October 4, 2025 • 35 mins
What if the real breakthrough in heart care isn’t a new drug, but a new way of listening? Cardiologist Monica Moaghan joins us from Enniskillen to unpack how modern cardiology can be both high-tech and deeply human—combining CT coronary angiography, strong GP partnerships, and practical prevention to stop cardiac events before they start.
We talk through a typical “consultant of the week” rhythm, then zoom out to the upstream moves that matter in rural communities: building trust with family doctors, bringing education into local halls, and turning simple markers—blood pressure, LDL, HbA1c—into life-changing action. Monica explains why CTCA is overtaking treadmill tests, how visualising plaque sharpens shared decisions, and where waiting lists and social care bottlenecks still hold patients back. Her take on women’s heart health is candid and urgent: Beyond the Bikini means recognising different presentations, respecting dual pathology, and correcting a long-standing bias that kept too many women under-investigated.
Alongside the clinical insights, we explore the culture behind safe, sustainable care. Monica shares how protected time with junior doctors, routine debriefs, and honest conversations about mental health reduce burnout and improve outcomes. She’s equally forthright about embracing informed patients—yes, even the ChatGPT printouts—by grounding every plan in a careful history, clear language, and transparent uncertainty. If you care about prevention, rural healthcare, imaging advances, and the human skills that make medicine work, this conversation will stay with you.
If this resonates, follow the show, share it with a colleague, and leave a review to help more listeners find these stories. Tell us: which number will you check first—BP, LDL, or HbA1c?
👩⚕️ Guest Biography
Professor Monica Monaghan is a Consultant Cardiologist and Clinical Director for Medicine, Primary Care, and Older People at the Western Health and Social Care Trust in Northern Ireland. Specialising in multimodality cardiac imaging, she also leads initiatives focused on prevention, community engagement, and holistic patient care. Monica is deeply committed to “upstream medicine” — empowering both patients and healthcare professionals to understand their own health metrics through her Know Your Numbers campaign. She also teaches medical students from Queen’s University Belfast, Ulster Graduate Medical School, and the Royal College of Surgeons in Ireland.
- Location: Enniskillen, Northern Ireland
- Organisation: Western Health and Social Care Trust
- LinkedIn: https://www.linkedin.com/in/monica-monaghan-35b8a825/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
DrAndrewGreenland (00:00):
So, welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the personal stories and
professional insights of peopleredefining what care and
wellness look like today.
I'm really excited abouttoday's conversation because our
guest is Monica Monaghan, whoworks with the Western Health
and Social Care Trust inNorthern Ireland.
Monica brings a wealth ofexperience in care delivery and
community support, and she has apassion for seeing how health
(00:20):
systems can evolve to meetmodern challenges.
I know she does lots of otherthings besides.
Monica, it's wonderful to haveyou here on the show.
So thank you very much forjoining us this afternoon.
ProfessorMonicaMonaghan (00:31):
Thank you very much, Andrew.
Delighted to be here anddelighted to participate.
DrAndrewGreenland (00:35):
Wonderful.
And are you calling fromNorthern Ireland now?
ProfessorMonicaMonaghan (00:40):
So I'm currently in the Southwest Acute
Hospital, and that is in a towncalled Enniskillen in the
southwest of Northern Ireland.
Wonderful.
And famous for the literarygreats, and this is the town
where Oscar Wilde and SamuelBeckett were educated.
DrAndrewGreenland (01:02):
Fantastic.
I've just seen an Oscar Wildeplay this very week, and I'm
going to be seeing another oneat the weekend, so I can relate
to that connection with thosefamous playwrights.
So maybe if we could start atthe top, can you share a little
bit about your role at WesternHealth and Social Care Trust and
how this fits into the biggerpicture of supporting
communities?
ProfessorMonicaMonaghan (01:21):
Yes, so I'm a consultant cardiologist,
sub-specialising inmultimodality cardiac imaging.
So everything fromechocardiogram to CT, coronary
angiogram, and cardiac MRI.
(01:44):
So that's really the day job,job in cardiologist.
And then I also hold a role inmedical education, in the
teaching of the medical studentswho rotate through the
hospital.
And we have three universitiesQueen's University in Belfast,
(02:10):
Ulster Graduate Medical School,and then also the Royal College
of Surgeons in Ireland.
And then I also hold a role inthe medical directorate, and so
I'm clinical director formedicine, primary care and older
people, and I sit at theassociate medical director as
(02:32):
well.
So it's a varied uh job, no twodays look the same.
And that's uh and that's reallywhat holds my interest.
That's that's a great thing.
DrAndrewGreenland (02:44):
Amazing.
I always admire people thathold multiple hats, and I just
wonder how you fit all of thatinto your week.
How does it how does your weekpan out?
How do you balance all thesecompeting responsibilities and
interests?
ProfessorMonicaMonaghan (02:56):
So we run a consultant of the week
model.
So when I'm the consultant incharge of the cardiac unit, then
I'm very much the cardiologist,and around that, then I fit in
the other duties andresponsibilities.
(03:16):
So it's an early start uh tothe day.
Um typically about 7 a.m.
Um and in those couple ofhours, I suppose, before we
become clinically busy, I can uhget some of the other um roles
done, the the paperwork, theendless emails, um preparation
(03:42):
for meetings.
So a lot of it is is justpreparation, I suppose, the
night before, um, inanticipation of what the next
day might bring.
But being in cardiology, that'soften highly unpredictable.
Um but the predictable and theschedule things, um, then I fit
(04:04):
all the on-scheduled aroundthat.
DrAndrewGreenland (04:07):
Got it.
Yeah, well, anything in theacute care is uh, as you say,
always unpredictable.
As an emergency physicianmyself, I can completely relate
to that and very difficult toplan for anything.
But um, what um motivated youto pursue the kind of direction
in health and social care fromyou know your sort of background
in medicine.
ProfessorMonicaMonaghan (04:27):
Sorry, just repeat that.
