Maddison, David Clarkson

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David Maddison was Dean of the Faculty of Medicine from 1972 to 1974 and Foundation Dean of Medicine at Newcastle University from 1974 until 1981. He was a brilliant and provocative writer and speaker, restlessly seeking for new ways of humanising medicine, psychiatry and medical education. His work in Newcastle pioneered community-connected, problem-based learning and new structures of admission, and elevated the teaching of communication skills to an essential element of the curriculum. His sudden death at 54 left medicine and medical education much the poorer.

David was born in 1927 and educated in Sydney. As a child he was a musical prodigy, giving his first public performance as a pianist at the age of seven and played with the Sydney Symphony Orchestra at the age of nine. He was encouraged to pursue a musical career as a pianist by Artur Rubinstein and invited to become a pupil of Artur Schnabel in Holland. However, with the outbreak of WWII, travel to Holland was no longer a possibility. His love of music lasted all his life and co-existed with his medical career. David performed for the ABC (both radio and television) until the late 1960s and gave innumerable public recitals throughout his life, as well as playing for the delight of his friends and students.

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Choosing medicine as his principal career, he graduated with honours in 1948. He trained as a physician and then as a psychiatrist, with an intense and deep interest in psychoanalytic techniques. In 1956, he took a travelling fellowship to the United Kingdom, Europe and North America.

He returned to Sydney to become Senior Lecturer in Psychiatry within the Faculty and was appointed professor of psychiatry in 1962. During the period of his occupancy of this Chair, he significantly changed the face of psychiatry in New South Wales and Australia, often provoking strenuous opposition from traditionally minded colleagues. According to Bruce Singh:

[He] influenced thousands of undergraduates by his lectures and his charismatic personality, and he radically influenced the training of psychiatric nurses by his personal efforts and through his book “Psychiatric Nursing”, first published in 1963[1]… He established a fine Department of Psychiatry at Prince Alfred and attracted to that institution a string of registrars and staff specialists many of whom have gone on to carry his ideals and aspirations into the forefront of clinical practice and academic psychiatry.[1]

In 1964, David spent a year as Visiting Professor of Psychiatry at Harvard University and commenced his seminal research work on bereavement and its consequences. Whilst at Harvard, he was deeply impressed by the work of Gerald Caplan on Community and Preventative Psychiatry and on his return to Australia, set about incorporating innovative notions and methods of psychiatric care into the Australian setting. His Professor of Psychiatry, Beverley Raphael, recalls:

David Maddison was an innovator with respect to mental health. Following his sabbatical leave in the USA… he became interested in prevention in mental health as well as life crises such as bereavement in leading to psychiatric vulnerability. His broad approach and his scientific contribution strongly influenced myself and others in this field and led to developments relevant to mental health aspects of disaster response. As a teacher of psychiatry and a mentor, he challenged and supported the development of ideas and initiatives in the field of mental health.

David’s benevolent views of psychiatry extended to the wider context of his thoughts about medicine. He was alarmed by the dehumanisation of modern medicine, a problem that he traced to archaic methods and the content of medical education, and inappropriate medical school admission procedures. He loathed phrases such as ‘taking a history’ – as though the clinician has a right to ‘take’ anything from the patient. He wrote and spoke on these matters with sharp wit, scholarly substance and a positive view of possibilities for reform. His growing interest in medical education led him to occupy the office of Dean of the University of Sydney Faculty from 1972 to 1974. He worked with similarly-minded colleagues to introduce a new five-year curriculum at the University, increasing the influence of behavioural and social science.

David was also Chief Censor of the College of Psychiatrists and was elected President in 1974. The standards he introduced then are said to have “formed the basis for the College examination system”.[1] He served on the editorial boards of various journals including The British Journal of Medical Psychology and the Australian and New Zealand Journal of Psychiatry and acted as consultant to many groups, ranging from voluntary associations to government agencies to WHO.[1] In 1974 David was asked to advise the University of Newcastle on a new medical school. He sat on a selection committee to appoint the new dean but no suitable applicant was found. Subsequently, a delegation from Newcastle came to Sydney and asked David if he would consider the position himself. He accepted, seeing opportunities to implement his ideas about medical education in a fresh setting. On his appointment, journalist Ian Hicks quoted David as saying, “the longer I am in medical education, the more I see a need to relate it to the needs of the community.”[1]

During his tenure as Dean of the Newcastle medical school, David recruited Faculty staff who shared his vision of a medical curriculum that was informed by the current profile of illness in the Australian community, that took seriously the humanity of patients, that emphasized the social determinants of health, and that recruited mature and motivated students to undertake medical training. The new medical school based its learning on student groups working together on clinical medical problems, and devised criterion-based assessment and new forms of course evaluation. Many of these approaches, now considered standard practice, were startlingly new and disturbing when David oversaw their implementation in Newcastle. Then, amidst the intense activity of the new medical school, David died of a heart attack on 3 November 1981, not living to see the first cohort of students graduate in 1983.

Beverley Raphael reflects on David’s establishment of the Newcastle Medical School:

[O]n an Australian bush campus, he systematically developed and documented the theoretical frameworks for the Newcastle school. His ideals were of a school where students were specially selected; a faculty attuned to the medical and social needs of the community; an integration of disciplines in clinical problem solving; the systematic development of clinical and interpersonal skills; [and] a school where science and humanity linked in medical training.[1]

According to his Foundation Professor of Community Medicine, Stephen Leeder, David supported him and his colleagues,

[to] implement a radical and new approach to medical education using problem-based learning in groups. Maddison sent frequent, bracing and lengthy memos to his faculty – not about administrivia, but challenging our educational theory and practice – the way we did things, thought about things, organised things. Sadly, this high academic practice – writing, debating, contesting, and constantly reviewing – is not something I have encountered to the same extent anywhere else.[1]

Citation: Mellor, Lise (2008) Maddison, David Clarkson. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.