Professor John McGrath, Head of St John's Institute of Dermatology, King’s College, London

AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.

Today, the subject is Professor John McGrath, head of St John's Institute of Dermatology, King’s College, London. Professor McGrath is also professor of molecular dermatology, and lead of the Genetic Skin Disease Group. He is internationally renowned within dermatology and an expert in epidermolysis bullosa. He also has a disease named after him - ‘McGrath syndrome’.

A podcast of this interview is available here:

 

How did you get to where you are today?

To get to where I am today has been a 30-year journey as a dermatologist. Before that I spent five years studying medicine. And before that I was a medical student, also at Guy's hospital. So I've actually been at Guy's since 1980. It seems like a long time, but that's my journey. 

 

What attracted you to dermatology as a specialty?

Fundamentally, it boils down to having an inspirational teacher as a medical student. There was one teacher who took a genuine interest in medical students, called us by our first name, and teased us gently. 

That might not be allowed today but it worked back in the 1980s. He brought us into the field of dermatology, thinking: ‘This is fantastic. This is a lovely profession with great people’. So he was inspirational to me. But not just to me. 

If you turn the clock back to the mid-1980s, about 30% of the UK's dermatologists, scattered around the UK, had all been trained at Guy's hospital. So this one mentor and teacher was truly inspirational to a lot of people. One can never undersell the importance of a great teacher in directing the careers of many people. So that was the reason why I became interested in dermatology.

 

Who was this dermatologist?

The famous dermatologist that got me, and many other people interested in dermatology, was called R. S. Wells. Those were his initials, but he was known as Charlie Wells. He was a wonderful teacher, and I have so much to be grateful to him for.

 

What are the biggest changes in dermatology during your career?

Dermatology has changed an awful lot over the last 30 years. When I first started, we had 60 inpatients. Now, we don't have any inpatients. We were predominantly looking after inpatients with psoriasis and eczema. 

We put patients with psoriasis into tar baths, gave them ultraviolet treatment, and then pasted products onto their skin - some of which were tar based, some of which were equally messy compounds. 

We had otherwise healthy individuals, in hospital, who were receiving these treatments directly onto their skin. Psoriasis in those days was thought to be a skin disease. One of the changes that has happened over the last few years has been the realisation that psoriasis is actually an immunological disorder, and the treatments have evolved to match that immunopathology. 

That immunopathology has started to be stratified and personalised, so we can give outpatient therapy that targets an inflammatory pathology, rather than the skin directly. 

My own field - genetics and dermatology - has also changed dramatically. Inthe last century, we were classifying and collecting patients - a bit like stamp collecting - describing them, and documenting them, photographing them, and thinking that one day, we will find some genes. 

Actually, that's what we've done now. The power of modern genomics has led to gene discovery, mutation identification, and a whole field of translational research, which is starting to benefit patients through the testing of new forms of therapy. 

If you go across every part of dermatology, you will see that modernisation, and a complete re-thinking of patients with skin disease, and how we can start to help them. That's what we're doing now - we're really starting to bring new benefits for patients, and that's wonderful. 

 

Where do you see dermatology heading?

Dermatology is at a crossroads. It's considered an ‘ology’, but an ‘ology’ encompasses all sorts of bits of science, and all sorts of bits of clinical practice. On the one hand, some people regard dermatology as very superficial - almost like a cosmetic or an aesthetic sub-specialty. 

There are people who will train in dermatology, and then who are drawn to that branch of aesthetic medicine - some of which people may believe isn't really medicine at all, but which nevertheless provides a service for those who feel that is an important part of their life. 

Within medical dermatology, what I see happening over the next several years is an embracing of technology and science and new pharmacology to try and help patients. 

For example, let's think about modern technology and IT, and Artificial Intelligence and Machine Learning. All of us have got used to using apps to identify flowers, or to read wine bottle labels, but that same Artificial Intelligence can now be applied to diagnosing lesions on the skin - so, if you have a pigmented lesion, you'll be able to diagnose it. 

You can combine that with Machine Learning and Artificial Intelligence to help you predict the future. Let's say, for example, somebody starts to get an early drug rash. You can take a photo of it, and then using the energy of that particular device, and all that intelligence that you've fed into it, you can then start to predict what's going to happen in a weeks' time, or two weeks' time. 