DrAndrewGreenland (04:28):
I was just interested to know what
motivated you to pursue thedirection in uh social care and
health.
ProfessorMonicaMonaghan (04:35):
So I have a background in in research
um and in molecular biology.
So my whole interest in inmedicine was driven by evidence
um guidelines, and then I tookup the post here in the Western
(04:56):
Trust in 2016 as a consultant.
The population is is largelyrural, um, and with that comes
its own challenges andopportunities, and very much, of
course, as well an agingpopulation, and with that,
(05:17):
there's a recognition that whilewe're specialists in cardiology
or in imaging, I think there'sa responsibility when we meet a
patient or meet the patient withtheir family, that there needs
to be a holistic assessment, andthat's what I enjoy most.
(05:39):
Of all the roles, I think thebest is still sitting down
either with a patient in clinicor a patient at the bedside and
listening and understandingtheir story and giving them that
time and space.
I realize that we don't sit inisolation, so I might be able to
(06:05):
organize for an aortic valvereplacement or send somebody for
a heart transplant.
That's only a very small partof their journey and of where
they sit, and the holistic care,and this is what whenever I'm
teaching medical students or onward rounds, trying to
(06:27):
understand that holistic care ofwithin the whole community
setting and social care is soimportant as clinicians, and
understanding way beyond justheart health, and that's I think
where we can make huge impactas doctors and as part of a
(06:49):
larger team, so less siloedworking and more, I think,
joined up thinking, and moreintegration between hospital and
community, and that's I supposewhere my my passion sits
working as part of a team,working with the patient,
(07:11):
working with their family, andthen that has led to some
projects where we have goneoutside the hospital and have
worked in communities, in localcommunities, to talk about heart
health, about exercise, aboutfrailty, um, about type 2
(07:35):
diabetes, and those have beenvery, very enjoyable because
we're meeting people outside oftheir pajamas, if you like, um,
in their own communities, andwhat's important to them.
DrAndrewGreenland (07:50):
Amazing, and I completely resonate with this.
I my um interest in functionalmedicine, which is taking a very
holistic approach to diseaseprevention, disease management,
totally get where you're comingfrom.
I just wondered how this fitsinto a kind of stretched health
model.
Obviously, it's slightlydifferent for you in Northern
Ireland versus the UK.
(08:10):
But how does how does this fitin?
Do you have a challenge intrying to do this really
important work in the confinesof a stretched system?
ProfessorMonicaMonaghan (08:18):
Yeah, and I think it's important to
recognise that one individualcan't do everything, but two
individuals working closelytogether can can be do more, and
three can be exponential.
And it's really doing the verybasics right, and that might
(08:38):
just be simply starting off withcommunication, meeting um GP
colleagues who, of course, areintegral in rural communities.
We still very much have thefamily doctor model here, where
(08:59):
the general practitioner hastreated maybe the third
generation, and with that comesso much institutional medical
memory, and me coming in,building relationships with
general practice, with pharmacy,suddenly you start to develop a
(09:23):
momentum, and I have that goodrelationship with a number of
key individuals in thecommunity, family doctors who
are really striving within theconfines of the human resource
and the financial resource tostill deliver really excellent
(09:48):
care and the ideal, which isupstream care, managing chronic
disease before the patient comesto my cardiac unit with their
event.
So I have great relationships,excellent colleagues, and
(10:09):
there's a real willingness torecognise that change is needed
and that together we can do somuch more.
So, for example, tonight I'llbe going to uh a meeting in
another local town in our nextcounty called OMA, where myself
(10:31):
and one of my excellent GPcolleagues will be giving a talk
to a host of healthcareprofessionals on the role of
upstream medicine, the role ofthe healthy heart, the role of
chronic disease management, therole of exercise, um, and a host
(10:55):
of other issues which ispassionate to me, which I'm
passionate about, which is umsort of know your numbers, and
and that's the other thing thatI think is very important.
We look after patients, but weforget that we ourselves one day
will become a patient.
And how does that look like?
And what can we do to, Isuppose, prevent that happening
(11:17):
for as long as possible andgetting that into our psyche?
Um, and that's really part ofthe know your numbers campaign,
which we're actively promotingwithin the trust as well.
DrAndrewGreenland (11:30):
Thank you.
You mentioned know yournumbers, and in terms of how do
you measure the impact of whatyou do?
I mean, for what do thosenumbers look like?
And I guess you must have madea significant difference, but
how do you measure the impact ofthe things that you do in this
realm?
ProfessorMonicaMonaghan (11:46):
So, just to give you the context,
maybe it's because I've almostbeen in post-10 years, and
therefore my peers are startingto get that getting into that
age bracket as well, wheredisease starts to manifest
itself.
But in the last couple ofyears, I've treated a bigger
(12:10):
than expected number ofhealthcare professionals and
doctors with cardiac disease andwith myocardial infarction and
angina.
And I think the the overallunderstanding was we are we
(12:32):
could look after ourselvesbetter.
So many of us do not know whatour our simple parametrics are.
So, our blood pressure, forexample, what is what is the
expected normal blood pressurefor a 50-year-old or a
60-year-old?
And there's new guidelines outlast year where we really should
(12:52):
be trying to get to 120 over80.
Then what's our HBA1C?
So many have undiagnosed type 2diabetes, and breaking down and
talking about understandingcholesterol, so the good, the
(13:13):
bad, and how can we improvethat, and just having taking the
time as healthcareprofessionals, taking the time
out to get those things measuredand to have a think about what
I can do differently as a doctorso that I can continue to
function well and deliver carewell, and that's really where
(13:37):
the thinking around know yournumbers came from because of the
disease profile that I'm seeingin colleagues.
DrAndrewGreenland (13:46):
Got it.
So, what um I was gonna say, Imean, you've been doing this
work for a little while now.
How has it evolved with timesince you first started at the
trust?
