Dr Nick Talley: No Guts, No Glory

On September 11th, Dr Nick Talley, co-author of the OSCEs bible, ‘Clinical Examination’, presented a talk at the Society of Medical Innovation and Technology’s inaugural event: Innovation in Health Speaker Night.

“Variety,” Dr Talley believes, “is the spice of life”.  Whether he’s returning from an international medical conference in Washington D.C., attending gastroenterology clinics at the John Hunter Hospital, presenting a talk to more than 100 students about innovation or spearheading the Medical Journal of Australia as editor-in-chief, Dr Talley is one of Australia’s most influential voices.

An extraordinary career  

On Australia Day, he was named a Companion of the Order of Australia (AC) – the nation’s highest honour. He is ranked as Australia’s top scientist according to Google Scholar Citations. With over 1,000 publications and more than $10 million in grants, Dr Talley is leading the world in neurogastroenterology research.

Dr Talley is leading the world in neurogastroenterology research.

He graduated medical school at the University of New South Wales in the class of 1978. For forty years, he has paved a path for himself that is nothing but extraordinary. Pursuing his passion, Dr Talley trained as a gastroenterologist at the Royal North Shore Hospital; whilst, simultaneously completing his PhD in gastroenterology.

And, it would be an understatement to say he is active in the medical sphere. From co-directing a research program at the renowned Mayo Clinic, to presiding over the Royal Australasian College of Physicians, to chairing the Council of Presidents of Medical Colleges, Dr Talley has helped shape and define major medical institutions across the globe.

Unlocking the secrets of the human gut

Dr Talley has also thrown himself into his research projects. His team has discovered a breakthrough in the world of gastroenterology. He noticed that a common presentation was unexplained epigastric pain which most people believed was a functional disorder. Dr Talley and his team investigated and have become instrumental in discovering an organic cause of this symptom associated with increased duodenal eosinophils.

“It took a little bit of time for me to understand how to do research and how to get excited about it because it’s a process – you have to learn it.”

He is also researching whether primary gut mechanisms involved in the development of irritable bowel syndrome (IBS) are drivers for psychological distress such as anxiety. Linking the diverse fields of neurology and gastroenterology, Dr Talley and his team believe that gut inflammation can also lead to changes in the brain. Suppose they find their answer, then the next step would be to consider the use of IBS treatment for other mental and neurological diseases. There are definitely interesting times ahead. But, in the meantime, Dr Talley and his team are set on probing for answers in the puzzle that is the gut.

The Ductus team were fortunate enough to ask Dr Talley some questions! Read our Q & A below.

Clinician. Researcher. Educator. How do you balance multiple hats in your career? Do you have a favourite of the three?

I love teaching. In fact, I like teaching more and more as I progress. There’s something exciting about talking to people who are interested in what you are trying to impart, and I can learn an awful lot from the interactions. I wish I had time to do more actually.

It took a little bit of time for me to understand how to do research and how to get excited about it because it’s a process – you have to learn it. You can ask questions, but you need to know how to answer them. But once you understand how to answer them, it’s really exciting seeing new data for the first time.

Clinical practice is great too, but I don’t think I’d enjoy doing it seven days a week. I also have a family and I like to see them and do other things, so it is hard. All I can say is it is never perfect and you just do the best you can.

So, when did you start to do research?

I didn’t start research in medical school; although, I was interested in it, which I kind of regretted. Then when I was about three years post-grad, I took a break from fulltime clinical medicine and training and actually did research. And that was very fortuitous. I like the idea of answering clinically relevant questions. Subsequently, I’ve learned more about basic science and the interaction of basic science and clinical science.

“Students should do research and I don’t think it should be seen as an add-on or an optional extra and not really relevant to be a doctor.”

While we’re on the topic of learning, do you think medical schools are adequately preparing students for the future?

I think medical schools are doing their best. I have no doubt that the core skills medical schools teach are going to be relevant to practitioners, but many of the things being taught will probably go by the way side at some point. I think medical students, like all professionals, will need to be prepared to re-train regularly throughout their career.

