The Big Interview – Dr Umesh Dashora
An “eternal optimist”, Dr Umesh Dashora has worked with some of the leading names from within the field of diabetes.
The keen badminton player has worked in India and Oman, as well as the UK. Since settling here, he has become involved in launching the Rowan Hillson Inpatient Safety Award and has also spent time looking at recommendations to address an “unmet need” for structured education and training for midwives managing diabetes in pregnancy.
Here, he tells The Diabetes Times how COVID-19 has permanently changed the landscape of diabetes care and what he thinks have been the most positives changes within diabetes care in recent times.
Your journey into medicine is an interesting one. Can you give us an overview?
I started my journey in medicine from the capital city of the historic state of Rajasthan in India. After graduating as a best student of the outgoing batch I was joined by my class fellow who became my wife. I decided to do a post graduate degree in medicine from a unit with interest in Neurology.
After a brief stint of running a private nursing home I decided to receive specialist training in diabetes in endocrinology in Mumbai and Later Bangalore. My first job within the field was for the Ministry of Health, as a Regional diabetologist.
I had eight fantastic years in different regions of Oman while bringing up children and living with colleagues near hospitals. Oman gave me a chance to clear UK examinations for the Membership of Royal College of Physicians although I am ashamed to say that it took a couple of attempts. Once a member, there was only one way to go.
Professor Philip Home from Newcastle was kind enough to accept me for a clinical attachment and at the age of 42 I once again moved to a different country. This time it was to be the UK.
Within one month of coming to the UK, Professor Roy Taylor believed in me and gave me my first job. On the strength of that three month job I made the rather brave (or foolhardy) decision to move my family to the UK.
Luckily I got subsequent jobs including a research job with Professor Home which gave me another research degree. With this experience, and after failing a number of interviews for the training post in endocrinology (because apparently I was too old and I had too much on my CV), I finally got a training number in Southampton and completed my specialist training in Endocrinology.
Luckily a consultant job came up in Hastings when I was completing the training and I was successful in the interview for this job. Once in the consultant job I was able to contribute to the work of Royal Colleges, British Medical Association, British Association of Physicians of Indian Origin and the Association of British Clinical Diabetologists which was all hugely soul satisfying.
The Chief Executive of East Sussex Healthcare NHS Trust, Dr Adrian Bull and Medical Director Dr David Walker are exceptionally supportive to their staff including me. After becoming a consultant I collected another degree (my third masters) in Medical Education from Brighton Medical School and became a graduate of Mary Seacole leadership programme.
I would highly recommend all these to the new consultants. These are not financially compensating activities but one is able to contribute to many useful projects and meet some of the most wonderful and clever people in the profession. I had good fun.
How has your journey to medicine impacted your approach with dealing with patients?
It has given me a holistic and comprehensive view when I attend to my patient. I can relate to their stories and priorities, which means I am able to bond with them better. Most of them go home happy and sometimes amused when they leave my consulting room.
You have medical experience working in India and Oman, as well as the UK, how has this helped you nurture your career?
I have been lucky (and restless) throughout my life as I want to do projects which are useful and I want to do them more and better. I was lucky to meet some wonderful people who supported me in my journey and gave me the chance to contribute more. I will forever be thankful to them.
Moving through cities in India and then countries, I think I obtained diverse and extensive experience of medical problems, but also medical staff. This helped me when I was working with staff and Speciality Grade (SAS) doctors at the KSS deanery and I was able to immediately understand, help and support international doctors who make huge contributions to NHS work.
You are involved with launching the Rowan Hillson Inpatient Safety Award how important is this awards programme and why?
This started 10 years ago when I was seeking to find a way to standardise insulin prescription charts in the UK so that insulin errors can be reduced. In that quest, I met Dr Chris Walton who is another amazing clinician and was the chair of ABCD that time.
He asked me to talk to Professor Mike Sampson about this. Professor Sampson gave me the idea of working on an awards programme which seeks out the best insulin prescription charts in the country and then puts them on the ABCD website for Trusts to use if they wanted.
I have never met anybody who is as supportive and is able to get the best from people as Professor Sampson. He contacted Dr Rowan Hillson who was delighted to support the project.
