The return of a physical ECCO Congress finally gave me the chance to interview people in person for ECCO News. So, after an early morning start, the outgoing Chair of Y-ECCO, Charlotte Hedin, and I sat down to talk about what led her into gastroenterology, the impact of moving country mid-career and the Y-ECCO Communication Toolbox, which has recently been made available on the ECCO e-Learning Platform.
Charlotte, have you always wanted to be a gastroenterologist?
No. My father is a retired eminent professor of gastroenterology and previous President of the British Society of Gastroenterology (Professor Chris Hawkey). So when I qualified as a doctor, the one thing I decided I was absolutely, definitely, never going to be, was a gastroenterologist.
So I got really interested in tropical medicine. The Oxford tropical medicine unit was kind enough to give me a small sum from the Wellcome Trust, so I joined a research project looking at pregnancy and malaria in Bangladesh. Ironically it involved rectal investigations of pregnant patients to measure the flow of the parasites in the rectal microvasculature (orthogonal polarisation spectral imaging). It’s really interesting to look at because women who are pregnant lose their natural immunity and become vulnerable to malaria again, as they were when they were children. This results in significant malaria mortality in pregnant women. So the project was looking at what has changed in the mother’s immunity because until they are pregnant, they are like everyone else and experience malaria much like a mild flu.
So what happened?
My then boyfriend, now husband, did not want to live in Bangladesh and was pretty keen for us not to have my career happen in a tropical country. So I ended up back in the UK doing infectious diseases as a UK-based doctor. I was initially quite keen to be a tropical medicine doctor, but rapidly realised that the options for that are very limited in the UK, mainly in just two centres.
Throughout this time I'd kept in contact with a gastroenterologist I had worked for at Whipps Cross in London, Elspeth Alsted. And throughout this time, when I was going backwards and forwards as to whether I was going to be a tropical medicine doctor or an infectious disease doctor, she kept phoning me up and asking me if I had a proper job yet. Unfortunately, I didn't get a training post in tropical medicine, so at that moment I was feeling quite kicked in the teeth by the world of infectious diseases, and I was then told that the interviews for gastroenterology jobs were in 2 weeks. Why don't you apply? And I did. And that's how I ended up being a gastroenterologist.
One of the things we do at Y-ECCO is support basic science research undertaken by Y-ECCOs with the annual Basic Science Workshop. Tell us about your research background. Did you always want to do a PhD?
I think whichever branch of medicine I was going into, I'd always been interested in having a research career. I guess having studied at Oxford, you're quite immersed in that sort of environment and meet a lot of people who have that clinical academic career. I think I'd always assumed I was going do a PhD and I'd grown up with it as well. Research was a big part of my dad's life and we did have his research fellows come round for Christmas dinner and things like that.
Then a PhD position was advertised in IBD. At this point I'd done mixed general gastroenterology, but had worked with some good doctors there who were keen on IBD. IBD and liver were the two bits of gastroenterology I thought the most interesting, and there was a PhD that was advertised with James Lindsay, Kevin Whelan and Andy Stagg.
And so I went for the interview, and talked to my dad about it, and my dad said that he had examined James Lindsay's PhD and he said to me, whatever this man is going to do is going to be brilliant because he is fantastic, and he was absolutely right. Not only that, but my other two supervisors turned out to be equally talented and really complemented each other. I was lucky enough that Kevin, James and Andy selected me as their PhD student and I couldn't really have asked for a better education in research and a better upbringing in terms of quality to make sure that the paper you produce is of good quality. And in all honesty, it gives me another arm to my career. It gives me another part of my life and another world to exist in that is outside of the clinics and you know, I value both of them very much, but I think it is very rewarding to be able to have both of those parts in your work.
You are British born and raised but now live and work in Stockholm. How did this come about?
After spending time with a false start in one career in infectious diseases and then switched tracks, I then switched on to research. I took maternity leave on several occasions, so I've managed to make my specialty training already take a very, very long time. So when I was a year off obtaining my completion of specialty training certificate, I moved to Sweden, which is where my husband is from. There are many things about that I would recommend and there are many things about that I would absolutely not recommend.