Is that patient going to have a trivial skin rash, or are they going to be in a life-threatening mess two weeks down the line? So, that's one side of medicine and dermatology I can see evolving.

The other main bit is: what are we doing with patients who have got these certain diseases in our clinic? Acne, eczema, psoriasis - these are the main conditions we see in dermatology. We're starting to get a better understanding of the disease pathobiology. 

We're starting to be able to stratify people into groups, to tell them about their disease course, about their optimal treatments, and hopefully to manage them in a much better way. 

The future is about trying to offer more bespoke therapies that help individuals, on the basis of accumulating knowledge and advances in therapeutics. So, it's a really exciting time to be a part of medical dermatology as we look to the next several years.

 

Could AI potentially replace some of what dermatologists do in the future?

The way that the technology is being developed, it's providing accurate diagnosis, and it has the potential to get better and better. For example, on some of the imagery and intelligence, it's used for predicting drug rash progression. 

The computer is much better than both consultants and residents in dermatology. The way I see a lot of those apps and that diagnostic information evolving is more as a primary care screening tool, or a societal screening tool - where people can look at something, get a rough idea, rather than just Googling loads of images on the internet. 

That's what people do, isn't it? When there’s  something wrong with you, you think: ‘What have I got?  I've got red spots on my forearm, I've got purple spots on my trunk. Are they round, are they square, who knows what they are?’ You Google away and you try to find something. 

So I think it will act as a better ‘Google sieve’ in terms of directing people. It will help GPs, and it may help to signpost people towards better specialist care. There is really so much pathology out there in terms of skin rashes, and every dermatologist would love to have a slightly smaller workload, or a workload where many of the patients are pre-selected for optimal use of specialist time.  

AI is not really a threat, but an evolution in technology, which is going to change practice for the better. So I'm happy about some of those developments.

 

What advice would you give to medical students and doctors interested in dermatology?

It's great that dermatology is a competitive specialty, because when I was at medical school it was thought to be one of the backwaters of professional training. In fact, a lot of students called it ‘derma-holiday’. 

Of course, it has changed somewhat over recent years, and in the United States it's the most popular residency programme to get into, with on average about 450 people chasing every residency position. 

In the UK it has also become more competitive, and so a lot of people are trying to nudge forward, and see what they can do to put themselves to the front of that queue. The main thing is to have a genuine interest in dermatology, and get as much exposure as you can. 

The British Association of Dermatologists has provided a number of incentives to help medical students. Not only with prizes and offers around meetings, but this whole ethos of a medical students’ training group or support group, to try and foster that initial interest, and make things open up for a career in dermatology. 

Students at King's are fortunate in having great attachments through St John's Institute of Dermatology, Guy's and St Thomas', and King's College, London, where there is amazing clinical exposure as well. 

So you have, hopefully, great teachers and great opportunities. The St John's Institute of Dermatology is also developing a lot of web-based support for meetings, for videos, YouTube channels, and all sorts of other educational aids. 

Many of us have also been involved in developing a European undergraduate curriculum with online teaching, blended learning, and web books. Having the opportunity to immerse yourself in whatever dermatological exposure you can get is the best way forward. Then, just keep your fingers crossed and hopefully you will make it.

 

How did you first become involved in research?

I think everybody has an individual story to tell. For me, when I came into dermatology, I thought I was just going to be a clinical dermatologist. I came in because I was fascinated by the intrigue of making diagnoses - seeing a rash, making a diagnosis, coming up with a treatment, getting somebody better. 

So when I was at medical school, I didn't do a BSc -I thought I was going to go straight towards a clinical career. I was fascinated by dermatology because of this mentor and teacher, Dr R. S. Wells. I managed to get an SHO position in dermatology at Guy's and St Thomas' and I did clinical work. 

Then I tried to get onto the resident training list at that time, and the job that was available was in Oxford. I interviewed for a clinical job in Oxford, but unfortunately didn't get it, so I had to come back to London. The only job that was available was a research position at St John's. 

I took it, because I wanted to stay in dermatology. And once I'd taken it, I suddenly discovered that I loved it, that there was a passion, and I was going to be wanting to do this for quite some time. So serendipity played an enormous part in my arrival into research in dermatology. 

Nowadays, there are some people who will have a much more structured approach. We're fortunate to have the Biomedical Research Centre, which can help some primers, in terms of getting people into research. 