ProfessorMonicaMonaghan (13:57):
So I suppose we all develop at
different speeds, and and uh ittakes some time to get embedded
into a job to buildrelationships, to become
(14:17):
equipped to deal with more thanjust uh the the job that we're
trained for in medical school,which is of course very much the
anatomy and physiology and theapplication of that, and yet
what we do every day goes waybeyond uh anatomy and
physiology, and my role hasevolved from clinician to I
(14:46):
suppose a leadership type rolein the clinical director, and
then one of the other roleswhich I enjoy very much is the
is the teaching and nurturingand fostering of our resident
doctors or non-resident doctorsand our medical students, and
(15:11):
trying to share the experienceand going a little bit beyond
just what their curriculum mightask of us to deliver.
Um we meet every Friday, forexample, with the our FY1 tier
doctors, and that's a protectedhour where we have the
(15:33):
opportunity and a safe space toshare experience, to talk about
communication challenges,conflicts.
And that's I think myimpression is that's probably as
useful as maybe spending anhour teaching them on diabetic
(15:54):
ketoacidosis, which they willget as well, and they will see,
but it's that opportunity, andthat's what I enjoy about the
last 10 years.
Probably that's only started todevelop more in the last few
years, and we all have todevelop the confidence to be
(16:15):
able to share our feelings andwhere we have learned and where
we could do better, and thencascade that on to our
colleagues as well who arecoming through to understand
that it's okay to say, A, Icould have done that better, and
(16:35):
or B, actually, I'm not in agreat place.
Could you give me somesignposts to get to a better
place?
DrAndrewGreenland (16:45):
Do you think that's something that's been
neglected over time?
I mean, obviously, you'repicking up on it now, but do you
think that's something that hasbeen neglected in sort of
conventional training?
We're kind of leaving thesepeople behind to fend for
themselves and not having theseconversations.
ProfessorMonicaMonaghan (16:58):
Yeah, I do.
I think despite the best will,very often we do get caught up
in the day-to-day runnings of anorganization and the running of
a busy ward or in a busyemergency department, and we
become accustomed to dealingwith life and death situations,
(17:24):
and it can be easy to forgetthat there maybe were other
people as part of that resusteam, for example, um, who would
really like to have five or tenminutes to have a conversation
or a debrief, and that might bea week later or a month later,
(17:46):
because we do we all carry thosecases with us, and I do think
that in the delivery of acurriculum very much focused on
disease and illness, and that wecan forget about our
(18:08):
psychological wellness andwell-being, and and how do we
cope and manage that in ahealthy way, or how do we even
recognize it at an early stagebecause it might not manifest
itself in a traditional way?
Um, and that's something thatwe do here in the organization
(18:32):
is try to have a focus on mentaland psychological well-being as
well as physical well-being.
We'll talk about healthymanagement strategies.
We talk about movement andexercise or music or chess, and
(18:54):
when our new doctors comethrough in rotation, I'll have a
presentation, for example, onadvanced life support.
But what I much prefer is justsit down and hear what I ask
them what is one interest youhave that is nothing to do with
medicine, and that's really metrying to get an understanding.
(19:18):
Do they have an interest?
Do they have a support network?
Because I recognize that we arein a rural area.
We many of our doctors could betwo hours from maybe their
families, and it's importantabout building that network of
(19:40):
support for them when they'rehere as well on the hospital
site, and knowing that there'san open door policy.
DrAndrewGreenland (19:49):
I think it really is so important, and
you're right, if we don'trecognise this and it ends up
with being burnout some yearsdown the line.
So I think what you do and theway you treat and look after and
listen to your juniors isabsolutely key for the rest of
us to take from.
Also, from your perspective,what are the major shifts that
you're um seeing in the healthand social care realm right now?
ProfessorMonicaMonaghan (20:08):
So I'll answer on a number of levels.
As a cardiologist, uh, one ofthe most exciting, and I think
one of the biggest impactfulthings that we're doing now is
the investigation of anginausing CT coronary angiography,
and that is in all the hospitalsin our trust, and we have a
(20:33):
number of skilled cardiologistsdelivering this.
So we've moved away from thetreadmill for the investigation
of chest pain, and we've movedtowards where we can actually
visualize the coronary arteriesand we can predict the health of
the arteries, and that guidesus on prevention strategies.
(20:59):
So we might know that there'sdisease there and there's
athlosclerosis, but the goalthen in a shared care model of
discussion is around theprevention of the event, so the
event being the infarct, whichthen could lead to heart
failure.
So that's that's one big, andthat's endorsed by NICE, which
(21:22):
is which is excellent, and and Iwould love to see more
investment in CT coronaryangiography across the region.
And I think that's aligned withour health minister, um, who is
also very keen on this shiftleft move upstream.
(21:43):
Other things that have come, Isuppose, through my own practice
is the ageing population, theand where there are deficiencies
in social care in thecommunity, leading to lengthy
(22:03):
hospital stays, and people whowant to be back in their own
homes, independent, contributingto the community, having to
remain in hospital because wedon't have that social package
available, and that's I know alot of focuses on that, and we
(22:30):
know that lengthy stays inhospital will lead to increased
frailty and sarcopenia andreduced psychological
well-being, and it's sofrustrating for patients, for
their families, and it's adetriment to the community
(22:51):
because they're not therecontributing and being active in
the community.
So that's one area that isfrustrating, but I think that by
getting educational programsout earlier to our population,
(23:12):
maybe in their 50s, their 60s,their 70s, about keeping active,
doing small things can have bigdifferences.
So even if you're walking 20minutes, 30 minutes, that will
have a big impact on bonehealth, for example, uh, in the
decades going forward.
(23:32):
And that's what we're trying toget across in messaging about
women's health.
Traditionally, cardiology, wespoke about, we recognized that
the typical features of angina,for example, in our in our men,
the classical, typical, but nowthere is a movement and it's
(23:58):
growing worldwide by a number ofkey individuals, which is
wonderful to see, and that'spercolating now down through all
the societies, down into oursmall communities, about the
recognition of heart disease inwomen.
