Our specialty guest interview features Dr Patrick O’Halloran this week, a GP now training in sport and exercise medicine (SEM) in Birmingham. This interest has taken him across the world as a doctor in sporting competitions such as the Commonwealth and Olympic games. We grilled him on his experiences to help you get a glimpse into this new, unique specialty.

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To start Patrick, run us through your CV, how did you get to where you are now?

I graduated from the University of Birmingham in 2011. I undertook an intercalated BSc in SEM at Queen Mary’s University of London during that time and combined that with studying for a qualification in Sports Massage Therapy. After graduating I completed foundation training in the West Midlands Deanery at the Queen Elizabeth Hospital and Worcester Royal.

I went on to complete my GP vocational training scheme in Bath and finished this in August 2016. Alongside this, I studied part-time for a Postgraduate Diploma in SEM at the University of Bath and am currently in the process of completing my research to make this an MSc.

I am now in the first year of the SEM Higher Specialty Training programme in the West Midlands Deanery. This currently involves working in A&E and I combine this with working as an out of hours GP and as the doctor for Academy players at Wolverhampton Wanderers.

I have always had a keen interest in teaching and research and recently co-edited an educational resource for medical students on exercise prescription with the FSEM. I have also provided medical care for organizations including Gloucester Rugby, British Gymnastics, BUCS, and at the 2014 Commonwealth Games and 2016 Olympic Games.

Why did you decide to complete your intercalated BSc in SEM at QMUL?

It was very much the subject matter that made my decision. A friend pointed the course out to me and as I read about it my interest grew. The course has an excellent reputation and excellent teaching staff.  I went to an open morning and was really excited by everything that I heard and the staff that I met. It was difficult to get exposure to this area of medicine at Birmingham so it seemed like a fantastic opportunity to get a broad exposure to the subject at a stage which would help me to tailor my learning and future training to give me the best chance to pursue a career in this field.

Doing this course was by far the best decision I ever made. It really ignited my passion for the topic. It was hard work but, because I found the subject matter so fascinating it didn’t feel that way at all.  It has provided a great foundation for the things I’ve done since. Being given the chance to drive a research project of my own helped me to find real enjoyment in research and to look for future opportunities to do more after that.

Why did you become a GP?

I knew I wanted to pursue a career in SEM from a very early stage and was fortunate to be training while the specialty was being formally recognized. I knew that there were several possible routes to follow, namely CMT, GP and ACCS. In my 4th/5th year of medical school, I decided to go through the GP training route.  I felt that this would be most suitable for me in terms of the training and the way general practice lends itself to having a portfolio career in the longer term.

I hadn’t done any general practice in my foundation years. Initially, I found it very hard. I moved to a new area and was working in a small, isolated practice. I struggled to enjoy it and began to see it as a “means to an end” to let me access the later training I wanted to do.

However, I moved to another practice for the latter part of my VTS and things really clicked. I was working in an excellent training practice which exposed me to the diverse range of challenges seen in general practice whilst allowing me to develop the skills to get to grips with them. I was lucky to have an inspirational group of trainers and fellow trainees who helped me to develop a genuine enjoyment for the art of general practice and to see the skills learnt as integral to my future career rather than as a gateway to further training.

I learnt from this experience that in general practice and probably lots of other areas of medicine, no two practices are alike and some will just be a better fit than others.

You’ve been all over the world as a doctor for various sporting competitions. What was the best trip you’ve ever taken in this capacity? Tell us about your highlights.

I would say the best trip has been looking after the GB men’s artistic gymnastics and trampolining squads during their pre-Olympic holding camp in Portugal. This key preparation before flying to Rio was a chance for the two teams to get ready for the games and to spend time in a fresh environment away from their main UK training base.

My role was to attend training sessions and be on call for the medical needs of both the staff and athletes. The work was like the day to day challenges of general practice but with the extra pressure of having the biggest global sporting event in the world just around the corner!

I really enjoyed this trip because the travelling party were terrifically friendly and it was enjoyable to spend time with them. Travelling under the banner of “Team GB” was very exciting and we met a lot of people on the trip keen to wish us luck and support the team. It was a great chance to learn from the other support staff (strength and conditioning coach, performance analyst, sports psychologist, physiotherapist) and allowed me to ask them a lot of questions to pick up advice to take back home and apply elsewhere. Both the athletes and staff at that camp were some of the best in the world so spending time learning from them is something I am very grateful for.

What’s been the most challenging situation you’ve had to cope with as an SEM doctor?

