Two sides of the same coin: clinical and research activity in maternal care

Veronica Giorgione
Nationality: Italian 
Work Institution: St George's University of London
Research Interest: Preeclampsia, preterm delivery and fetal congenital heart disease
Favourite Hobby: Tasting new and delicious food. I am a foodie ;)

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​In September 2018, after working as a junior doctor for 5 years at the San Raffaele hospital in Milan, I completed my Obstetrics and Gynecology training. Then, I had to answer the question: What next, what could or should I do? There were two opportunities I had to consider.  
The first logical option was to start the job I trained for, as an Obs. and Gyn. specialist in Italy. But, as I love a challenge, and as I thought this would have been the safer option, I decided to pick the second opportunity, to apply for the iPLACENTA project as I thought that it sounded more exciting and rewarding in the long run. I then took the plunge and moved to London to commence this incredible experience as a PhD student at St George’s University of London. 

St George’s University Hospital of London

When I arrived in November 2018, the instant positive impact I experienced at St George’s Hospital was incredible. I felt lucky that I knew my two supervisors, Prof. Basky Thilaganathan and Prof. Asma Khalil, who are gifted with being both great clinicians and scientists. It was a privilege to be working with them and gaining the additional knowledge they could provide. Before meeting them, I did not appreciate that these qualities could coexist in one person at such a high level. 

In just a few weeks, I also realised how amazing the Fetal Medicine Unit (FMU) at St George’s Hospital is and how many pregnant patients are looked after and cared for . The staff immediately impressed me with their dedication, accuracy and hard work. An example of this is a weekly multidisciplinary meeting where all cases are discussed by different specialists and joint decisions are taken. The FMU is a dynamic academic department where several areas of active research are undertaken. The FMU also holds regular research meetings and journal clubs delivered and presented by the research and clinical fellows. I was grateful to be in a position to start my PhD in this committed and stimulating environment.

Prof Khalil, Prof Thilaganathan and FMU fellows during one of the regular journal clubs

​My PhD project relates to the cardiovascular assessment of women affected by preeclampsia in the peripartum period (before and after delivery). Since the commencement of the project, I knew I would need to recruit patients in the following 3 years and that this would be key to the successful completion of it. 
But a question you may ask is, what is involved in recruiting patients? In all honesty, I was not familiar with this process and it was a new skill that I had to learn. I found it quite unusual compared to my previous clinical job as, whilst working in a clinical setting, patients are the ones who make the request to see a doctor to seek assistance. Whereas in my new situation, I had to be the one to ask patients to assist me and offer them an explanation as to why I was doing it and the reason it was so important. 

A cartoon that illustrates a funny conversation between a doctor and a patient.

This meant that the relationship between me and patients was going to be completely inverse to what I was used to. I had to learn how to explain the goal of my project and get them to volunteer to take part. As this is normally, and perfectly understandably, a traumatic and troubling time for mothers and babies alike, it can be extremely tough to approach mothers to ask for their assistance. However, I have been really impressed and pleasantly surprised by the reactions I received to my request for volunteers. The participants demonstrated a strength and positivity, despite their circumstances, by their agreement to donate their time and blood/placenta samples to research and I think this is because they understood the reason behind it, which was of course to help other pregnant women affected by the same disease.
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Because of my obstetric background I can also provide them with useful explanations and observations as they feel free to speak to me on a more informal basis. I have been fortunate enough to build a close bond with many of these women and a lot of them have continued to keep me updated about how their babies and them are getting on, which I have found to be beneficial to both my research and on a personal level. 
During this process, I’ve also reinforced how fundamental it is to spend time with patients, listen to their stories and communicate a sympathetic understanding of their situation. This has meant that I am improving one of the most meaningful aspects of my job as a doctor, which is to develop my communication and empathetic skills. This has been a curious paradox in view of my previous clinical job, but it is one that I am extremely grateful for. 

While I miss my clinical job enormously, as I was in a position to be the clinician to help patients directly, my hope is that my research findings will prove useful in the future for considerably more patients than those I would have taken care of during the time I have spent on the project. 

I would like to take this opportunity to thank all my lovely patients who are taking part in my iPLACENTA project!

A presto, 
Veronica