And we have we have got thebikini medicine, as it's called,
so good.
(24:18):
So the bikini medicine is thebreast cancer, the gynee
cancers, and we're so good atthat, and yet in cardiology we
have let that slide.
So there's a movement nowcalled Beyond the Bikini, and
it's really about motivating andeducating women in the
(24:42):
communities and alsocardiologists and doctors about
recognising heart health inwomen, and that we are not many
men, we are not smaller men,that we present and can present
in different ways.
And just because we might alsohave the vasomotor symptoms of
menopause, or we might also haveanxiety, or we might also have
(25:07):
palpitations, we're also allowedto have dual pathology, and we
might actually be presentingwith angina or an underlying
heart disease.
I think there is a recognitionout there that sometimes we
have, as clinicians, beendismissive to some degree, but
(25:30):
that's changing, and that is, Ithink, a very healthy place to
be right now as a woman havingmenopause.
DrAndrewGreenland (25:44):
Thank you.
What about um patientexpectations or even
generational differences?
What are you seeing frompatients in and how is that
affecting the way you delivercare?
ProfessorMonicaMonagha (25:56):
Patients are, I think, more empowered.
They are they have the accessnow to the internet, they will
have looked up and read abouttheir symptoms before they
attend, and that I think, ingeneral, is a good thing because
(26:18):
they will come with questions,and it's an opportunity then for
us to guide, listen first, andlisten where are they coming
from?
What is this story?
They might chat GPT may haveadvised them on what this might
(26:40):
be.
Um, and I don't think any of usshould feel threatened by that.
I think it's an opportunity tosit down, listen, um, learn, and
um, and then just talk through.
Well, here is what I'mthinking, um, based on what
(27:01):
you're telling me.
And I might need to do anothertest to prove that, I might not,
but the real basic, Andrew, isstill back to his really good
history and examination andspending that time listening.
So I think expectation anddemand, if that's the right
(27:24):
word, not sure it is, but thathas gone, that has increased,
but that's not necessarily a badthing, and moving away from the
paternalistic um doctor-patientrelationship is also a good
thing.
There's more shared care, thereis the onus on us to be honest,
(27:52):
open, and transparent, and alsoit's okay to say, you know, we
work in diagnostic uncertainty,and we might not have all the
answers, but I might be able totalk to somebody or signpost you
to somebody who might give usmore information and restore you
to better health, and I supposewe're funded to do some things
(28:18):
really well, so treat heartattacks, treat valve disease,
treating heart failure, but allof the things that go around
living with a chronic disease,we don't necessarily maybe have
the time and resources to dothat, and that's why I'm so
(28:41):
grateful to organisations likeNorthern Ireland Chest Heart and
Stroke and other voluntaryorganisations who do provide
that wraparound care when wemaybe can't, as clinicians, give
the time that's absolutelyessential, or the funding to
areas like psychology orphysiotherapy and things like
(29:05):
that.
So I have to say, I doencourage patients to bring
along their questions.
I always tell them you willforget.
So when I come to see you onthe wardround tomorrow, write
everything down or bringsomebody with you to clinic
because four years is betterthan two.
DrAndrewGreenland (29:24):
I I smile in jest because um I've had those
patients that bring theirreferrals from Dr.
Google and Dr.
ChatGPT pages and pages andpages.
So I smile in jest, but Icompletely get your point.
It's important people come withall of their concerns and
questions and have them allanswered properly by a clinician
who can take a good history andexamine and do all the things
(29:46):
that the electronic things thatyou mentioned can't do.
With all the improvements thatyou've mentioned and the early
intervention and preventativemedicine, what are the
challenges or bottlenecks thatare still most impactful in the
work that you do right now?
ProfessorMonicaMona (30:00):
Challenges, waiting lists.
Would love to get patientstheir echocardiogram, which is
you know such a such afundamental front door mobile
test, and how wonderful would itbe with all the advances to be
(30:20):
able to bring that point of careultrasound into the
communities.
So I suppose there is afrustration around what it could
look like and what it does looklike, and then sometimes the
bureaucracy around making a goodidea, or at least what I might
(30:41):
think is a good idea, happens.
And that's certainly achallenge.
I think the human resourcethere is a willingness there,
and there's a drive, there's akeenness to explore AI and
artificial intelligence, but Istill think we still have to get
(31:05):
the actual intelligence rightin order to get the artificial
intelligence right.
And other frustrations, thetiming, um just not enough time
sometimes to do everything, andfeel that I could have done that
(31:30):
better when you reflect.
But I suppose that's part ofthe learning, um, and that we're
still continuing to evolve ashealthcare providers.
So I still think get the basicsright and everything else will
(31:51):
follow, but it is it's it'sseeing that increase in chronic
disease in the community andwhere there might have been
opportunities to interveneearlier, and we can only see
that with the benefit of thehelicopter view when they
(32:13):
present into cardiology withtheir event.
And in fact, one of the thingsthat I'll be speaking about
tonight with my colleague Dr.
Emer Darcy is about the role ofQ risk and that this has been
adopted uh through NICE, and yetI can see it when I scan so
(32:37):
many so many people in their 50sand their 60s, and we're so
good at measuring things that wecan see that they've had their
LDL measured innumerable times.
We can see it climbing, andthere were opportunities there
to intervene on this disease,and there was a reassuring cure
(33:00):
risk, and yet the patient stillpresents then with the event or
with an advanced form of thedisease.
I know that there is a movementout there as well of
like-minded individuals whowould love to move beyond these
(33:20):
scoring systems, which arereally just guidelines, and
maybe move towards a moreaggressive preventative strategy
with all the things that wehave now that we can offer
people that we didn't reallyhave 30 years ago.
DrAndrewGreenland (33:38):
Thank you.
Finally, um, looking back, ifyou were to start, if you were
starting in your various rolesagain fresh tomorrow, what would
you approach differently if youhad your time again?