There are many other opportunities as well - through a Wellcome Trust,  MRC, NIHR, and a whole host of other training programmes where you can get some exposure to research. For me, it was serendipity, pure and simple.

 

What are your current research interests?

My research is mainly to do with genetic skin diseases - people who have got mutations in genes that affect their skin. It can affect the way that the skin holds together. I study a group of conditions called ‘epidermolysis bullosa’, which means that injury to the skin causes blisters and poor wounds. 

That is a fundamental interest of mine. I’m also interested in lots of other skin conditions, including the ichthyoses - the scaly conditions that we have. When you look at all of these genetic skin conditions, you meet and manage to quantify unmet need. 

You see patients who are suffering, and you see a lack of decent treatments for patients. So, my research is really about understanding the biology and the molecular pathology of those diseases, and what goes wrong at a cellular level, and then using that information to try and develop some new treatment for patients. 

That might be just something straightforward, like repurposing a drug or a medication that's already out there that science tells us will benefit that patient. Or it's about taking on new technologies in terms of cell therapies, gene therapies, protein therapies, building clinical trials, and trying to take patients through to better quality of life.

The most important thing about doing research with patients is that you must listen to them, and find out what they want. It's all right for the doctor to say: ‘I want to do amazing gene therapy, get a paper in Nature, and be a fantastic hero for the scientific community’. 

If the patient says to you: ‘Actually doctor, I want you to improve my wound healing, to do something about my itching, to do something about my pain’, then that's where your efforts would be better directed. Listen to patients. That helps to develop your research ideas and your agenda. 

It changes all the time. New science comes along, clinical problems change slightly, the focus will change, and you need to try and move with that as well. Fundamentally, listening to patients and trying to help patients have a better quality of life is what drives my research, and the many other people who are also interested in this arena of translational research. 

 

Tell us more about epidermolysis bullosa.

Epidermolysis bullosa (EB) is a bunch of conditions that affect about half a million people in the world. They're all characterised by the same type of problem - where if you injure your skin - a bit of minor trauma to the skin - instead of that not causing any problem, the skin will form a blister. 

That blister may have slow wound healing, and it may be painful and lead to scarring. So, EB is a collection of diseases in which there is trauma induced skin fragility, and there is no cure at the moment. That's where I come in, as a clinician scientist.

 

What is McGrath syndrome?

I'm interested in discovering. If something hasn't been solved, then all of us with a curious mind want to find what's going on, don't we? When I first started in dermatology, and with an interest in genetics, we were just collecting patients. 

We didn't have the tools to work out what was going wrong with their skin. Then during the 1990s, new technologies came along. We were suddenly able to discover genes, sort them out in terms of mutations, and sequence them. 

Then, once you put all that technology together, you had a bunch of ‘gene hunters’. I would call myself a late 20th century ‘gene hunter’, where you can look at the skin, collect the skin, collect the blood, and use this emerging technology to try and identify genes. 

There was a great culture of gene hunters throughout that time, identifying genes, identifying mutations, putting genes and diseases together. Some of the diseases that were found hadn't really been described before. 

If you were lucky enough to have a new disease and to be able to use the technology to find a gene and a mutation, then it was a little bit like sticking your flag up the mountain. You could claim that one. 

That's where ‘McGrath syndrome’ came from - the first genetic disease involving desmosome cell, cell junctions. There are only about 18 patients in the world who have this condition, so you're unlikely to bump into somebody with McGrath syndrome in a clinic near you soon.

 

How do you go about identifying new conditions and the mutations responsible?

I am passionate about gene hunting, and the technology has changed so much over recent years. When I first started in research, people would spend their entire PhD thesis cloning one part of one gene. We started to use techniques called ‘candidate gene hunting’ and ‘genetic linkage’ to try and identify these mysterious genes that were out there. 

Then, over the last decade, everything has changed. We now have new technology. We have next generation sequencing, where you can take your DNA and you can put it into this amazing technology, and as long as you've got the capacity to filter it and analyse the data appropriately, you can get your answer out the other end in a much more efficient and speedy manner. 

This whole field of gene hunting has been mechanised and speeded up. I often liken it to the romance of some fisherman sitting by a river doing fly-fishing. That's the old-style gene hunting. 

This very slow process, which felt like a wonderful thing to do, has now been replaced by deep-sea trawling, where you take a net and you just push it along the ocean bed, and scoop everything up, and then you throw things out afterwards to try and identify something that's there. 

