A landmark appointment for obstetrics and gynaecology
By sa | December 19, 2018 | 0
Dr Cliona Murphy, Consultant Obstetrician and Gynaecologist in the Coombe Women and Infants University Hospital and Tallaght University Hospital, Dublin, was recently appointed the first woman Chair of the Institute of Obstetricians and Gynaecologists in Ireland in its 50-year history.
Dr Murphy qualified from University College Cork in 1993 and did her internship the following year between Cork University Hospital and Mallow General Hospital. She initially decided to specialise in surgery and, at the time, Cork was one of the first areas in the country to have a defined three-year surgical training scheme.
She obtained her Fellowship in Surgery in 1997 and an opportunity to work with Consultant Obstetrician and Gynaecologist Dr Andrew Curtin steered her in the direction of what would be her chosen specialty.
Surgery's loss was obstetrics and gynaecology's gain and following training in Cork, Limerick and Dublin — Dr Murphy served as Assistant Master to Dr Mike Robson at the National Maternity Hospital, Holles St, in 2008 — she was appointed to a permanent post in the Coombe Women and Infant's University Hospital in 2009.
She served as Ireland representative to the Council of the Royal College of Obstetricians and Gynaecologists (RCOG) from 2012 to 2016 and was Head of the Gynaecology Department at Tallaght Hospital from 2012 to 2016.
Dr Cliona Murphy
In September this year, Dr Murphy was appointed as the 18th Chair of the Institute of Obstetricians and Gynaecologists in Ireland. She took over the chain of office from Dr Peter Boylan and will be Chair for a three-year term until 2021.
On taking up the Chair, Dr Murphy said: "I would like to pay tribute to my predecessor, Dr Peter Boylan, for his outstanding contribution to women's health in Ireland and his dedication to the Institute of Obstetricians and Gynaecologists over the past three years."
Commenting on her appointment as the first female Chair of the Institute, Dr Murphy told the Medical Independent (MI) there was a certain amount of "inevitability" to the move.
"I think it was inevitable; it is not that I am anything special or anything like that, it is more that now an awful lot of consultants who are appointed are women, so I think there was an inevitability to it," Dr Murphy said.
"A generation ago in my mother's generation, very few women went into consultant posts because of the marriage ban…there has been a big shift in society and in fact a lot of the deans in the other societies now are women. So I think it is that society has changed; there are more women in the workforce and more women are consultants."
When Dr Murphy herself was training to be a surgeon, she said there were few female surgeons; however, she said she didn't feel that she was treated any differently.
"I suppose looking back it was quite traditional, but if you worked hard and you did your work, that was what mattered."
She said she found obstetrics and gynaecology "less hierarchical" compared to surgery and she credited Prof Patricia Crowley, former consultant obstetrician and gynaecologist at the Coombe, as someone who was a positive role model for many young female trainees in the specialty at the time.
Dr Murphy's priorities as Chair of the Institute for the next three years include: The implementation of the national maternity strategy; focusing on the quality and accessibility of gynaecology services; and the recruitment and retention of doctors, nurses and midwives across the health sector.
She also said "the recent historic vote to repeal the Eighth Amendment requires implementation, underpinned by resources. The Institute is committed to playing a key role in its implementation".
Dr Murphy advocated for a 'yes' vote in the recent campaign to repeal the amendment to the Constitution.
For a profession traditionally known to be reasonably conservative, the fact that more than 1,000 doctors lent their voices to the campaign as part of the 'Together for Yes' group sent a powerful message.
Dr Murphy explained that, like a lot of her colleagues, she was reluctant and unsure as to whether or not to get involved in the campaign. "We felt our role was in giving medical evidence, giving the experience that we had seen in our working lives and trying to give a voice for some of those women who would not be strong enough to stand up and give their personal stories," she said.
According to Dr Murphy, the Institute is currently in the process of drawing up clinical guidelines for the provision of termination of pregnancy services and she expected them to be in place in time for the planned introduction of the service in the New Year.
However, she said it was challenging to draw-up clinical guidelines in tandem with the legislation, as usually there would be a time lag between the enactment of legislation and the introduction of a new service.
