Lamiese Ismail1, Yixin Wang2
1Department of Obstetrics and Gynecology, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK；2 GPM Editorial Office, AME Publishing Company
Correspondence to: Yixin Wang, GPM Editorial Office, AME Publishing Company. Email: gpm@amegroups.com.
Editor’s note
The West China International Multidisciplinary Conference on Gynecological Oncology and Female Pelvic Floor Dysfunction 2024 was held successfully in Chengdu from May 31st to June 2nd, 2024. The conference presented the latest advancements in gynecological oncology and female pelvic floor dysfunction.
During the conference, Dr. Lamiese Ismail from the John Radcliffe Hospital, Oxford University Hospital, delivered a speech on “Status quo of endometriosis in the UK” on June 1st, 2024. We have had the privilege of inviting Dr. Lamiese for a brief interview to share some take-home message of her speech, as well as her enduring passion about Obstetrics and Gynecology and her perspectives on its future advancements (Video 1, Figure 1).
Figure 1 Lamiese Ismail
Expert introduction
Dr. Lamiese Ismail is a prominent consultant in obstetrics and gynecology at the John Radcliffe Hospital, Oxford. She has undertaken advanced training in various specialized areas, including Advanced Labour Ward Practice, Benign Abdominal Surgery, Vulval Disease, and Hysteroscopy. Her clinical experience spans multiple hospitals and regions, providing her with a diverse and comprehensive understanding of obstetrics and gynecology. Dr. Lamiese Ismail ‘s tenure as a consultant at the John Radcliffe Hospital, following her time as a national training number holder in the Oxford region, has further enriched her clinical acumen. She has worked in busy tertiary referral units, managing various cases with complex medical and social needs. Her primary interests are cancer diagnostic work, ambulatory gynecology and operative laparoscopy.
Dr. Lamiese Ismail’s contributions extend beyond clinical practice. She actively engages in research endeavors and has published numerous articles in esteemed medical journals. Subsequently covering topics ranging from postoperative complications to environmental impact and challenges in disease management. Moreover, she is also deeply committed to medical education. Therefore playing an important role in teaching medical students and junior doctors.
Her dedication to maintaining high standards of care is further evident in her involvement in management and clinical governance activities. Dr. Lamiese has held various roles, including RCOG College Tutor and participating in guideline development. Therefore ensuring adherence to best practices and the continuous improvement of patient care.
Dr. Ismail looks forward to sharing her insights, exchanging knowledge, and contributing to the collective effort to improve women’s health care around the world.
Interview
GPM: As a reputable expert in the field of obstetrics and gynecology, what inspired you to pursue this specific path?
Dr. Lamiese Ismail: As a medical student, I had various diverse interests until the point that I did obstetrics and gynecology, and I instantly fell in love with the specialty. I felt it was such an amazing area of medicine where I was able to advocate for women, empower them, and help them make decisions about their care. The wonder of being able to see new life being breathed into the world when babies are born, is just the most amazing and gratifying feeling. So I fell in love with obstetrics first. But when I did gynecology, I also realized that there are many challenges that women face over and above pregnancy. It's very important again to be able to support women through these crises and difficulties in order to improve their quality of life because women are so integral to society - as mothers, wives, and grandmothers. It is important that they are fully functional within the society for the success of us as a species.
GPM: How has your diverse clinical experience across multiple hospitals and regions contributed to your professional growth and expertise in obstetrics and gynecology?
Dr. Lamiese Ismail: I think I'm very blessed to have worked in different healthcare settings. I'm from South Africa originally and then I moved to the UK. The transition from a low-income setting to a first-world health setting has allowed me to see a wide range of medical challenges faced by patients, particularly women. And it has given insights into not only common conditions, but also to very rare situations. As part of our training in the UK, we have to work in smaller hospitals and tertiary centers. Again, we're able to get a breadth and depth of knowledge into the various conditions that women have to face both in pregnancy and outside. I just think I've been very blessed to be able to work in various parts of the UK and beyond and to be able to draw on these experiences for the benefit of my patients.
GPM: You presented a lecture on “Status quo of endometriosis in the UK.” How do you perceive the current advancements and challenges in the management of endometriosis in the UK?