ProfessorMonicaMonaghan (33:49):
So great question.
Um I would I think it wouldtell my younger self to maybe
take life a little bit lessseriously.
I I do do a lot of exercise,um, which I love.
(34:13):
Um I would maybe take more timeto consider.
Um we're all inclined to maybetry to please and say yes to
roles, and sometimes it's alsookay to say no, thank you.
(34:37):
Um, that's just not for me atthe moment.
Um I'm even thinking throughtraining, how many family things
that I I missed because of thetraining programme and the
delivery of service.
And looking back now as anolder person, um there is some
(35:02):
regret there, and and that'spart of what I teach our
resident doctors too, that thatlife is important and that life
outside of medicine isimportant.
DrAndrewGreenland (35:13):
Monica, thank you so much for your time this
afternoon and sharing theseinsights.
It's been such an honest andinspiring conversation, and I'm
sure our listeners are going toderive enormous value from
listening to this podcast.
So, really many thanks to youand your time this afternoon.
ProfessorMonicaMonagh (35:29):
Pleasure, thank you, Andrew.
So, welcome back to Voices in Health and
Wellness.
This is the podcast where weexplore the personal stories and
professional insights of peopleredefining what care and
wellness look like today.
I'm really excited abouttoday's conversation because our
guest is Monica Monaghan, whoworks with the Western Health
and Social Care Trust inNorthern Ireland.
Monica brings a wealth ofexperience in care delivery and
community support, and she has apassion for seeing how health
(00:20):
systems can evolve to meetmodern challenges.
I know she does lots of otherthings besides.
Monica, it's wonderful to haveyou here on the show.
So thank you very much forjoining us this afternoon.
ProfessorMonicaMonaghan (00:31):
Thank you very much, Andrew.
Delighted to be here anddelighted to participate.
DrAndrewGreenland (00:35):
Wonderful.
And are you calling fromNorthern Ireland now?
ProfessorMonicaMonaghan (00:40):
So I'm currently in the Southwest Acute
Hospital, and that is in a towncalled Enniskillen in the
southwest of Northern Ireland.
Wonderful.
And famous for the literarygreats, and this is the town
where Oscar Wilde and SamuelBeckett were educated.
DrAndrewGreenland (01:02):
Fantastic.
I've just seen an Oscar Wildeplay this very week, and I'm
going to be seeing another oneat the weekend, so I can relate
to that connection with thosefamous playwrights.
So maybe if we could start atthe top, can you share a little
bit about your role at WesternHealth and Social Care Trust and
how this fits into the biggerpicture of supporting
communities?
ProfessorMonicaMonaghan (01:21):
Yes, so I'm a consultant cardiologist,
sub-specialising inmultimodality cardiac imaging.
So everything fromechocardiogram to CT, coronary
angiogram, and cardiac MRI.
(01:44):
So that's really the day job,job in cardiologist.
And then I also hold a role inmedical education, in the
teaching of the medical studentswho rotate through the
hospital.
And we have three universitiesQueen's University in Belfast,
(02:10):
Ulster Graduate Medical School,and then also the Royal College
of Surgeons in Ireland.
And then I also hold a role inthe medical directorate, and so
I'm clinical director formedicine, primary care and older
people, and I sit at theassociate medical director as
(02:32):
well.
So it's a varied uh job, no twodays look the same.
And that's uh and that's reallywhat holds my interest.
That's that's a great thing.
DrAndrewGreenland (02:44):
Amazing.
I always admire people thathold multiple hats, and I just
wonder how you fit all of thatinto your week.
How does it how does your weekpan out?
How do you balance all thesecompeting responsibilities and
interests?
ProfessorMonicaMonaghan (02:56):
So we run a consultant of the week
model.
So when I'm the consultant incharge of the cardiac unit, then
I'm very much the cardiologist,and around that, then I fit in
the other duties andresponsibilities.
(03:16):
So it's an early start uh tothe day.
Um typically about 7 a.m.
Um and in those couple ofhours, I suppose, before we
become clinically busy, I can uhget some of the other um roles
done, the the paperwork, theendless emails, um preparation
(03:42):
for meetings.
So a lot of it is is justpreparation, I suppose, the
night before, um, inanticipation of what the next
day might bring.
But being in cardiology, that'soften highly unpredictable.
Um but the predictable and theschedule things, um, then I fit
(04:04):
all the on-scheduled aroundthat.
DrAndrewGreenland (04:07):
Got it.
Yeah, well, anything in theacute care is uh, as you say,
always unpredictable.
As an emergency physicianmyself, I can completely relate
to that and very difficult toplan for anything.
But um, what um motivated youto pursue the kind of direction
in health and social care fromyou know your sort of background
in medicine.
ProfessorMonicaMonaghan (04:27):
Sorry, just repeat that.
DrAndrewGreenland (04:28):
I was just interested to know what
motivated you to pursue thedirection in uh social care and
health.
ProfessorMonicaMonaghan (04:35):
So I have a background in in research
um and in molecular biology.
So my whole interest in inmedicine was driven by evidence
um guidelines, and then I tookup the post here in the Western
(04:56):
Trust in 2016 as a consultant.
The population is is largelyrural, um, and with that comes
its own challenges andopportunities, and very much, of
course, as well an agingpopulation, and with that,
(05:17):
there's a recognition that whilewe're specialists in cardiology
or in imaging, I think there'sa responsibility when we meet a
patient or meet the patient withtheir family, that there needs
to be a holistic assessment, andthat's what I enjoy most.
(05:39):
Of all the roles, I think thebest is still sitting down
either with a patient in clinicor a patient at the bedside and
listening and understandingtheir story and giving them that
time and space.
I realize that we don't sit inisolation, so I might be able to
(06:05):
organize for an aortic valvereplacement or send somebody for
a heart transplant.
