims of traffic accidents.

Diamond was an advocate for a separate college of anaesthetists, instead of just being a Faculty of the Royal College of Surgeons. He was a signatory to a letter to the BMJ in April 1979, criticizing ‘. . . the comfortable view that anaesthetists are better off firmly tucked under the surgeons’ wing [. . .] and basking in the prestigiousness of their splendid building – the Royal College of Surgeons’.

The letter was signed by other consultant anaesthetists at Frenchay Hospital, including Drs Peter Baskett, David Cochrane, Ronnie Greenbaum, Robin Weller, David Wilkins, John Zorab and the only female consultant at that time,  Dr Sheila Willatts.

The same group supported the advanced training of ambulancemen (as they were called in the 1970s), and in 1976, Diamond was a co-author, with Dr Peter Baskett and Dr David Cochrane, of an article in the British Journal of Anaesthesia describing a pilot study of an urban mobile resuscitation service which could include the out-of-hospital deployment of an anaesthetist.

In 1975, 1976 and 1982, he published articles that aimed to improve the management of burns. In addition to the resuscitation of burns victims, these articles pushed for the provision of good analgesia, particularly when changing burns dressings – a procedure that was dreaded by many patients. Another study, published in 1975, examined the feasibility of providing postoperative extradural analgesia after thoracic surgery.

Diamond was now more tightly focused on pain. Without getting formal permission from the hospital’s management, he established a chronic pain service. At first, this was with a theatre recovery nurse helping out with procedures, such as steroid epidural injections, in her lunch break. Demand for Diamond’s pain service quickly soared, and space was found in a spare building for a pain consulting room, minor treatment room and staff accommodation. He was fortunate to be working in a hospital built by the US Army, for D-Day and the European land war. Getting space was simply a matter of spending a weekend with cleaning materials and some tins of emulsion paint to open up a mothballed building. Soon, he had a full-time pain nurse, a secretary and dedicated pain block lists in an operating room.

At one point, a National Health Service (NHS) turf war threatened to derail the pain management programme, when the managers from outpatient services, anaesthetic services and therapy services could not agree on which budget would fund physiotherapy time in the new programme. Diamond resolved the issue by paying out of his own pocket, which got the recruitment underway, before getting the Chief Executive to arrange NHS funding.

The pain service at Frenchay Hospital became the largest chronic pain service in the Southwest of England, with clinical psychologists, specialist physiotherapists and an occupational therapist. Diamond recruited a clinical psychologist, Dr Nick Ambler, who had been a fellow with the Seattle group, to develop an outpatient pain management programme. He later attracted Dr Stephen Coniam and Dr Cathy Stannard as consultant colleagues.

Diamond was the president of the British Pain Society from 1991 to 1994. During that time, he drove the remodelling of the society’s constitution to allow full membership not just for doctors but also for members of the allied professions.

When he finished his term as president, the society’s membership reflected the composition of a well-run pain service, with nurses, physiotherapists, occupational therapists, pharmacists and clinical psychologists having full membership rights.

Back in Bristol, Diamond set in motion plans to have a joint pain clinic and palliative care facility. This was designed by his colleague, Dr Coniam, in partnership with Macmillan Cancer Support. The centre was housed in a purpose-built building in the grounds of the hospital. The adjacency of the two services made it possible to provide regional pain relief techniques for those palliative care patients whose pain could not be controlled by normal hospice methods without causing cognitive impairment and other complications.

Diamond developed informal training pathways for anaesthetists in training who wished to pursue a career in pain medicine. His clinical teaching method was a combination of permissiveness and an eagle eye. He was ready to intervene before things started to unravel. The trainees learned a lot, but not at the patient’s expense.

When he retired, he told me, as his successor in the NHS clinic, to keep anything in his office that would be useful and put the rest in a skip. He believed in a clean break!

Before retiring, he and his wife, Patsy, commissioned a steel canal boat, with which they sailed to France. After his retirement, in 1998, they navigated France’s inland waterways before settling near Béziers. Diamond suffered a stroke after emergency cardiac surgery for bacterial endocarditis. They moved back to Somerset in 2016 where he lived, with Patsy, until his death. He leaves Patsy, a son and a daughter from a previous marriage, plus four grandchildren and one great grandson.

Andrew Diamond, Consultant in Pain Medicine and Anaesthesia at Frenchay Hospital Bristol (b 03 May 1938; q London, 1961; FRCA), died from heart failure on 02 April 2023.

Dr Gareth Greenslade

Obituary first published in "Pain News" December 2023 Volume 21 Issue 4
A publication of The British Pain Society