Dr. Lamiese Ismail: As I was talking in my lecture earlier today, the All-Party Parliamentary Group has indicated that the government and the NHS as a whole, needs to do more to improve endometriosis care for women in the UK. I strongly support this point of view as well, because probably one in ten women are affected by the condition, and it has a severe impact on their quality of life. I think it is challenging because some of the recommendations that they have made go into things like providing mental health support for patients with endometriosis. Whilst in principle, that's a fantastic idea, we are sort of slightly limited in our ability to deliver that to patients because of financial constraints and that's quite frustrating. However, at the same time, I think we have been able to make lots of progress forward in terms of raising awareness (of clinicians and patients) about endometriosis. We're making diagnosis earlier and faster, in primary care, and at secondary and tertiary levels. We're able to provide good quality of care because we have greater access to medications. Additionally, there's a big promotion of research globally, including in the UK, which is all coming into effect and will bear rewards for patients who are struggling with endometriosis. So, I'm quite optimistic about the future for patients with this condition.
GPM: Could you share some approaches of diagnosing endometriosis promptly and accurately in the context of the UK healthcare system?
Dr. Lamiese Ismail: Obviously, in line with the NICE (National Institute for Health and Care Excellence) and the ESHRE guidelines, awareness is key. And it's very interesting to see that nowadays many patients come to my clinic and say, “I think I might have endometriosis” or “I wonder whether I might have endometriosis.” And often when I take a history from them, we both agree, that this is probably endometriosis. I find it quite fascinating that actually patients are so much more knowledgeable about this potential diagnosis.
We now know that endometriosis can have pelvic, gastrointestinal, urinary and thoracic manifestations. And by being aware of this, we are able to make a diagnosis earlier. We are also very blessed in that we can usually offer patients imaging and, if necessary, get them into the operating room to perform laparoscopic surgery in order to establish the diagnosis. I think in many other parts of the world, especially in low-income settings, this may pose more challenges. But I'm happy that I'm working in a setting where we're able to offer patients a reasonable route to achieve a quicker diagnosis so that they can start treatment in a more timely fashion and therefore lead more fulfilling lives with fewer effects from the disease.
GPM: What areas of clinical practice warrant further development in expediting cancer diagnosis?
Dr. Lamiese Ismail: I think there are many challenges in terms of prompt and early diagnosis of cancer, both globally and in the UK. One of the things, which I think is quite important, is setting up one-stop clinics. Essentially where patients are referred by the general practitioner to the hospital, they can ideally undergo scans and then have more invasive testing if that's required. I'm thinking specifically about the diagnosis of uterine cancer which often presents with post-menopausal bleeding. Therefore, by setting up one-stop clinics doctors can scan the patients, make an assessment of the womb lining to determine whether this is normal or not, and then they can offer patients something like an outpatient hysteroscopy straight away to take a biopsy. This will help to drive forward the diagnostic times that we can offer patients. And I think this is really something that we need to be fighting for in order to make sure that we can offer patients a diagnosis and treatment in a timely fashion.
GPM: Given your experience in managing various complex cases, have there been any cases or experiences that have been particularly memorable or instructive for you?
Dr. Lamiese Ismail: As I said before, I have had the benefit of being able to work in different health care settings and seen a wide range of cases, from simple to complex, in both fields of obstetrics and gynecology. One particular case that comes to my mind is a situation when I had to perform a perimortem caesarean section. It was a very sad case of a 32-year-old lady, who ruptured her membranes prematurely. And in line with the UK policy, we tend to observe such cases for at least 24 hours depending on the gestational age and then start antibiotics. I was called to this case in the middle of the night, because the patient had collapsed and suffered a cardiac arrest. In a few minutes, within a short period of time I had to make a decision (as a trainee doctor / resident) to perform a caesarean section outside the operating room, just with the patient on the ward, to deliver the fetus or the baby, in order to improve the chances that the mother might survive.
This case was about 10 years ago. It's interesting that just a few days ago, I was contacted by the father of the baby to say that his child was doing really well and he was very grateful for everything that I had done to save his child. Sadly his wife passed away as a consequence of the incident. But really in that context we did everything that we could have done. And I'm very proud of the fact that I was able to hold my composure in that very difficult and stressful situation and do what was necessary to improve the chances of survival for both the mother and the baby. I'm pleased to say at least I've managed to save one life, even though I couldn't save both of them. That's something I don't think I will ever forget because it is such a rare experience, many healthcare professionals may never encounter such a situation in their entire career. Although it was quite a harrowing experience, I count myself lucky to have been able to go through this experience because I think I have built up a different level of confidence in terms of how I go about managing patients, having been through something as difficult as that.