That's only a very small partof their journey and of where
they sit, and the holistic care,and this is what whenever I'm
teaching medical students or onward rounds, trying to
(06:27):
understand that holistic care ofwithin the whole community
setting and social care is soimportant as clinicians, and
understanding way beyond justheart health, and that's I think
where we can make huge impactas doctors and as part of a
(06:49):
larger team, so less siloedworking and more, I think,
joined up thinking, and moreintegration between hospital and
community, and that's I supposewhere my my passion sits
working as part of a team,working with the patient,
(07:11):
working with their family, andthen that has led to some
projects where we have goneoutside the hospital and have
worked in communities, in localcommunities, to talk about heart
health, about exercise, aboutfrailty, um, about type 2
(07:35):
diabetes, and those have beenvery, very enjoyable because
we're meeting people outside oftheir pajamas, if you like, um,
in their own communities, andwhat's important to them.
DrAndrewGreenland (07:50):
Amazing, and I completely resonate with this.
I my um interest in functionalmedicine, which is taking a very
holistic approach to diseaseprevention, disease management,
totally get where you're comingfrom.
I just wondered how this fitsinto a kind of stretched health
model.
Obviously, it's slightlydifferent for you in Northern
Ireland versus the UK.
(08:10):
But how does how does this fitin?
Do you have a challenge intrying to do this really
important work in the confinesof a stretched system?
ProfessorMonicaMonaghan (08:18):
Yeah, and I think it's important to
recognise that one individualcan't do everything, but two
individuals working closelytogether can can be do more, and
three can be exponential.
And it's really doing the verybasics right, and that might
(08:38):
just be simply starting off withcommunication, meeting um GP
colleagues who, of course, areintegral in rural communities.
We still very much have thefamily doctor model here, where
(08:59):
the general practitioner hastreated maybe the third
generation, and with that comesso much institutional medical
memory, and me coming in,building relationships with
general practice, with pharmacy,suddenly you start to develop a
(09:23):
momentum, and I have that goodrelationship with a number of
key individuals in thecommunity, family doctors who
are really striving within theconfines of the human resource
and the financial resource tostill deliver really excellent
(09:48):
care and the ideal, which isupstream care, managing chronic
disease before the patient comesto my cardiac unit with their
event.
So I have great relationships,excellent colleagues, and
(10:09):
there's a real willingness torecognise that change is needed
and that together we can do somuch more.
So, for example, tonight I'llbe going to uh a meeting in
another local town in our nextcounty called OMA, where myself
(10:31):
and one of my excellent GPcolleagues will be giving a talk
to a host of healthcareprofessionals on the role of
upstream medicine, the role ofthe healthy heart, the role of
chronic disease management, therole of exercise, um, and a host
(10:55):
of other issues which ispassionate to me, which I'm
passionate about, which is umsort of know your numbers, and
and that's the other thing thatI think is very important.
We look after patients, but weforget that we ourselves one day
will become a patient.
And how does that look like?
And what can we do to, Isuppose, prevent that happening
(11:17):
for as long as possible andgetting that into our psyche?
Um, and that's really part ofthe know your numbers campaign,
which we're actively promotingwithin the trust as well.
DrAndrewGreenland (11:30):
Thank you.
You mentioned know yournumbers, and in terms of how do
you measure the impact of whatyou do?
I mean, for what do thosenumbers look like?
And I guess you must have madea significant difference, but
how do you measure the impact ofthe things that you do in this
realm?
ProfessorMonicaMonaghan (11:46):
So, just to give you the context,
maybe it's because I've almostbeen in post-10 years, and
therefore my peers are startingto get that getting into that
age bracket as well, wheredisease starts to manifest
itself.
But in the last couple ofyears, I've treated a bigger
(12:10):
than expected number ofhealthcare professionals and
doctors with cardiac disease andwith myocardial infarction and
angina.
And I think the the overallunderstanding was we are we
(12:32):
could look after ourselvesbetter.
So many of us do not know whatour our simple parametrics are.
So, our blood pressure, forexample, what is what is the
expected normal blood pressurefor a 50-year-old or a
60-year-old?
And there's new guidelines outlast year where we really should
(12:52):
be trying to get to 120 over80.
Then what's our HBA1C?
So many have undiagnosed type 2diabetes, and breaking down and
talking about understandingcholesterol, so the good, the
(13:13):
bad, and how can we improvethat, and just having taking the
time as healthcareprofessionals, taking the time
out to get those things measuredand to have a think about what
I can do differently as a doctorso that I can continue to
function well and deliver carewell, and that's really where
(13:37):
the thinking around know yournumbers came from because of the
disease profile that I'm seeingin colleagues.
DrAndrewGreenland (13:46):
Got it.
So, what um I was gonna say, Imean, you've been doing this
work for a little while now.
How has it evolved with timesince you first started at the
trust?
ProfessorMonicaMonaghan (13:57):
So I suppose we all develop at
different speeds, and and uh ittakes some time to get embedded
into a job to buildrelationships, to become
(14:17):
equipped to deal with more thanjust uh the the job that we're
trained for in medical school,which is of course very much the
anatomy and physiology and theapplication of that, and yet
what we do every day goes waybeyond uh anatomy and
physiology, and my role hasevolved from clinician to I
(14:46):
suppose a leadership type rolein the clinical director, and
then one of the other roleswhich I enjoy very much is the
is the teaching and nurturingand fostering of our resident
doctors or non-resident doctorsand our medical students, and
(15:11):
trying to share the experienceand going a little bit beyond
just what their curriculum mightask of us to deliver.
Um we meet every Friday, forexample, with the our FY1 tier
doctors, and that's a protectedhour where we have the
(15:33):
opportunity and a safe space toshare experience, to talk about
communication challenges,conflicts.
And that's I think myimpression is that's probably as
useful as maybe spending anhour teaching them on diabetic
(15:54):
ketoacidosis, which they willget as well, and they will see,
but it's that opportunity, andthat's what I enjoy about the
last 10 years.