Erwin Castro, one of our diabetes specialist nurses and winner of multiple educational awards and Debbie Stanisstreet, another diabetes specialist nurse and I got together and we have been running this award now, with the help of Christine Jones, who is an exceptionally well organised and committed individual from the Joint British Diabetes Specialist for the last six years.
This award has unearthed a number of significant innovations from teams across the country which we have published in the British Journal of Diabetes for people and Trusts to adapt for their use and improve patient care.
Last year you were involved in looking at recommendations to address an “unmet need” for structured education and training for midwives managing diabetes in pregnancy. What interested you about this subject?
To be honest that was not my idea but I was asked to explore this by another keen and supportive consultant Huw Alban Davies who is the chair of Diabetes Care Trust and wanted to assess the education and training needs of midwives in the country.
As I said before, I jumped at the chance and supported writing up the survey which showed significant needs expressed by many midwives.
Dr Dinesh Nagi, the chair of the ABCD and Dr Huw had the vision of taking this work further and asking the Royal College of Midwives (RCM) if we could develop an online training module for the midwives.
The RCM was delighted with our offer and allowed Dr Nagi and me to develop the module for them. I have been told that on the last count 320 midwives accessed the course within four months of launch with more than 56 per cent completing the course.
How did your role change during the COVID-19 lockdown period?
I was a coward during the COVID-19 period. My chief executive, Dr Adrian Bull who is an exceptionally kind person insisted that I work from home due to my health conditions. I have therefore been shielding and feeling guilty. To compensate I have done a number of clinics and MDTs from home and our referral to treat target achievement in Endocrinology at ESH is over 95 per cent.
Do you think the landscape for treating people with diabetes has changed permanently and if so, why?
During these months I have realised that many patients with endocrine and diabetes problems can be seen virtually saving journeys, parking, fuel, time, money, office space, clinic support staff and environment. Out of about 600 patient contacts that I have seen virtually during my shielding period, there were only two patients who wanted to come to hospital rather than being seen virtually.
There will always be patients who need to be seen face to face but a significant number can be seen by a combination of video and telephone.
My colleagues Dr Dinesh Nagi, Dr Pratik Choudhary, Dr Peter Winocour and others have developed fantastic rebooting frameworks for people with diabetes and endocrinology who have missed their appointments, but now they can get the care based on their needs quickly.
Diabetes treatment and approaches have changed a lot in recent years. What have been the single, greatest changes in your opinion?
I think the greatest change is the recent explosion of diabetes medications which can reduce cardiovascular risk and death in people with diabetes. Some SGLT-2 inhibitors and GLP-1 analogues look very promising in not only controlling diabetes better but reducing weight, BP and cardiovascular and renal risk.
Talk us through a typical day in your professional life
I have an extremely varied and enjoyable working week. I wake up to a senior management meeting at 8 o’ clock. This is followed by a clinic, working lunch and another clinic.
On certain days of the week some clinics are replaced by working for Brighton Medical School as their deputy sub-dean, management and recruitment work,. This means taking part in a multidisciplinary meeting with fantastic colleagues for patients with pituitary, adrenal, endocrine and parathyroid problems.
I get to attend a number of interesting and very useful meetings from Royal College of Physicians of London as well as Edinburgh. I have taken the job of meeting secretary for the Association of British Clinical Diabetologists from this May. I am very much looking forward to organising some interesting diabetes meetings for colleagues.
What is the future of diabetes care in the UK?
I am an eternal optimist. The future is great. With people like Jonathan Valabhji, Partha Kar, Dipesh Patel, Ketan Dhatariya, Gerry Rayman and many others at the helm the future is secure and will forever improve. The Diabetes Prevention Programme is already showing rich dividends. What we desperately need is an integrated system of diabetes care with shared IT across primary and secondary care to provide seamless care to our people with diabetes.
What do you do in your spare time?
I enjoy playing badminton up to three times a week with colleagues and juniors. When I moved to Hastings it was compulsory for my juniors to play badminton with me if they wanted a good reference (joking of course). However, gradually the group has grown with many GPs and colleagues from other departments joining, so I quickly relaxed that restriction on my juniors. That has meant that I lose more games than I used to but I will blame it on the weather.