The greatest good fortune of my professional life has been to have had inspiring supervisors and mentors. Starting in the liver unit at the Royal Free under Andy Burroughs and Neil McIntyre, I was privileged to then have generous and comprehensive clinical training under Ian Barrison and Michael Willoughby. The critical influences in my SHO training were neurologists, from whom I learned that taking a history was more than a detective story but actually a way to understand human experience as lived through the process of a disease or disorder. But what completely transformed my ultimate career choice was being mentored by John Lennard-Jones and Michael Kamm at St Mark’s.
These outstanding clinical teachers taught me to prioritise careful clinical observations and produce a formulation of a case that would encompass each phase of a disease and its treatment. My twin subspecialty interests in gastroenterology and neurology share this central reliance on history taking and immersion in to the detail of a patient’s life. I was never a gastroenterologist who was especially driven by the “craft” aspect of endoscopy. Researching clinical questions was always a greater draw to me. The turning point in my career was working with nurses and physiologists in small focussed teams, answering issues that arose from seeing patients in the clinic, and then realising that data in print.
The future of the speciality? Understanding the gut microbiome will allow us to manipulate the gut flora and shape treatment of intestinal, neurological and systemic disorders. I think another key development will be on cancer prevention and early detection through non-invasive technologies in identified at-risk individuals, with endoscopy being primarily therapeutic. Therapeutic upper GI endoscopy will reach beyond the emergency setting to include treating reflux and dysmotility.
Advice to an aspiring gastroenterologist? Published guidelines should be considered as informative, not a binding definitive solution to the boundless complexity of presentations in every individual. Take all guidance with a filter - I am not keen on offering unsolicited advice.