Dr Philip J Smith is a Consultant Luminal Gastroenterologist and Honorary Senior Lecturer at University of Liverpool, Royal Liverpool Hospital, Prescot Street, Liverpool, UK.

What attracted you to a career in gastroenterology/hepatology?

To a certain extent, gastroenterology chose me! I was diagnosed with Crohn’s disease as a teenager and had lots to do with Gastroenterologists and surgeons (and other excellent health care professionals) and from that, my interest has grown and grown.  I talk about my experiences here on a BSG podcast for those who are interested.

What advancement in gastroenterology/hepatology are you most excited about and why?

I work as an Associate Editor of Frontline Gastroenterology and the Education and Digital Editor of Gut so I see lots of regular advancements that are published and reviewed for those journals.  It is difficult to choose a single advancement, as the specialty is so diverse that there are too many to choose from. Broadly though, I think the understanding of the microbiome in health and disease is growing and is really exciting.  It is also exciting how many new therapies are available for IBD patients now, there are so many new treatments in the pipeline. When I was first diagnosed, it was just steroids, unpalatable enteral nutrition, and Azathioprine really!

What do you enjoy most about your work?

Is it too ‘cheesy’ to say, looking after and meeting patients? That is honestly the best part and I am sure many would agree with that sentiment.  However, I love the diversity of the job: acute vs. chronic disease management, complex vs. more straightforward situations, the opportunity to be very subspecialised vs. more generalist, the huge opportunities for research and/or quality improvement, and being able to work as part of a multidisciplinary team (MDT) of nurses, pharmacists, dietitians, psychologists, and many more crucial people.  Finally, if that wasn’t enough, to have the opportunity to do procedures that can not only diagnose but also treat conditions is fantastic too. In short, I have never been bored.  My areas of interest are IBD, intestinal failure, and adolescent and young person transition (from paediatric to adult care). I like these areas as they fit together nicely (clinically and research wise), plus I feel great empathy with these patients particularly – some of them struggling day-to-day dealing with their often complex conditions supported by a MDT of health professionals. I have been fortunate enough to have been able to work in these areas, develop services, and publish in all of these areas. I have worked with, and for, some great people too.

What is the one thing you would change?

Honestly, my enjoyment as a Gastroenterologist is determined mostly by whom I am working with and the conditions I am working in. It is as simple as that. I have worked in incredibly hard situations, but because I have been with a great team (like the team at the Royal Liverpool Hospital where I work), it has still been enjoyable. I wish that those who take up leadership positions and roles recognised this more in the NHS – treating staff well, listening to them, and responding to concerns is so important. Listening to good people who have a proven track record of success is essential too. So, if there was something I would change broadly, it would be how staff are looked after – real wellbeing won’t come from claps or Pilates classes that few people can attend, but by truly respecting staff. This is important in my opinion as happier staff (that are not burnt out), can deliver even better patient care in the long term. There are other things I would change (such as the recent two tier system developed by NHS England and others in the recent Intestinal failure tender), because I think they will damage the attractiveness of some subspecialty areas in the future and worsen existing healthcare inequalities, but I could fill pages of text with my thoughts on this!

What’s the best advice you’ve been given in your career?

I am lucky in one respect that I have met and worked with some great people – some peers, some people more junior, and much more senior than me.  I have never had a specific mentor to give me opportunities (and open doors for me that otherwise would have been closed) in the way I have seen colleagues who have great mentorship (which is great for them and the way it should be), but I have had some great support from very specific people who have supported me and given me good advice through the good and bad times – they know who they are (at least they should do)! I have also met some horrible bullies on ‘my journey ‘ too – they should know who they are too! My family and parents have been amazing throughout all my training and given love, advice, and support as best they could. Together they told me to stick with good, honest people (avoiding those who introduce toxicity into my life – I have learnt the hard way with a few people) and always remember ‘to thine own self be true’. This has been great advice which has enabled me to sleep at night even when I have had to speak hard truths to powerful people. However, my best advice has come from my amazing wife and best friend, Beverley, who is a superb Paediatric Rheumatologist in Liverpool. We were 18 years old (and in the first year of medical school) when we started dating, and now we are both 40 years old and still as strong a team as ever – she is my rock. She has supported my career and all the opportunities I have been able to pursue, propped me up when I needed it (post surgery usually), ‘bollocked’ me when I needed it, in order to get perspective and motivation, but most importantly she has reminded me what is important in life, especially given my chronic disease. At times, I have lost sight of that.  She tells me regularly, “Philip, it is only a job” – she is right, and despite my love of all things ‘Gastroenterology’, they pale in significance to my love for her and our beautiful daughters Genevieve, Gabrielle, and Celeste.

What does being a BSG member mean to you?

I did not know anyone in the BSG or really in Gastroenterology before I started training to be a Gastroenterologist.  However, I was so excited to become a trainee I wanted to give as much back as I could to the specialty. In the era of ‘Trainees in Gastroenterology’ (TiG), I played a key role as the last ever chair of TiG in joining and developing the BSG Trainees section. I became secretary and chair of the BSG Trainees section and developed many of the courses that the section offers now (in their current guise at least), and personally developed the BSG Taster Course in Gastroenterology, which is one of my proudest achievements. I have loved being part of the BSG and have either sat or been involved in some capacity with almost every section of the BSG and all the respective committees through being elected. I have presented and chaired sessions at the BSG and helped devise many new innovations you now see – from its social media use through to the awards it gives to members. I have won a number of BSG prizes and was very proud to receive the BSG President's Medal also – the first time it was ever given to a trainee, alongside my good friends Dr Alenka Brooks and Dr Chris Lamb. I am proud of the charitable work I have done for the BSG and with its sister charity Guts UK (previously CORE) – personally developing the ‘GastroCycle’ charity events – this was my way of giving something back to research and researchers trying to get better treatments for patients with chronic GI disorders. I am now an elected councillor of the BSG and proud to represent the views of the membership as best and honestly as I can. I have made so many friends across the UK via the BSG, which I treasure. In short, being a very active member of the BSG has been fantastic and an essential part of my development as a Gastroenterologist. I am proud to fly the flag for the BSG whenever I can. I strongly encourage anyone who wants to get involved to do so – if I can do it, so can you!

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