In the 1970s and 1980s Jack Tinker directed the Middlesex Hospital’s intensive therapy unit, where he is widely credited with setting the standards of modern intensive-care practice. Before Tinker’s appointment in 1974 intensive care was a rudimentary clinical discipline with no continuity of care. Consultants used to drop by on an ad hoc basis to visit critically ill patients (located on side wards), writing instructions in the notes for others who were usually anaesthetists and were often junior medical staff.
Tinker created one of the first dedicated intensive-care units in the country, staffed by a team of assiduous doctors and nurses who he had personally trained. The unit, which grew to nine beds, while not the biggest in the country, was exceptionally well organised and provided a model of best practice. In addition to Tinker as director, there was a consultant, two senior registrars, three senior house officers, and a team of specially trained nurses. Through his editorship of the journal Intensive Care Medicine, authorship of three leading textbooks and the co-ordination of multiple training courses, Tinker had a far-reaching influence on today’s intensive-care physicians. In 1971 he helped to set up the Intensive Care Society in the UK, and did much to establish intensive care as a physician-led medical speciality in its own right.
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Jack Tinker was born in 1936 in Chorley, Lancashire, the only child of Laurence, a policeman, and Jessie, a school teacher. His childhood was dominated by the ill health of his mother, a scholarly woman from a mining family, who suffered heart problems as a result of rheumatic fever. Working ever harder to achieve academic success to please her, he won numerous awards at Eccles Grammar School and Manchester University. Reading pharmacology, he changed to medicine when reassured by his parents that the course would not strain their finances.
Tinker qualified in 1960, working at Manchester Royal Infirmary, first as a cardiothoracic surgeon, then switching to cardiology and general medicine. In medicine he was unusual in being dually qualified with FRCS and MRCP examinations (later achieving FRCP), giving him credibility with surgeons and physicians.
In 1966 he caught hepatitis B from a dialysis patient, and was in a coma for 48 hours. The now notorious Manchester outbreak killed nine people, and contributed to recognition of the need for dialysis to be undertaken in dedicated units. Tinker’s life was saved when the eminent liver specialist Dame Sheila Sherlock visited from London to advise on treatment.
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Battling depression after lengthy sick leave, Tinker switched from clinical medicine to research. Between 1967 and 1969, he worked with James Black (obituary, March 24, 2010) at ICI Pharmaceuticals on the development of beta-blockers. In 1969 Tinker was appointed as a lecturer at the Royal Postgraduate Medical School and moved his family to London. While working at weekends for a GP in Roehampton (who in return gave the family accommodation above the practice), his interest in clinical medicine was rekindled.
Undoubtedly, Tinker’s biggest achievement was the development of critical care at the Middlesex Hospital. Research highlights included the introduction of the so-called “Swan-Ganz catheter” to measure pulmonary artery pressure and cardiac output of critically ill patients. In a key paper published in 1987 in the New England Journal of Medicine, Tinker and colleagues described how disturbances in microcirculatory blood flow led to organ failure and death in some intensive-care patients. Their observations still stand today.
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Later he combined the director’s role with being postgraduate sub-dean, and unit general manager at the Middlesex Hospital. In March 1987 he was behind the scenes of the visit of Diana, Princess of Wales to open a new HIV ward. His knack for public relations resulted in the celebrated image of the Princess shaking hands with an HIV patient, which was syndicated around the world, and did so much to remove the stigma of Aids.
Regarding intensive care medicine as a young man’s game, Tinker switched to management, in 1988 becoming Dean of Postgraduate Medicine at the North East Thames Regional Health Authority. He was among the first to institute proper training programmes for house officers and junior medical staff, with his model of postgraduate departments subsequently becoming the norm throughout the country.
In retirement Tinker carried on working at the Royal Society of Medicine (RSM), first as Honorary Sub-Dean, then between 1998 and 2002 as Dean. Under his leadership the academic conference programme went from 11 major meetings in 1995 to more than 150 conferences and courses in 2002, being accessed by more than 15,000 health professionals. Tinker instigated the Key Advances series addressing the latest treatments, and founded the Fundamentals of Law courses which helped the medical and legal professions to understand what was required when the disciplines met in the legal arena.
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In 2000, as chair of the ethics committee of Dr Foster, (the company publishing comparative performance information about NHS hospitals), Tinker took on the task of listening to complaints and regulating the work of the organisation. He established the rules under which the committee worked, including legal and financial independence from the business.
Tinker played a pivotal role in the British Journal of Hospital Medicine (BJHM), first as editor and then as editor in chief. He focused on the importance of keeping the journal in touch with the training needs of readers. Tinker’s work with both the RSM and BJHM was enabled by his “extraordinary skill at networking”. Colleagues remember his uncanny knack of being able to walk into a room, make a connection with new people and come away with useful telephone numbers. His encyclopaedic knowledge of the British medical scene benefited all who knew him, not least those he advised on the most appropriate specialist for their condition.
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Additional part-time posts included senior medical consultant for Sun Life of Canada, medical adviser to Rio Tinto plc and medical adviser to the London Clinic, where he planned the ITU and health screening units.
His hobbies included marathon running and watching cricket and football. He was a member of the MCC and RAC clubs and a Chelsea seasonticket holder. In 1985 he set up the Scarborough Club, where like-minded friends with a serious interest in cricket met to spend a few days together at the Scarborough cricket festival.
Tinker is survived by his wife, Maureen, and two sons.
Jack Tinker, physician, was born on January 20, 1936. He died of prostate cancer on April 14, 2010, aged 74