After qualifying in medicine from UCD with honours, I left Ireland to do an internship in Baltimore and pursue training in internal medicine and nephrology at McGill University in Montreal. I subsequently trained in clinical epidemiology research at Yale University in the US, and returned to McGill to take up a faculty position. My career had 4 main themes or phases: 1. Practice of clinical nephrology; 2. Research in clinical epidemiology; 3. A change from nephrology to the practice of palliative care; 4. A leadership role in the development of McGill Programs in Whole Person Care aimed at reincorporating the facilitation of healing into the Western medical mandate.
What inspired you to pursue a career in Medicine?
I was interested in biology and animals. My mother asked why not study the most interesting animal of all and pursue a career in medicine. That made sense to me and from the age of 10 I never changed the decision to become a doctor. There may also have been the factor that my mother was seriously ill and the doctors who visited our house were treated with great respect and perceived importance. Perhaps I wanted that respect and at some level wanted to help my mother.
What was your favourite part of studying Medicine at UCD, and why?
I loved premed because it was being freed from the relative control and oppression of school, and the teaching was excellent. Later, I loved becoming clinically involved in hospital as this felt like really becoming a doctor.
What advice would you give to someone considering a career in Medicine?
Pursue a career in medicine because it fits some dream you have for your life. Don’t follow a career in medicine for financial reasons. Medicine can pay well but other careers can pay better, and my impression is that for doctors a primary pursuit of financial gain does not lead to satisfaction or good practice. The rewards of medicine are much deeper and more meaningful than financial success, which is more often than not, a diversion from what is really meaningful.
In what ways did your medical education at UCD help prepare you for your role as a Professor of Medicine?
We started with excellent instruction in how to examine patients and the importance of listening to patients. That initial sense of what medicine was really about remained with me throughout my career.
What led you to specialise in Nephrology and Palliative Care?
I specialized in Nephrology because it was such a logical and almost mathematical specialty that fitted my desire for clarity and understandability at an early stage in my career. My change to Palliative Care came as I matured. I realized that the missing element in my approach to medical practice was the willingness to face the suffering and death that is an inherent part of medical practice. I also met people who demonstrated in their lives and practice how rewarding this deeper aspect of medical practice could be.
Tell us more about your new book 'The Craft of Medicine'.
The Craft of Medicine (available on (opens in a new window)Amazon) is a memoir that follows my trajectory from starting medical school at UCD, to the development of a career in medicine that had ups and downs but was increasingly rewarding as I developed and changed. I use my own development in academic medicine to attempt to answer the question: “What does it mean to be a doctor today?” Not just the ‘how’ of medical practice but the underlying aim, which I believe is not just curing or controlling disease, but facilitating healing in our patients.
What’s the proudest moment of your career to date?
There is not one moment but many moments when at the bedside of a dying patient, often with their family present, I made a significant difference to their quality of life. This was not usually by solving a practical problem in which medicine would play a primary role, but by helping to unleash their inherent capacity for healing.
Who have been the most inspiring mentors or advisors throughout your career, and how have they influenced you?
There were 4 inspiring physicians who made a difference to my career and life:
- Frank Muldowney - a nephrologist at UCD who epitomized clear thinking and inspired me to become a nephrologist.
- John Seely - a nephrologist at McGill University, who represented the power of an adventurous spirit to open new possibilities and make life more exciting than I had ever believed possible.
- Alvan Feinstein - the father of clinical epidemiology at Yale University who taught me respect for the scholarship of clinical research.
- Balfour Mount - introduced Palliative Care to North America and demonstrated to me how deeply rewarding the care of dying patients could be.
What do you think will be the biggest challenge for doctors in the future?
The biggest challenge for doctors will be to remain aware of the central importance of their relationship with individual patients to the wellbeing of their patients, and the satisfaction of their own lives. This will be increasingly threatened by the pressure for efficiency and measurable outcomes, often driven by the institutional need for status and sometimes profit. We need a parallel process focussed on the humanity of both patients and physicians to sustain a medicine that is both technically effective and humanly satisfying.