Both fly fishing or deep-sea trawling can yield you a catch in the end. I know which one was the more romantic, and which one is the more efficient now. For gene hunters, this whole idea of next generation sequencing has evolved. 

Most importantly, it's now made it towards diagnostic work in the NHS. We are lucky within Guy's and St Thomas' to be part of the National Genomics Hub, and I'm the lead consultant for the South Thames Rare Skin Disease Lab. 

We're offering a national service doing this next generation sequencing, so that everybody out there can get the mutations identified and begin to be directed towards better treatment, or at least translational research that will start to improve their healthcare. It's an amazing transformation in terms of technology, and most importantly, it's starting to have an impact for patients.

 

Regarding your interest in translational medicine, what are some of your current ongoing trials?

With our Translational Research Program, if we go back to those patients with epidermolysis bullosa, (EB), we found what's going wrong in their skin. For example, one form of EB is missing a protein called Type VII collagen, which normally anchors the outer layer of your skin - the epidermis - to the underlying dermis. 

There's no Type VII collagen in the skin. So what can we do about that, to try and get collagen VII back in the skin? There are lots of options - you could make the protein and inject it back into the skin. You could try to fix the genes by gene replacement therapy, or start to edit the genes to try and improve their gene function. 

Or you could add some cells into the mix which secrete Type VII collagen, keratinocytes, or fibroblast, or bone marrow cells. The research we're involved with is trying to think through that whole process of genes and cells and proteins and drugs, and work out which is the best way to test that in patients. 

Can we do a clinical trial? Can we then take that forward towards a therapy that can be prescribed by doctors in the clinic? 

For example, for this form of EB where collagen VII is missing, one of the most useful treatments that we've discovered in early phase clinical trials is to infuse some bone marrow cells called ‘mesenchymal stromal cells’, which are like fire extinguishers. 

They don't put the Type VII collagen back in the skin, but they mop up all the collateral damage that's there to improve the patient's symptoms. The skin is less red, the wounds heal better, the itching goes down, the pain goes down, and patients love it. 

So we've got early phase clinical trials completed, and then we've been able to move to the next stage, which is to persuade NHS England to put in a lot of money to do a much larger trial that's national, that involves placebo and crossover. 

Hopefully, from that platform we can then get to the next stage, which is to change the best practice in clinical guidelines, so that we can prescribe this for patients on a regular basis, so that it becomes part of their healthcare plan towards a better life, and living with EB in a more acceptable way. 

That journey is about my translational research plan - dealing with that unmet need to try and help patients with EB, and many other genetic diseases, to have a better life.

 

What research questions would you hope to answer over the next 15 years?

There are many questions that we would love to be able to answer. One topic that we have been working on at the moment is this whole field of gene editing. It seems so neat to be able to silence genes, or to repair genes, by making little holes in them and then putting in little templates of corrected DNA. 

It's really that feeling that you're almost treating a gene like a Word document, and being able to just cut and paste, or cut, according to what you need to do. More than that, being able to use the technology to change a typo, to change a single letter abnormality in your DNA through base editing, or this newer technology called ‘prime editing’. 

Being able to see this technology work in cells is a great ambition over the next year. Then to be able to think: ‘How can you get that from a cell in a Petri dish into a human being who's got these cells that aren't functioning well. 

Can you do that gene editing in vivo, to try and help the patient?’ That whole topic of taking technology and making it real for patients is something I'm very passionate about. 

Beyond that, I think we will see a lot more advances in research for patients. In my field of genetics, we're going to see cell and gene and protein and small molecule therapies advance forward. Even across more common diseases, for example something like eczema. 

Many people would have heard of atopic dermatitis or eczema, and they'll be thinking that dermatologists just put steroids and moistures onto that. That would have been true maybe just a few years ago, but technology is now splitting atopic dermatitis into a whole series of sub-diseases, each with their own profile of pathology. 

It's different in children compared to adults, it's different according to your ethnicity, there are skin barrier abnormalities, there are immunological abnormalities. Most importantly, there's a whole new range of treatments - of monoclonal antibodies, of small molecule therapies, of biologic drugs - that are coming out. 

Being able to use research tools to match the patient with one of these particular treatments is going to be really satisfying, both from a research point of view, and most importantly, from trying to help patients. So I see a huge amount of research going on that stands to benefit patients over the next several years, and I very much hope to be a part of that.