Personally, this would be a situation in which I advised an athlete and their coach not to play or train until symptoms of what could have been a serious problem had been further investigated. This was not a decision which I took lightly as it came at a key point in the season for both the athlete and their team. However, the seriousness of the symptoms was such that it was warranted despite the ramifications for the athlete. This was challenging enough but when that advice was ignored and the player was returned to training and playing things became very difficult. Having made it clear to all parties that this was an unwise thing to do I eventually had to stop working with that team.

What did you learn from your experience in the Rio 2016 Olympics?

Rio was probably the highlight of my sports medicine experience so far for several reasons. Not least because my family are Brazilian so having the chance to see them and explore Rio while it was welcoming the world was very special.

My role at the games was as a doctor for athletes of any country at the beach volleyball competition in the stadium on the beach at the Copacabana. It was spectacular in every way. The utilization of medical services by athletes at the beach volleyball was actually pretty low, partly because most of the nations involved were large enough to have brought their own extensive medical teams back at the athlete village.

However, I took quite a few important lessons from it:

It’s important to work out how to keep yourself in good shape for both the athletes and your own enjoyment. The hours are long and the conditions are challenging. It’s important to consider carefully what to carry and what your strategies will be to look after yourself physically and mentally.

The resources available to local organizing committees in other nations are variable. Medications, airway equipment, professional skills, the medical support provided are all different. In Brazil it is sometimes difficult for public hospitals to source adequate materials so the equipment that made it’s way to the Olympics was variable.  If travelling with a team “pack your own parachute” and consider how to manage tricky situations without relying on local services.

The skills of local medical staff will be different. Coming not long after the junior doctor contract dispute in the UK, I was interested to hear how poor the conditions were for our counterparts in Brazil. As a consequence there were not many doctors who were able to take time away from work to volunteer. This meant the team was made up of medical students, nurses, nursing students etc. and had a very different balance of skills and experience compared to what was available at the London Olympics.

It is important to find the right balance between enjoying the atmosphere and performing at the top level.

Google translate is the best thing since sliced bread.

What do you think are the most critical personality traits that a doctor should possess for a career in SEM?

For SEM, persistence is probably one of the most important qualities. The developing nature of the specialty means it is hard to find good information about how to get involved and what routes to take. There are multiple different routes into SEM and if you talk to 10 different consultants you will probably find 10 different pathways that have been taken. There are lots of resources out there to guide people who are interested but you need to be persistent and analytical to work out which direction will suit you best.

It’s also important to be academic.  We need to grow the evidence base in SEM, particularly in a sport where the evidence can sometimes be playing catchup when a new treatment becomes available (for example, with Platelet Rich Plasma). SEM physicians need to contribute towards research and be responsive to new developments in the evidence base.

An understanding of your own competence is probably the most vital trait. For example, there is a big demand for doctors to cover matches pitchside and it can be very exciting to be offered that role. Clubs, however, may not make the distinction between consultant and foundation programme doctor so it is important to think carefully about opportunities which are presented, whether you are adequately qualified and competent to take on those roles and be honest with yourself about the risks those roles might pose to you as a professional. Remember you are a doctor first and a doctor in sport second.

Do you think you will ever become a full-time SEM doctor? Does such a role even exist?

Yes, I hope to be able to work in the specialty full time eventually. There are many examples of doctors working full time in SEM although this is most often in the form of a portfolio career working for several different organizations through the week. It is more unusual to find posts which involve full-time work for one organization but more will probably develop.

However, this may not appeal to everyone and though there are opportunities for SEM Consultants there are also opportunities for GPs with a special interest to balance the two specialties.

As previously mentioned, alongside GP training you have been a doctor for all kinds of sporting events, from local rugby fixtures to international competitions. How do you keep a work-life balance when you’re so busy? What’s your advice to junior doctors at the start of their career about this?

I think the best advice I could give would be for junior doctors to get into the habit of really making best use of the PDP. When I was in the foundation programme the PDP part of the ePortfolio became a chore. However, I now believe that setting goals in the long and the medium term and planning backwards to say “so in the next year, these are the areas I’m strong in and these are the areas I need to focus on” has been most helpful for me in trying to head towards a better balance.

Finally, what is your number one piece of advice to junior doctors who are interested in SEM?

I’ve been very lucky to have had some excellent and inspiring mentorship from very early in my career and I would encourage anyone aspiring to enter the field to look for that. SEM is a very friendly and welcoming specialty. The fact that you have to hunt out opportunities to do it results in a very passionate and enthusiastic group of people practicing in the field and taking the time to find a good role model is, I would say, the best investment you can make.

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