Probably that's only started todevelop more in the last few
years, and we all have todevelop the confidence to be
(16:15):
able to share our feelings andwhere we have learned and where
we could do better, and thencascade that on to our
colleagues as well who arecoming through to understand
that it's okay to say, A, Icould have done that better, and
(16:35):
or B, actually, I'm not in agreat place.
Could you give me somesignposts to get to a better
place?
DrAndrewGreenland (16:45):
Do you think that's something that's been
neglected over time?
I mean, obviously, you'repicking up on it now, but do you
think that's something that hasbeen neglected in sort of
conventional training?
We're kind of leaving thesepeople behind to fend for
themselves and not having theseconversations.
ProfessorMonicaMonaghan (16:58):
Yeah, I do.
I think despite the best will,very often we do get caught up
in the day-to-day runnings of anorganization and the running of
a busy ward or in a busyemergency department, and we
become accustomed to dealingwith life and death situations,
(17:24):
and it can be easy to forgetthat there maybe were other
people as part of that resusteam, for example, um, who would
really like to have five or tenminutes to have a conversation
or a debrief, and that might bea week later or a month later,
(17:46):
because we do we all carry thosecases with us, and I do think
that in the delivery of acurriculum very much focused on
disease and illness, and that wecan forget about our
(18:08):
psychological wellness andwell-being, and and how do we
cope and manage that in ahealthy way, or how do we even
recognize it at an early stagebecause it might not manifest
itself in a traditional way?
Um, and that's something thatwe do here in the organization
(18:32):
is try to have a focus on mentaland psychological well-being as
well as physical well-being.
We'll talk about healthymanagement strategies.
We talk about movement andexercise or music or chess, and
(18:54):
when our new doctors comethrough in rotation, I'll have a
presentation, for example, onadvanced life support.
But what I much prefer is justsit down and hear what I ask
them what is one interest youhave that is nothing to do with
medicine, and that's really metrying to get an understanding.
(19:18):
Do they have an interest?
Do they have a support network?
Because I recognize that we arein a rural area.
We many of our doctors could betwo hours from maybe their
families, and it's importantabout building that network of
(19:40):
support for them when they'rehere as well on the hospital
site, and knowing that there'san open door policy.
DrAndrewGreenland (19:49):
I think it really is so important, and
you're right, if we don'trecognise this and it ends up
with being burnout some yearsdown the line.
So I think what you do and theway you treat and look after and
listen to your juniors isabsolutely key for the rest of
us to take from.
Also, from your perspective,what are the major shifts that
you're um seeing in the healthand social care realm right now?
ProfessorMonicaMonaghan (20:08):
So I'll answer on a number of levels.
As a cardiologist, uh, one ofthe most exciting, and I think
one of the biggest impactfulthings that we're doing now is
the investigation of anginausing CT coronary angiography,
and that is in all the hospitalsin our trust, and we have a
(20:33):
number of skilled cardiologistsdelivering this.
So we've moved away from thetreadmill for the investigation
of chest pain, and we've movedtowards where we can actually
visualize the coronary arteriesand we can predict the health of
the arteries, and that guidesus on prevention strategies.
(20:59):
So we might know that there'sdisease there and there's
athlosclerosis, but the goalthen in a shared care model of
discussion is around theprevention of the event, so the
event being the infarct, whichthen could lead to heart
failure.
So that's that's one big, andthat's endorsed by NICE, which
(21:22):
is which is excellent, and and Iwould love to see more
investment in CT coronaryangiography across the region.
And I think that's aligned withour health minister, um, who is
also very keen on this shiftleft move upstream.
(21:43):
Other things that have come, Isuppose, through my own practice
is the ageing population, theand where there are deficiencies
in social care in thecommunity, leading to lengthy
(22:03):
hospital stays, and people whowant to be back in their own
homes, independent, contributingto the community, having to
remain in hospital because wedon't have that social package
available, and that's I know alot of focuses on that, and we
(22:30):
know that lengthy stays inhospital will lead to increased
frailty and sarcopenia andreduced psychological
well-being, and it's sofrustrating for patients, for
their families, and it's adetriment to the community
(22:51):
because they're not therecontributing and being active in
the community.
So that's one area that isfrustrating, but I think that by
getting educational programsout earlier to our population,
(23:12):
maybe in their 50s, their 60s,their 70s, about keeping active,
doing small things can have bigdifferences.
So even if you're walking 20minutes, 30 minutes, that will
have a big impact on bonehealth, for example, uh, in the
decades going forward.
(23:32):
And that's what we're trying toget across in messaging about
women's health.
Traditionally, cardiology, wespoke about, we recognized that
the typical features of angina,for example, in our in our men,
the classical, typical, but nowthere is a movement and it's
(23:58):
growing worldwide by a number ofkey individuals, which is
wonderful to see, and that'spercolating now down through all
the societies, down into oursmall communities, about the
recognition of heart disease inwomen.
And we have we have got thebikini medicine, as it's called,
so good.
(24:18):
So the bikini medicine is thebreast cancer, the gynee
cancers, and we're so good atthat, and yet in cardiology we
have let that slide.
So there's a movement nowcalled Beyond the Bikini, and
it's really about motivating andeducating women in the
(24:42):
communities and alsocardiologists and doctors about
recognising heart health inwomen, and that we are not many
men, we are not smaller men,that we present and can present
in different ways.
And just because we might alsohave the vasomotor symptoms of
menopause, or we might also haveanxiety, or we might also have
(25:07):
palpitations, we're also allowedto have dual pathology, and we
might actually be presentingwith angina or an underlying
heart disease.
I think there is a recognitionout there that sometimes we
have, as clinicians, beendismissive to some degree, but
(25:30):
that's changing, and that is, Ithink, a very healthy place to
be right now as a woman havingmenopause.
DrAndrewGreenland (25:44):
Thank you.
What about um patientexpectations or even
generational differences?