 

What advice would you give to aspiring clinical academics about how to be successful in research?

One of the key things when you embark on a research journey is that you need to have pretty thick skin. You will have successes and failures, highs and lows. So stamina and ‘sticking at it’ is important. I'd never thought that research was going to be the field for me, but here, 30 years on, it’s still my field, and I'm loving it just as much as I did all that time ago. 

So what is it that makes people like me think research is a good thing? I think it's to do with the people you meet. If you just finish up in a lab and have a dry project, and you're not interacting with many people, that's very sad and you're probably not going to love it. 

If you start a research career and you meet lots of people who teach you things, and you learn and grow and develop new interests around those new skills that you've got, I think that's fascinating. 

My suggestion for developing a research career is to be open, enthusiastic, to try and position yourself alongside some good people who can teach you, and then gradually your own skill-set will improve, and hopefully your interest. 

If you're a clinician who sees what unmet need is like, and you can see the route to getting there, then that research journey can be incredibly inspiring. We all need mentors. I have my own mentors. 

We all need a network of people who we chat to all the time, and we try to work together to make research an important part of our lives, and, most importantly, to do something for patients as well. So immerse yourself in a good lab - that's the way to succeed with research.

 

What are some of your proudest achievements?

I tend to be happy with a lot of things in life, and within my professional goals. I tend to think of short-term, medium-term, and longer-term achievements. When you're starting off in a research career it's nice to have a few short-term goals, to be able to publish a few little papers - it motivates you to move on. 

Then you start to think: ‘What do I need? I need to plan a little bit more into the future. I need to think about research which is going to be a series of questions rather than just one or two questions’. You start to go on a journey of getting funding, and getting projects, and working with other people to try and solve slightly more complicated problems and answer those questions. 

Then beyond that, there's always a bigger topic as well. I will not be really fully satisfied until I can see transformation in the lives of people living with EB and other genetic diseases. I want to be able to feel that my work, integrated with the work of so many other people, has been able to transform lives. 

So every time when I think the work is going well, I ask myself: ‘How have you actually changed the life of this person living with this condition? Is it any different from what it was five years ago, or ten years ago?’ Most of the time for genetics, it's not really changed a lot. 

So that is the motivation to keep going, and to keep planning, and to keep going to that next stage. I have to say that doing research is a curious and frustrating time, but every so often you have a little ‘eureka’ moment - it's like a massive endorphin surge. 

If you get one of those eureka moments, then you're just ready for the next one, and the next one, and the next. I suppose that's what research drives you forward to - trying to get personal success, but more importantly seeing the bigger picture. When you do that, suddenly 30 years have come and gone, and hopefully you will have had some sort of impact and legacy.

 

Have you had any setbacks during your career, and how did you overcome them?

I only got into research because I failed to get a clinical job in Oxford, and so that was a disappointment at that stage. After that, you try to apply for grants. I tried to get some funding from the Wellcome Trust and didn't get it. I then had to take an alternative route to build some career development. 

Actually, I was fascinated by a paper published by the Wellcome Trust that showed that people who had just missed out on Wellcome Trust grants did slightly better than the people who were awarded the grants. That's maybe because it’s a case of: ‘I'll show you guys just what I can do if you've chosen not to fund me’. 

That sort of bloody mindedness may be part of the journey. I don't know whether that's considered a good or a bad thing. As you go through academic life, you will have many more grant rejections than grant successes. 

You will have many opportunities where you think something is going well, where you’ve invested so much time and effort into something, and then you are disappointed. There is an obstacle, a hurdle that's there. Being able to deal with those sorts of setbacks is extremely important. 

Sometimes you will find the science doesn't go particularly smoothly. You can plan all these experiments, you can work a way forward, and then suddenly there is some technical or other block that means you have to double back or change tack and see where you want to go.

On a personal level, there may be things that go well - you might be invited to give various lectures, or you might get various mini awards. There are also lots of things that don't happen in your life in terms of awards and celebrations of your successes. So juggling all of these successes and failures is part of an academic journey. Having a thick skin is one of the most important aspects.

 

What gives you the greatest satisfaction in your current job?

I love being with patients a lot of the time. Talking to patients, listening to patients, and trying to work with them to help them, is still one of the most important aspects of my job. Patients come first.

