Kevin is a consultant Gastroenterologist at the Family Cancer Clinic in St Mark’s Hospital. He is an Honorary Senior Lecturer Imperial College London where he supervises students undertaking projects into hereditary colorectal cancer. He has a wealth of experience in hereditary colorectal cancer and recently authored the new guidelines on the management of hereditary colorectal cancer.

What attracted you to a career in gastroenterology/hepatology?

I had a gut feeling about wanting to be a gastroenterologist because I just enjoyed it. I didn't grow up wanting to be into bowels, but I felt like there was a lot of variety in the working day and it was kind of a sociable job that involved working with lots of people in different departments. There was a good mix of inpatient and outpatients, medicine and lots of potential future career routes go down and although I've always had a strong interest in cancer genetics. In Gastroenterology there's a very much a focus on cancer prevention, which kind of appeals to me as well because there's an opportunity to prevent people suffering, and that was quite a big attraction for me when I was making my decision about what I wanted to do. I also liked working in completely different areas of gastroenterology as well, as all those things reflect the kind of examples of the variety within the specialty and patients that come with different problems that relate to those different organ systems.

What advancement in gastroenterology/hepatology excites you the most, and why?

I am excited about two areas really. One is in genomics and the other is in the advent of minimally invasive tools to evaluate risk and to offer people a more personalised approach to treatment and prevention. Those two areas are linked in a way, because they're both diagnostic tools which achieve those elements of personalization and improve outcomes.

Why genomic medicine and gastroenterology? When I trained, and certainly for the first few years after I qualified, it was really seen as a kind of something which was a bit of a niche area, and it wasn't something that was necessarily relevant to clinical practise. But I think that is changing and we can now order genetic tests as gastroenterologists, we don't have to refer them to a different specialty. Increasingly, we can change our treatment according to how we can stratify the treatments according to genetic information. Either about the bacteria, virus, or about the people we are treating. We can use genomic medicine to personalise how we how we treat because some people respond differently to the same drugs as well as to evaluate risks. So, I think there are lots of practical ways that we can use on a on a day-to-day basis where we can employ. And rather than just offering something as a treatment because you think that this is something that's been offered for a long time, it seems to work. Trying to really understand how it works, makes it easier to explain that to patients.

And with regards to non-invasive tools, I think that we're moving to an era whereby we used to offer everyone the same thing, but now we can identify people who are a lot more at risk of disease, and therefore more likely to benefit from having invasive investigation, or having a treatment, or managing their risk because we can, without having to be very aggressive with our investigation, identify those who are likely to specifically benefit the most. We can utilise our resources more effectively by using those tools because rather than doing lots of normal tests.

What do you enjoy most about your work?

I enjoy getting really involved in my own subspecialty area the most and then what following people up over time as you diagnose them and then initiate treatments and then seeing what happens ultimately, because of that treatment or intervention. And I feel like with gastroenterology, we have a specialty whereby we can do all those things. We can follow people up over a patient pathway in secondary care predominantly. However because I work in a subspecialty area in cancer genetics, I also deal with families and I really enjoy dealing with families because there is a dynamic in families that maybe isn't something that people tend to experience in other areas of clinical medicine outside maybe clinical genetics because we, we manage families over years and see people who were children when you first who are now adults. And also you see that families are all very different from each other and no two families are the same. And dealing with those dynamics, I think is very interesting on a psychological and on a practical level. I thought maybe it's something that's kind of reflected more in the sub special area that I work in maybe than other areas, but something that I enjoy very much.

If you could change one thing in gastroenterology, what would it be?

The one change I would make is that the needs of the workforce are evolving more quickly, and this means that trainees should be able to specialize more directly in gastroenterology, perhaps more than they have been able to in recent years. The needs of the gastroenterology workforce must be balanced with the overall needs of the NHS, which is an important consideration. There isn't necessarily one right answer, but I feel strongly that gastroenterologists should train in a more focused way within their specialty, possibly with less emphasis on other areas that might distract from this career path.

Having come from Ireland, where the healthcare and training system is differently structured, I’ve had the opportunity to see a different approach. I’ve now been in the UK for 24 years, and I still believe the opportunities available within the NHS are outstanding. The NHS is part of a highly integrated health system, which offers many advantages. Despite the challenges we face, even countries that are better resourced than we are look to the NHS with envy, particularly because we manage to maintain equity of access and standardize care in a way that prevents large pockets of poor care.

We need to continue evolving as a specialist society, taking full advantage of changes in technology and applying them more effectively. At the same time, we need to be more focused within our specialty training. For example, trainees should be given better opportunities to focus on areas like endoscopy at an earlier stage, without being sidetracked by other specialties like general medicine. However, this needs to be done in the context of managing the healthcare needs of the entire population, which is not an easy challenge.

What does being a BSG member mean to you?

I love being a member of the BSG. I've been to, I think every single but one BSG conference in the last 20 years and there are a few different reasons for that. One being that I love to meet up with Gastroenterology colleagues that I find Gastroenterologists generally are, you know, people are like along well with, good colleagues who don't take themselves too seriously, but do care an awful lot about their work.

I think the BSG has a culture which is consistent with those values, and the BSG provides many opportunities for people who want to develop themselves professionally through the sections or being involved in presenting academic work.

And I think that the investment that people make in the BSG is repaid multiply. I enjoy meeting with colleagues that I trained with, who have gone into different subspecialty areas. I wouldn't normally have any contact with, but being at the conference every year is great opportunities to meet up people. So I enjoy the academic aspects, the team working and the social aspects of being in the BSG as well as the career opportunities that it provides.

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