What are you seeing frompatients in and how is that
affecting the way you delivercare?
ProfessorMonicaMonagha (25:56):
Patients are, I think, more empowered.
They are they have the accessnow to the internet, they will
have looked up and read abouttheir symptoms before they
attend, and that I think, ingeneral, is a good thing because
(26:18):
they will come with questions,and it's an opportunity then for
us to guide, listen first, andlisten where are they coming
from?
What is this story?
They might chat GPT may haveadvised them on what this might
(26:40):
be.
Um, and I don't think any of usshould feel threatened by that.
I think it's an opportunity tosit down, listen, um, learn, and
um, and then just talk through.
Well, here is what I'mthinking, um, based on what
(27:01):
you're telling me.
And I might need to do anothertest to prove that, I might not,
but the real basic, Andrew, isstill back to his really good
history and examination andspending that time listening.
So I think expectation anddemand, if that's the right
(27:24):
word, not sure it is, but thathas gone, that has increased,
but that's not necessarily a badthing, and moving away from the
paternalistic um doctor-patientrelationship is also a good
thing.
There's more shared care, thereis the onus on us to be honest,
(27:52):
open, and transparent, and alsoit's okay to say, you know, we
work in diagnostic uncertainty,and we might not have all the
answers, but I might be able totalk to somebody or signpost you
to somebody who might give usmore information and restore you
to better health, and I supposewe're funded to do some things
(28:18):
really well, so treat heartattacks, treat valve disease,
treating heart failure, but allof the things that go around
living with a chronic disease,we don't necessarily maybe have
the time and resources to dothat, and that's why I'm so
(28:41):
grateful to organisations likeNorthern Ireland Chest Heart and
Stroke and other voluntaryorganisations who do provide
that wraparound care when wemaybe can't, as clinicians, give
the time that's absolutelyessential, or the funding to
areas like psychology orphysiotherapy and things like
(29:05):
that.
So I have to say, I doencourage patients to bring
along their questions.
I always tell them you willforget.
So when I come to see you onthe wardround tomorrow, write
everything down or bringsomebody with you to clinic
because four years is betterthan two.
DrAndrewGreenland (29:24):
I I smile in jest because um I've had those
patients that bring theirreferrals from Dr.
Google and Dr.
ChatGPT pages and pages andpages.
So I smile in jest, but Icompletely get your point.
It's important people come withall of their concerns and
questions and have them allanswered properly by a clinician
who can take a good history andexamine and do all the things
(29:46):
that the electronic things thatyou mentioned can't do.
With all the improvements thatyou've mentioned and the early
intervention and preventativemedicine, what are the
challenges or bottlenecks thatare still most impactful in the
work that you do right now?
ProfessorMonicaMona (30:00):
Challenges, waiting lists.
Would love to get patientstheir echocardiogram, which is
you know such a such afundamental front door mobile
test, and how wonderful would itbe with all the advances to be
(30:20):
able to bring that point of careultrasound into the
communities.
So I suppose there is afrustration around what it could
look like and what it does looklike, and then sometimes the
bureaucracy around making a goodidea, or at least what I might
(30:41):
think is a good idea, happens.
And that's certainly achallenge.
I think the human resourcethere is a willingness there,
and there's a drive, there's akeenness to explore AI and
artificial intelligence, but Istill think we still have to get
(31:05):
the actual intelligence rightin order to get the artificial
intelligence right.
And other frustrations, thetiming, um just not enough time
sometimes to do everything, andfeel that I could have done that
(31:30):
better when you reflect.
But I suppose that's part ofthe learning, um, and that we're
still continuing to evolve ashealthcare providers.
So I still think get the basicsright and everything else will
(31:51):
follow, but it is it's it'sseeing that increase in chronic
disease in the community andwhere there might have been
opportunities to interveneearlier, and we can only see
that with the benefit of thehelicopter view when they
(32:13):
present into cardiology withtheir event.
And in fact, one of the thingsthat I'll be speaking about
tonight with my colleague Dr.
Emer Darcy is about the role ofQ risk and that this has been
adopted uh through NICE, and yetI can see it when I scan so
(32:37):
many so many people in their 50sand their 60s, and we're so
good at measuring things that wecan see that they've had their
LDL measured innumerable times.
We can see it climbing, andthere were opportunities there
to intervene on this disease,and there was a reassuring cure
(33:00):
risk, and yet the patient stillpresents then with the event or
with an advanced form of thedisease.
I know that there is a movementout there as well of
like-minded individuals whowould love to move beyond these
(33:20):
scoring systems, which arereally just guidelines, and
maybe move towards a moreaggressive preventative strategy
with all the things that wehave now that we can offer
people that we didn't reallyhave 30 years ago.
DrAndrewGreenland (33:38):
Thank you.
Finally, um, looking back, ifyou were to start, if you were
starting in your various rolesagain fresh tomorrow, what would
you approach differently if youhad your time again?
ProfessorMonicaMonaghan (33:49):
So great question.
Um I would I think it wouldtell my younger self to maybe
take life a little bit lessseriously.
I I do do a lot of exercise,um, which I love.
(34:13):
Um I would maybe take more timeto consider.
Um we're all inclined to maybetry to please and say yes to
roles, and sometimes it's alsookay to say no, thank you.
(34:37):
Um, that's just not for me atthe moment.
Um I'm even thinking throughtraining, how many family things
that I I missed because of thetraining programme and the
delivery of service.
And looking back now as anolder person, um there is some
(35:02):
regret there, and and that'spart of what I teach our
resident doctors too, that thatlife is important and that life
outside of medicine isimportant.
DrAndrewGreenland (35:13):
Monica, thank you so much for your time this
afternoon and sharing theseinsights.
It's been such an honest andinspiring conversation, and I'm
sure our listeners are going toderive enormous value from
listening to this podcast.
So, really many thanks to youand your time this afternoon.
ProfessorMonicaMonagh (35:29):
Pleasure, thank you, Andrew.
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