Close behind them would be the young people who come to work in my department. Whether they are scientists, or medical students, or doctors - it’s about being able to build some training and a team around them, to try and inspire them to grow and develop and take on this journey. 

A lot of research is like a relay race, where you carry the baton for a while, and then eventually hand it on to somebody else. Actually, most of the time it feels like you're carrying the baton running round the backbend into a headwind. 

Occasionally you will cross the line first, but more importantly, it's to build that team of people that you can then carry forward into the next era of research. Patients, and the team that surround you, are very inspiring. Those are the sort of things that I would mark as motivational and successful. 

 

In addition to R. S. Wells, have you had any other role models?

There are many people in dermatology who have inspired me, and I am so grateful to all of them. There are far too many to mention - almost on a daily basis I bump into people who I find very inspiring.

Of course, there are headline figures who stand out for me. My very first job in dermatology research was in the lab of Professor Robin Eady. Professor Eady was very famous - partly because he was a dermatologist who worked on the pathology of EB in the very early days, but he was even more famous as a human being, because he was the world's longest surviving renal failure patient. 

He developed renal failure as a medical student, and then went for 27 years before he had a renal transplant. So his journey inspired me, and he was a very good mentor. After he had his renal transplant it meant that every lab outing we had to have a Chinese meal, because he could finally take all that salt that he had not been able to take before! 

What I really enjoyed about Robin was the way that he did things. He trained in electron microscopy. He trained me in a very precise way to do experiments properly. 

He was a bit mean and tight with the budget, so it meant that all the reagents in the lab had to be used optimally, but that was a good discipline. It taught me how to do experiments well, and, when writing manuscripts, to be very meticulous and accurate. I really appreciate Robin teaching me those principles of how to do research tightly and properly. 

I had another mentor when I went to do my postdoc time in the United States - a Finnish-American called Professor Jouni Uitto. Jouni taught me how to do things in an incredibly dynamic way. He was somebody who embraced life, and worked incredibly hard, and had a group that generated so much data. 

We were discovering genes on a Friday, mutations on a Saturday, and writing papers on a Sunday. It was that kind of intensity. Juoni taught me a lot of things about the passion for research, and the ability to get things put together. I was very impressed with that. Jouni also had some skills that I will never manage to do. 

When he used to write book chapters, he would just dictate them. Most of us sit for hours with the internet or books, trying to write book chapters. He would just simply pick up his tape recorder and start dictating: ‘This is Juoni dictating the dermis’. Then he would give an entire book chapter. 

That's something I aspire to do but I don't think I will ever manage to achieve that sort of greatness! So, in terms of mentoring, those two guys were very important to me. But my clinical colleagues, even the students and the visitors that come to my lab, and the patients, they all inspire me to try and do better and better, all the time. 

 

What important lessons have shaped you as a researcher and clinician?

The important point for being a researcher is to try and think: ‘Why are you doing this, and what do you want to achieve?’ In my case, it's about trying to build a better life for patients whose quality of life is really impaired. 

It's recognising that unmet need and wanting to do something about it. Then it's about: ‘How can you do something about that?’ Trying to set a realistic plan, short-term, medium-term, and long-term. To create an impact that will help change those lives. 

So stepping back and thinking about what you want to achieve is very important. We all get caught up in the day-to-day rush of life. It's very easy to start chasing mini problems all the time. As a researcher it's your duty to step back every so often, and just survey where you're going, and how you're going to do it. 

‘Less haste, more speed’, some of the time, and thinking about what you're trying to do. Always having that goal of thinking of a patient who has a real problem. Always in my mind are images of my patients with these terrible conditions. 

The driving force to getting the research done, to making all those plans, is trying to think: ‘How could that skin be different, and how could I make a difference to that person's life? That's a very strong motivation to keep that research ethos and focus as it should be. 

 

What advice would you give to medical students and junior doctors to have a fulfilling career?

What is the secret to being a great medical student and a successful doctor? Well, my view on medical school may be slightly controversial, because I know that many students have undergone massive curriculum changes, and of course with the pandemic many people have been forced to work from home.  

My view on medical school is that it has about 1500 days to condition you to act and think and behave like somebody that society calls a doctor. What that really means to me is it stresses the importance of practical exposure and experience. 

I think you learn medicine just by being somewhere and absorbing whatever's going on. Of course, there are facts and tests and other things that you have to do along the way, but so much of who you become as a doctor depends on the experiences you have. 