I think students should do research and I don’t think it should be seen as an add-on or an optional extra and not really relevant to be a doctor. And I think everybody needs to interpret the literature because it keeps changing, and you can’t be out of date in practice.

I am also extremely distraught about medical student and doctor suicides. I just want people to be aware that it’s never smooth sailing for anybody all the time. Be prepared for those difficult times. We all face them in all sorts of ways. And if you do face these hard times, talk to someone. Having a weakness is not actually a weakness. It’s not. It’s just being human, and we all have them. I am really hopeful that doctors can reach out to their colleagues and talk to others.    

Reading medical journals is certainly of one way to keep up with the rapid pace of change in medical practice. What does your role as the MJA editor-in-chief involve?

My job is to set the vision and direction of the journal, which I’ve worked very hard to do for the last three years or so. My job is also to ensure that every issue we publish is high quality and all the things you would expect it to be. I do help review articles in what we call the hanging committee, which is when we all sit around a table twice a week and look at articles that have come in and we make a decision if we will progress them or not. The best journals in the world have similar hanging committees.

We also have an issue planning meeting where we plan issues ahead as we work out what we will commission and what topics we want to try and encourage people to send us or write for us about. It’s a busy job. I do a lot of it afterhours. But I enjoy it and I feel I am hopefully serving Australian medicine by doing so.

Speaking of journalism, the health of asylum seekers in Nauru has made headlines around the world. What are your opinions on how we are handling the situation?

I think it is a tragedy for the individuals involved and, frankly, I think it is a black stain on us as a country. I feel we have really failed to act in a humanitarian and appropriate way.

I know there is a recent letter that has been written by a couple of doctors, also supported by AMSA and many other groups, which has been sent to the Prime Minister. I think 5500 doctors or more have signed it. I applaud the medicals students and the doctors who have stood up.

“It [the refugee crisis] is a tragedy for the individuals involved and, frankly, I think it is a black stain on us as a country.”

I think doctors have a moral obligation to not sit on our hands and ignore this. If we don’t say anything, in a sense, we are condoning what is going on, even if it’s morally reprehensible and that’s not an acceptable stance.

Eventually, the policy will change. People are going to look back and be outraged that this happened in history and the trouble is that we are living it in the present. I remember when I was in the college, I lobbied when I was the Chair of The Council of Presidents of Medical Colleges. I went to the government asking to go visit but they chose to ignore it. It’s very frustrating. We are not interested in politics, we are interested in people’s health and wellbeing.

Switching gears to the future of medicine: What are your thoughts on artificial intelligence?

AI is one of those revolutions that is occurring without us quite seeing all the implications. You can visualise the idea that a computer will be much better at interviewing and recording information than history taking done by a doctor. The way AI is data can be both integrated and brought from many different sources, to be interrogated by AI. And then new ideas, new hypotheses, new concepts and, perhaps, new facts can all emerge from that kind of research. Researchers will certainly be supported by computers.

And then you can see computers teaching students. You won’t need a teacher in front a classroom. In practice, pathology may be read by computers. And, you won’t need radiologists. You can see some specialities perhaps even disappearing.

This is all the extreme end, and I suspect it won’t quite happen the way I am saying but you can see that it will be cheaper to do it this way. So, when it’s more economically viable and better, then well, it’s a disruptive innovation. And disruptive innovations always win. Always.

Now to finish off, what do you feel has been the most unexpected accomplishment you have achieved?

I’ve had some fantastic moments in all the things I have been doing. As I said in research, finding something new is always really exciting and even if no one else cares about it, I care about it. Diagnosing somebody who has got a difficult problem and being able to help them is a fantastic feeling and I have had that multiple times. But also teaching people and having people say they got something out of it is wonderful too.

“I remember telling people I was writing a book and they laughed at me.”

But, I guess the most surprising accomplishment was getting my book published. I remember talking to people at the time. I was very junior. I was very raw. I didn’t care either. I remember telling people I was writing a book and they laughed at me. They said no one will publish it and even if they do, no one will read it.