Professor Patrick G Johnston MD PhD FMedSci delivered this article as the keynote at the Medical professionalism matters event, The doctor as a scholar, on Wednesday 03 February 2016, in Belfast.
Terence, Niall, Colleagues, it is a real pleasure to join you this evening, not as Vice-Chancellor of Queen’s, and former Dean of Medicine, but as a medical professional with over 30 years of clinical experience.
Before I go any further this evening, I would like to take this opportunity to wish Niall Dickson well as he prepares to step down from his role as Chief Executive later this year. Niall, I think everyone here this evening will agree with me when I say you have indeed done much to improve patient care. It’s a legacy many here aspire to.
You have presided over the GMC during a period when patient care and the medical professions have never been far from the headlines. I doubt that will ever change now.
But it is all of you, the people in this room tonight, who have a vital part to play in shaping and changing those headlines, in leading a new direction for medical professionalism and in creating a new narrative for patient care.
And the thread that will run through that change and that narrative is what I have been asked to address tonight – the importance of having a scholarly outlook.
Easy to think of it as a little bit outdated and old fashioned – it provokes the image of a wizened, Dickensian character, huddled over a desk with quill and ink pots to hand, reading by candlelight.
While the GMC may have thrown out a few artful dodgers in its time, it has not thrown out the importance of scholarship, indeed it has probably never looked more different nor been more important
Scholarly Outlook and Leadership
Today, having a scholarly outlook translates into one key enduring characteristic…leadership. In 1996, when I returned from working in North America, having been there for 10 years, I was confronted by a clinical training culture that had become unrecognisable; one that was more focused on developing competence than developing excellence. Thankfully, with the more recent changes developed as part of Tomorrow’s Doctor, we have moved beyond competence to expecting excellence.
In modern medicine, real professionalism sees us challenging ourselves in the practise of scholarly work as it applies every day, developing ourselves not just as doctors but also as compassionate carers. It is making ourselves credible as trusted clinical practitioners and decision makers, driving forward our professional knowledge, genuinely caring for others, by challenging what is out there and doing the right thing.
One of the people who inspired me to do medicine and indeed to become an oncologist was the polish born French scientist Marie Curie, the greatest female Scientist of the 20th century, who won the Nobel prize in both Physics and Chemistry. She described two types of mind-sets in science. The first was “The mind-sets who hurry to hunt down errors instead of establishing the truth.”
Today as a medical professionals, it is easy to feel as though there is an ongoing professional witch hunt. As though it is often the media and our policymakers who are the sadistic ones, hunting down errors, instead of working with us to establish the truth. And while some of that is undoubtedly true we, as professionals, also bare some blame in that we too often allow ourselves to indulge in the pettiness of local politics, professional rivalries and jealousy and get pulled down by the “disease of sameness” rather than standing up to the challenge of being accountable.
The second type of mind-set that Marie Curie described was the one that underpins scholarship where “One never notices what has been done; one can only see what remains to be done”.
As medical professionals, our outlook has to be that of the Scholar. We have to lift our gaze from the NHS navel, look to the future and see what it is that remains to be done. And, no one here tonight should be in any doubt – it is having a scholarly outlook, wanting to approach things with a deeper understanding that will enable us to do exactly that.
It enables us to increase our knowledge, enables us to question what we think we know, allows us to ask “How can we do this better”, allows us to challenge and to lead with conviction. And by equipping ourselves with the ability to do all of that, we are immediately differentiating ourselves.
Having a scholarly outlook enables us to develop the skills that mean we can stand up to difficult challenges; we can have those difficult conversations – in the right way, we can become caring, credible, insightful thinkers and trusted clinical leaders. As a result those around us especially our patients, feel valued and respect which builds trust in us and what we are doing. We become impactful leaders.
Today, I am privileged to lead Queen’s. I regard it as a great honour, and I can tell you it was not something that was ever on my radar when I graduated from medicine in 1982.
What was on my radar was becoming a competent physician, able to engage meaningfully with my patients and my colleagues, deciding what medical speciality I would follow and getting into the best training programmes available.
I knew medicine was not standing still and I had to move with it. In fact, I felt it was my job to get ahead of it, and the only way to do that, to feel like I was doing the most I could to improve people’s lives, was to increase my knowledge, to then share that knowledge across clinical boundaries and then to question new knowledge I had gained.
Where did that impulse come from? It came from the need to approach things from a different point of view and to make a difference.
I had seen the lack of progress in treating cancer patients in the early 1980’s but also the promise of chemotherapy and bone marrow transplantation. As a result I developed a thirst for knowledge, and clinical expertise about cancer, drug resistance, pharmacogenomics or developing new treatments.
Most importantly I learned to live within the unknown and leave behind the need for certainty and comfort.
Today, as Vice-Chancellor of Queen’s, I haven’t left those lessons behind – quite the opposite in fact. Meeting the needs of society, striving for excellence, walking into the unknown are the goals which have informed my Vision as a Vice-Chancellor.
For the medical profession, we have created an International Medical School and Institute of Health Sciences, ensured that medical practice and discovery are seamlessly intertwined, created an environment where the continuum of learning is a lifetime journey and not an academic or professional degree course.
Medical education has come a long way in a relatively short time but learning has always underpinned what we do.
Now ‘enough’ is not enough and that is what is at the heart of Tomorrow’s Doctors.
It is a role that is increasingly becoming one that’s focused on developing leadership that is solving the issues that matter to people and societies globally.
Reforming cancer care
Let me give you an example from my own career of why scholarships matters. When I returned from the United States to Belfast, Northern Ireland was at the bottom of the cancer survival table in the UK and today we are near the top. This did not happen by chance but rather by having strong, focused leadership and a clear vision and plan on how improvements could be made. We also had a group of medical leaders with courage and the conviction to carry it through.
There was significant opposition from community groups, patient advocacy groups and local politicians. However, the biggest professional challenge lay within the medical profession itself. It was only when they understood that other medical professionals were prepared to challenge in a respectful, transparent way using an evidence based approach that opposition melted away.
Importantly, today at least 150 people are walking around in Northern Ireland each year who previously would have succumbed to cancer. In recognition of the impact of that work, we received a Diamond Jubilee Queen’s Anniversary Prize, from her Majesty the Queen, for our leadership of the Northern Ireland Comprehensive Cancer Services Programme and its impact on patients and wider society.
So how did we do that? We did it by developing a commitment through scholarship to the 6 C’s. What are the six C’s? Walt Disney came up with four of them, when describing leadership and success. But as they say ‘Talent imitates, Genius borrows or steals!’ Disney talked about “curiosity, conviction, courage and constancy”. For me, there are two additional C’s – commitment and compromise. If we ensure that we invest time each week in nurturing our scholarly outlook, in ensuring we live and breath those values then that journey toward leadership, that journey which can make such a difference to us, to our patients and their families and to society, will be crystallised for all of you.
I’ll finish this evening with some lines from the Centenary Stanza penned for Queen’s by the Nobel Laureate Seamus Heaney which to my mind are emblematic of what scholarship is about and why it is so important “… Here exercise of mind has stood To us, for us, These hundred years, And will, for good.”
I hope that in your journeys, you develop the determination and commitment to continue to exercise your mind, to continue to question and challenge. Having a scholarly outlook will also stand to you for good, as it has and will for generations of medical doctors to come.