While the Institute is drawing-up the clinical guidelines, Dr Murphy said that the model of care was being developed by the HSE with input from the Institute.
Dr Murphy said it was currently difficult to predict how many women would need secondary as opposed to primary care for an abortion.
"The idea was that most of it would be medical care in the community; a lot of that depends on how many GPs are able to provide the service either due to work or personal values, so there is that," according to Dr Murphy.
"Another is what gestation women in pregnancy are going to be presenting at. If they are over nine weeks, they are very likely to need to go to the hospital and then there is a bit of work being done as to Rhesus, if you are Rhesus-negative, whether you will or won't need to go to the hospital. So, there are a few things that could change the patient flow and requirement to go to a particular hospital."
Once a woman is admitted to hospital for a termination, they will have the option of taking medication or undergoing a surgical procedure. Dr Murphy said ideally, there would be more medical than surgical terminations, as that would be safer for women. However, she said it was difficult to know until women presented for care.
"We have a fair idea and there are preparations being made; numbers-wise, we really won't know until we are a few weeks in… so it will be an ongoing review as to whether we are providing what people need."
Educational need
There is also an educational need for obstetricians and gynaecologists in Ireland who wish to provide the service.
Dr Murphy said that the Institute held a training session in September with the support of the RCOG and more were in the pipeline for the coming weeks.
It is expected that like other specialties, such as GPs, obstetricians will have the option to opt out of providing a termination of pregnancy service as conscientious objectors. However, if they conscientiously object, they must refer the women on to another colleague in a timely manner.
"I think there is a spectrum. I think there are some people like myself and colleagues who will say 'yes', I will be involved and there will be others who maybe will want to see how the service starts," Dr Murphy said.
"There may be a certain discomfort and there are some who have a big difficulty with it. I think one has to acknowledge that there is a spectrum there and there is an anxiety again among some as to resourcing. I expect the Medical Council direction on conscientious objection will still stick to that — if you cannot provide care with regard to your conscience, then you have a duty to refer on to somebody else and in a timely fashion. I would say there would be respect for conscientious objection, but not for obstruction."
Another of Dr Murphy's objectives for her time as Chair of the Institute is to encourage more engagement between obstetricians and other specialties and healthcare professionals, such as their midwifery colleagues. She said she would also like to engage more with lay people or appropriately qualified members of the public who can advise on a range of issues, such as patient leaflets and guidelines, etc.
"I think there is a role where we can reach out to patients or users of the health system and get their perspective on things which sometimes can be different to a medical person," she said.
One of the biggest controversies to hit women's health in Ireland recently was that surrounding CervicalCheck and last month the Institute held a special event at the RCPI titled 'Lessons from the Scally Inquiry'.
Speaking ahead of the event, Dr Murphy said there were lots of lessons to be learned from the Scally inquiry, which include the importance of effective communication and the need to restore public confidence in the health system.
"One of the main things to come out [of a scoping inquiry] was on disclosure and how people were given or give results and part of the meeting next week is looking into ways that communication could be done better. I think there was a very particular situation where people were having to give out information about smears that were relooked at and the doctors themselves weren't even in full possession of the facts. So, I think it was a particularly difficult situation on both sides and then obviously, families who are dealing with grief and loss almost experiencing it all over again, so it is a very difficult time for everybody."
Finally, Dr Murphy said that part of her aim for the next three years as Chair was to focus on the recruitment and retention of doctors, nurses and midwives across the health sector.
"We are very fortunate to still be attracting really high-quality, really good people into obstetrics and gynaecology," according to Dr Murphy.
"Our trainees are fantastic; they are a diverse range, they are really great people, but we sometimes see where really great people after one or two years move off into another area and I think it is a reflection on how onerous obstetrics and gynaecology is. It is quite demanding, and we must look after our trainees. We also need to pay more attention to the idea of burnout in both consultants and trainees. People obviously have high expectations and the media is there when anything does go wrong, and everybody feels that very acutely, even if they are not personally involved… it knocks professional confidence. It amazes me at times that we have such a great bunch of trainees coming through. I do think the future is bright, but we do need to look after our trainees."