I think it's great to work in a different country. It's a real eye-opener. I think you learn a lot about your own practice and you learn a lot about assumptions that are made when you work in the same environment all the time. However, being a first year doctor again was not a great move in terms of career development. I couldn't speak Swedish when I first arrived in the country and I was pregnant when I moved and was on maternity leave for the first year, so during that year I learned enough Swedish to be able to work. But when I started work my Swedish was not great. So in a way I had to be junior again because I didn't have good enough language skills to be able to take on the responsibility of being a consultant at that point. But it does mean that I got my first registrar post in 2004 and I am not yet a consultant.
What does ECCO mean to you?
I am probably ECCO’s biggest fan. I really am. I think ECCO is a great organisation. Nearly everybody does it free of charge and yet people are very committed. It's an organisation of people who can and do regularly deliver excellence, people who genuinely care about the patients that we deal with and want to push forward projects to improve patient care across Europe. And then again, I think it's also a society or organisation that doesn't take itself too seriously despite all of that.
You are outgoing Chair – tell us about some of the things that Y-ECCO does for young members.
I wasn't involved in starting up the Basic Science Workshop, but I was an attendee right from very early on and the fact that we continue to deliver is something that I'm very proud of; I think gives a different platform to younger researchers.
Obviously, we also have finally delivered the IBD Communication Toolbox. It is very much within the Y-ECCO remit to generate a resource for trainees to use to improve their communication skills with patients. It's been a project that was in the making a long time before I even joined the committee and we have managed to put that together and it now exists on the ECCO Platform (https://e-learning.ecco-ibd.eu/course/view.php?id=96). The concept of the IBD Communication Toolbox is to try to capture one of the most valuable moments you can have in training, where you sit with a good doctor who really knows what they're doing. Listening to an expert in the field and hearing how they deal with patients’ questions is a great way to develop your own communication toolbox. We felt that there were elements of that that could be captured in a podcast.
So we then went and asked patient organisations to help us to put together some of the questions that are most important for patients, such as “What is dysplasia?”, "The drug I'm on isn't working. What should I do?”, “I want to get pregnant. How does my drug affect that decision?” Once we had honed down our list of topics, according to the advice from the patient representatives, we asked people who are eminent in the field to give a 10- to 15-minute podcast about how they would communicate about that topic with the patient. The emphasis was not so much on the data – there are other podcasts in ECCO that emphasise that – but more on how to communicate that data in a way that's relevant for patients.
So now you are stepping down as Y-ECCO Chair, we don’t want you to get bored. You have recently become an associate editor at the Journal of Crohn’s and Colitis (JCC). Tell me how you got involved with that and what are the challenges?
I was very happy to be asked to do this job in the autumn. It's a challenging job because there are a lot of papers submitted to JCC all the time, but it is a huge learning opportunity to be involved with the process, looking at articles and making decisions about them.
The biggest challenge, however, is that although there are very many people who would like to have their paper published in JCC, there are very few people, fewer than we need, who are prepared to do a review. It would be excellent if we could increase our pool of reviewers.
What would you say to a young ECCO, or even an older ECCO Member, who feels nervous about reviewing a paper or putting themselves forward?
I think it's very worthwhile reviewing. Firstly, it is educational in itself. You learn about what kind of research people are doing, and they can give you ideas for your own research. Even if you're not involved actively in research, it gives you an idea of what's on the horizon in our field. I think if you are involved in research and writing papers, by reviewing other people's papers you get better, you can anticipate things that are important to a reviewer before you even send the paper.
I do think it would be great if we had more resources to help people to develop their reviewing skills. In my institution at the Karolinska, we are setting up a course for doctoral students to learn to review papers, and I think a similar resource available to the ECCO Community, JCC readers, or perhaps more widely, would be really excellent.
Thank you, Charlotte, for sitting down with us today and sharing your story. Good luck with the next steps and we hope to see you back on an ECCO Committee soon!