Niamh Cahill speaks to GP, pharmacist and entrepreneur Dr Paul Ryan about his passion for evidence-based treatment in primary care
When Dr Paul Ryan made the decision to leave his full-time, pensionable job as a pharmacist at Cork University Hospital (CUH) to pursue a career in medicine, a long road lay ahead. It would be 10 years later — five years in undergraduate medicine, one year as an intern and four years on the GP training scheme — before he began his dream role as a GP. The journey was not without sacrifice and hardship for him and his young family, he explains.
“I was a medical intern at 31 years of age and was working 80-100-hour weeks. That was stressful for my wife and I, we had two young kids at the time,” he recalls.
But as busy as he is now, teaching, caring for patients, and locuming as a pharmacist, to name but a few of his roles, he takes comfort from the fact that his current working week is nothing like it used to be.
“I’m living the dream and loving it. I got what I wanted. But it took a long time to get there.” The affable Tipperary native qualified as a pharmacist 17 years ago. But a longing to teach and study medicine, piqued during his college years, would ultimately lead him in a new direction. “I went to Trinity years ago and there was one lecturer we had for clinical pharmacology; his name was Prof Martin Henman. He would stand up and go through the treatment of all conditions without PowerPoint or notes… all evidence-based. And I thought, ‘I want to be him’.
“I absolutely love evidence-based treatment of conditions seen in primary care. When I went back to college to study medicine, I always wanted to be a GP.”
The hard work ultimately paid off. The consolidation of pharmacy and GP knowledge acquired by Dr Ryan is both rare and exceptional in primary care in Ireland.
When Dr Ryan returned to college, his medical school fees were €12,000 annually. Unable to work as a pharmacist, Dr Ryan found a new way of making money to fund his education, while also pursuing his passion for teaching. He created pharmabuddy.ie, an educational, professional platform for pharmacists, which now boasts around 4,500 pharmacist members and is used by over 1,400 pharmacists daily.
“I started teaching pharmacists about therapeutics and how medications work and what evidence base should be used. It grew and now pharmabuddy is a professional forum for pharmacists and an education platform,” he explains. Dr Ryan regularly gives talks via the platform and frequently invites expert speakers onto the forum, the latest of whom was women’s health expert and GP Dr Deirdre Lundy.
The forum is not only educational, but also acts as an important connection between pharmacists, often in the interests of patients.
“What I love about pharmabuddy is about two weeks ago, there was a child discharged from Crumlin and sometimes with paediatric medicines, they’re not always in stock. There was a very stressed mum looking for medication and couldn’t get it. So the pharmacist put a post up on the forum and a pharmacist with the medication got in touch and got the child sorted.”
In recent years, Dr Ryan has continued to nurture his interest in education for the benefit of GPs. In 2019, he founded GPconsult.ie, an educational platform for GPs with concise, informative consultation templates on hundreds of medical conditions seen regularly in general practice. It is a free service offering evidence-based medical knowledge on more than 300 conditions in a condensed format.
“I’m a nerd,” he laughs when explaining how the service operates. “I basically study guidelines and make them relevant to Irish general practice.”
Each template covers certain questions and topics that should be recorded in order to ensure correct diagnoses.
Templates offer data on specific conditions, covering patient history, what questions to ask, what to look for on examination and finally what to prescribe. All drug products are listed in alphabetical order. Commenting on how the service was established, he said it began as a modest Microsoft Word document. “It contained information on certain products used to treat particular conditions, as it is often difficult to remember all the medications used for a certain condition. Then other GPs asked me for it and I shared it around.”
Over time, GPs from all over Ireland added evidence-based information to various templates and “it took off”.
Even today, the service allows GPs to suggest new recommendations and information on conditions, ensuring templates are kept up-to-date and relevant. All suggestions are checked by the GPConsult team to ensure they are evidence-based before inclusion There is a GPConsult team of over 80 Irish pharmacists and GPs working together to keep the templates up to date, evidence-based and relevant.
Feedback is that the templates are invaluable to GPs who are “time-poor”, according to Dr Ryan. As well as saving time, when logged-in, GPs can search through over 300 conditions and use the appropriate template to help conduct a thorough patient examination, asking relevant questions, recording patient responses and details.
“If you sit down to study eczema, for instance, there’s about 60 pages on guidance from the UK or Australia on how to manage it properly. The problem is in primary care, be it a pharmacist or GP, we see about 400 or 500 conditions on average. On average, a patient wishes to discuss three separate issues in a 10 minute consultation.
“Sometimes it’s really difficult to document the consultation into one or two pages when the patient is sitting in front of you. That’s all I do. I summarise the international guidelines and make it relevant to GPs and pharmacists.’”
As well as working as a practising GP at Mayfield Family Practice in Cork city, Dr Ryan locums as a pharmacist regularly. He is ICGP Therapeutics Lead, which involves teaching GPs about the latest guidelines on therapeutics, as well as serving as a member of various HSE working groups, including one currently on updating guidance on oral vitamin D supplementation.
Dr Ryan is also Assistant Programme Director of the Cork GP Training Scheme. As founder of Prescription Revision, a service offering podcasts, video tutorials, and intensive revision days on prescribing in everyday clinical scenarios, he gives talks on medical conditions to GPs and to date has performed over 500 presentations on various conditions seen in primary care. As founder of Prescription Revision, a service offering podcasts, video tutorials, and intensive revision days on prescribing in everyday clinical scenarios, he gives talks on medical conditions to GPs and to date, has performed presentations on over 50 conditions.
The workload on the surface appears enormous, but it allows Dr Ryan to work from home two days a week.
He can now collect the kids from school, something 80-hour weeks as a medical intern would not have facilitated, he said. Like all GPs, he has found navigating the pandemic “very stressful” and onerous. From his perspective as a pharmacist, the crisis has illustrated the importance of questioning evidence around medication, as well as the power of social media.
“When someone makes a statement, learn to question it, would be my advice. Don’t just accept it at face value,” he advises. “Remember the dose makes the poison, ie, that drugs are all poisons, it is the dose that determines whether a drug is poisonous or not.”