We all know as medical students you will have good and bad experiences - you will bump into somebody who seems to be very helpful, and somebody else who is grumpy and unhelpful. These are all actually positive experiences - you are being conditioned to act and develop as a doctor. 

All those times you turn up for an outpatient clinic and the doctor's busy, or you only see a patient or two, and think: ‘Was that a very efficient way of learning medicine?’ I would say it is. 

This is because you are seeing so much just by watching the interaction between a patient, a doctor, a nurse, what's going on in the waiting room, what's going on in the corridors, just absorbing everything that's going on there. This is why I feel that the pandemic has been bad for medical education. So many people at home, so many people out of that exposure - that place where you absorb lots of activity.

My advice to medical students is, when you're allowed to, just get yourself on campus, get yourself into situations where, like a sponge, you can absorb everything that's going on around you. You will then filter it in terms of what's good and what's bad, but it's all shaping your career as you move forward. 

One of the good things that King's has done over the last several years, is to develop the Personal Tutor system, by hooking up medical students and other students with more senior people, and building a relationship over several years. When that works, it can be really powerful in developing a framework, a backbone, and an ethos for becoming a medical practitioner. 

I have been lucky enough to supervise many students in that tutor capacity over the last several years, and some of those students have learnt so much in my lab. They've worked as summer students, and they continue to attend my lab over this period. 

Sure, they do some research, but I also take the opportunity to try and develop their personalities and their careers, and help shape all of those things that I think will turn them into great doctors. Hopefully, that will stand them in good stead - or at least that's what they tell me once they've been through the system -and I hope it does work for them.

Exposure and experience are the most important factors in anyone's training. Hopefully, that can be helpful to people in thinking about what they should be doing, and that's a good way forward. 

 

How has having experienced so many different cultures shaped you?

I truly do feel that I am a citizen of the world. I feel lucky to have grown up in many countries. Growing up in Japan in the 1970s, in Australia when I was a teenager, and then many other countries - it's been wonderful. 

I've also been lucky enough to be invited professionally to lecture in dozens of countries all around the world. It's a real joy and a pleasure to do that. I feel that just building this team that we have - a network of people who have similar interests - does help you as an individual. 

It gives you some satisfaction, some purpose, some focus - realising that there are lots of other people who think and work like you, and have the same motivation to try and help patients with similar sorts of illnesses. 

I love all of that international exposure, and collaboration. You realise that people around the world are pretty much the same - we all have the same worries and aspirations. Hopefully, we all have the same eventual benefit for our patients. And that's why I love being an international researcher. It's great fun. 

 

Tell us about your passion for gardening, and your own variety of sweet peas in particular.

I love gardening. I've always been a very keen gardener. And let me start by saying they're not called ‘McGrath sweet peas’ - it's not an eponymous sweet pea. When I was a medical student, I used to grow a lot of sweet peas. 

It’s a wonderful thing to be growing, because there's so much work you have to do in preparing the soil, nipping out the buds, growing a single cordon, taking out the side shoots. All to get these blooms that you can then enter into various shows and win prizes. 

So maybe there's some competitive element to why I was interested in gardening. Why sweet peas and why myself? I worked with one of the companies that manufacture sweet peas called Kerton Sweet Peas in Bridgewater. 

They had a new variety that they were looking to name, and because of the EB work that I do, I encouraged them to name it after one of the major patient support groups called DEBRA - the Dystrophic Epidermolysis Bullosa Research Association. 

They kindly did that, and then we saw this sweet pea move through clinical trials - they have the same clinical trials that we have, called the ‘National Sweet Pea Trials’. Eventually it’s decided who makes it at the end. This sweet pea called DEBRA made it through certain rounds of national selection, but in the end didn't quite make it to the final show benches. The main fault with the DEBRA sweet pea was that it developed blisters in wet weather - how ironic is that? 

So I've been passionate about sweet peas, but I'm also passionate about lots of other gardening. These days I'm more of a begonia person - I exhibit begonias as well - but that's another story for another time.

 

What's your favourite book?

I love reading, and I love novels. My favourite author is R. Austin Freeman, who writes medico-legal detective stories that involve a doctor called Dr John Thorndyke.

He’s like a Victorian Quincy, being able to solve these particular problems. It's so well written. I love reading those sorts of stories. One day I would love to be like Dr John Thorndyke.

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.