Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
We expect Nobel Prize winners to be high profile researchers of almost celebrity status, pioneering cutting edge science that changes the world at a stroke. And, then I heard that one of this year’s winners was William C Campbell, a fellow Irish man. I didn’t recognise the name, was unfamiliar with his work, and knew nothing of his background. But, as the media story broke, I learned more about him. He came from Ramelton, a small village in County Donegal, far from the bright lights and, like many Irish doctors, undertook his graduate work in the US. His research was in worms - not the type of glamorous cutting edge clinical science that features in glossy magazines but, from the messy world of vials and dishes and parasitic roundworms kept in the freezer.
“You must be kidding!” was his reaction, when telephoned with the news.
But, his findings did change the world. Not our convenience world of high technology based medicine, but the lives of many millions of ordinary people living in in the developing world. He was part of a team that developed Ivermectin, a treatment for Onchocerciasis (River Blindness)- a condition that covered just over one page in my undergraduate medical textbook, and a topic I probably ignored as unlikely to feature in exams. Let’s salute the achievements of one who changed the lives of so many, whose unglamorous lifetime’s work could easily have been forgotten even in the country of his birth, and who has gone from unsung to hero in a single stroke of a Swedish pen.
Unglamorous specialties seldom achieve Oscar-style notoriety. Just as Nobel Prizes are unlikely to be awarded to your local geriatrician, community psychiatrist or family doctor, the quiet champions in the background of medicine are rarely singled out for stardom. Yet, their contribution to the health of individual patients requires as much dedication and commitment as any scientist- without the international travel, high profile research publications nor celebrated keynote addresses. Their scholarship too may also go unrecognised. And, I was reminded of this when reading a book I recently received in the post. It is a work of considerable erudition and endeavour, reflecting the contribution of a colleague who not only devoted his life to medicine but has made a major contribution to postgraduate education. It looked like a textbook but it was much more than this; it was the work of a man who dedicated his life to patients, who valued his vocation and, most of all, loved teaching the next generation.
“Are you interested in Chronic Disease?” he asks. "Unglamorous, maybe, but perhaps you should be… especially if you are a patient, a carer, a physician in hospital, or community practice, a nurse, a physiotherapist, a social worker, an occupational therapist, a manager who commissions or administers health services, a politician, a health economist, or are involved in training for these social roles or professions.”
And, this is the world of chronic disease - the messy complicated frustrating teary jigsaw of everyday life where the needs of those with long terms conditions are, primarily “to live ordinary lives”. This is a book embedded in practice and every GP will identify with this picture he describes “Now doctor, before I go…it’s about my mother; she’s not been able to come in herself. She’s a lot worse and I can’t cope with her”, and how this consultation leads into exploring the management of every unfashionable aspect of medicine- and, that the current ten minute consultation can no longer sustain such care. There are no solutions, as many of the problems associated with chronic disease are insoluble but, it’s a guide to help us use our emotions as a diagnostic tool, understand the suffering, and manage the messiness of chronic disease in the real world. He brings us to the bedside of patients with chronic disease, explores the first steps of postgraduate training as junior doctors being to negotiate the complexity of general practice, and shares the wisdom of a lifetime of care.
Lightning doesn’t strike twice in that North West corner of Ireland and I doubt if Paddy McEvoy, need wait by the phone for a call from Stockholm. His book, “Chronic Disease Management” is, however, a monument to his own achievement, and a permanent reminder of his commitment and contribution to another unglamorous part of medicine. A wonderful book from a quiet, humble yet most impressive colleague. A star.
Author's disclosure: I have known Paddy McEvoy for many years. I will not benefit in any way from promotion of this textbook. “Chronic Disease Management” Radcliffe Publishing, London2014 ISBN-13:978 190891 156 8