UCL Queen Square Institute of Neurology


Interview with Dr Martin Grecco

Dr Martin Grecco is a consultant Neurologist from Argentina.

What are your fondest memories of Queen Square?
This is a very difficult question, as the whole experience of being at UCL and Queen Square was fantastic. For example, the ward rounds, Gowers’ grand round etc, the place itself and the mix of the traditional way of teaching neurology with new information and new techniques. The way they presented the cases, for me, was the classical approach to teaching neurology, reminiscent of the big neurologists from the 19th century in London and Paris. Also, I really loved the master classes that were part of the MSc/Diploma in Clinical Neurology. There we had the privilege of having small group teaching with the most important professors and researchers and to have not just a classical type of lecture but also the chance to interact. This was something that you don't usually have in other environments, the possibility of having people like Professor Simon Shorvon  or Professor Alan Thompson being there just for you. We also had the opportunity of interacting with other students, researchers and clinical fellows. Many former students and classmates have since become famous. It is very nice when you read a paper in Neurology or other important journals and you realise that the first author was someone who studied with you. One of the fellows with Professor Shorvon was from Italy, Monica Ferlisi, and she has published important papers on super refractory status epilepticus. It is amazing, because you are connected with people that are, or have become, the best in the field. Even the final exam was a pleasant experience; something that was very unique and educational. Lastly, all the people that I got to know, my classmates who started with me and who I have contact with today, helped make it an exceptional time and one of which I have many fond memories. I would also like to highlight the support we had from the Education Unit, in helping make the whole experience fantastic.

Dr Martin Grecco

I remember the outpatient clinics of the consultants and, for example, it was a great experience with Professor Kailash Bhatia and there are some things that I remember in my practice today from these experiences: seeing a patient with movement disorders, the procedures and the clinical reasoning. When we went to the wards we received bedside teaching from the registrars. I recall Dr Nikhil Sharma’s teaching and his approach with patients, likewise with Professor Nicholas Wood and his Ataxia clinic. When I went to Queen Square there were many topics I wasn't really confident about. Professor Shorvon demonstrated some aspects of epilepsy that were not clear to me, how to conduct a thorough history and what to check. In many respects this was one of the most useful lessons I took from my time there, as the physical exam is something that is universal, but it's the approach to the patient, the clinical reasoning, and the questions you have to ask the patients which are key. One of the best to demonstrate this is Professor Andrew Lees.  His recent talk at the leading edge neurology course highlighted the neurologist being like Sherlock Holmes in some ways and the importance of paying attention to the details. Perhaps I should have learned even more from these great neurologists, but I was there just a couple of months and not years. I think that when you have the opportunity to be there with these people, you learn through a process of experience and immersion. 

You first came to Queen Square in 2005. Can you tell me about this experience?

I had time to do an observership abroad as part of my residency training in internal medicine. I completed four years of internal medicine before my observership. I decided on neurology and the first place I contacted was the Karolinska Institute in Sweden. However, I was rejected, so I considered other places, maybe Spain because of the language, and then I thought of the UK. I was aware there were plenty of great neurologists but not how to apply. The British Council in Argentina recommended the National Hospital for Neurology and Neurosurgery; the rest is history! It has happened to me several times during my career that every time I wanted to do an observership in another part of the world, even in my own country, they have said no, and every time I wrote to someone in the UK I was accepted. In 2005 I had one month with Dr Gavin Giovannoni. Although McDonald had passed away by the time I arrived, MS was a very important speciality, an epicentre of research. It was fantastic, and I have to admit that at that time my English and my knowledge of neurology was poor. It was just one month, but it whetted my appetite for the future.

Why did you pursue a career in medicine?

My sister is two years older and she studied medicine, so I think that influenced me. Also, at secondary school the one subject that I really liked was biology. The other things I considered apart from medicine were to be a historian or a journalist. 
I studied at a private university, Universidad del Salvador, a Catholic university related to the Jesuits, therefore a very influential person at that time was the Dean, Jorge Mario Bergoglio, who is now the current Pope (I was also baptised by him). Both my mother and my father went to this university, and that influenced my choice. In the capital city there is just one public university, the University of Buenos Aires, which is very big, besides six or seven private universities. Most people regard a public university as providing the best quality education. In my case, I decided to go to a private university, because its quality of teaching was more or less the same academically. Public universities in Argentina have the trait of not being very well organised, whereas in private universities you have some advantages, for example, it's more like the colleges in Cambridge or Oxford. Things are very clear, well organised, class sizes are much smaller and your progress is monitored. 

Who has inspired you in your career?
Despite choosing the speciality of internal medicine, which was more to set the foundation and to have a good clinical background, those who inspired me most were from neurology. During medical school I had the opportunity to undertake three weeks of neurology training. At the time I was at the university, there was a neurologist whose teaching was unorthodox, but this made me more interested. Then, one of the most influential for me was the person under whom I received neurological training in Argentina and with whom I spent three years. The hospital was the teaching hospital of the public university (Hospital de Clínicas), and the head neurologist was called Prof. Jorge Luis Ferreiro. He was really special, because he reminded me of the famous neurologists with respect to his knowledge and  reasoning. There are many stories of consultants or neurological teachers doing a diagnosis without touching the patient. Just seeing the patient across the room and saying “okay this patient might have ALS” is amazing. He was brilliant, but he retired from his position while I was finishing my training. He was very influential. All the rest are from England. During neurology training, I had the opportunity to go to Oxford to do an observership at John Radcliffe with Professor David Hilton Jones who was working with Professor Angela Vincent. It was also within the same department where Professor John Newsom Davis worked, one of the most important neurologists in terms of neuromuscular diseases. I developed a real interest in neuromuscular disease from this visit, and my experience provided a clear example of what British people and British neurologists are like. I used to read a lot of papers by Professor David Hilton Jones in Practical Neurology, which is a great journal. Since authors provide their email contact addresses, I wrote to him and said I am a junior neurologist from Argentina, and would be really interested to come for an observership. The next day he replied, and said I was welcome to come! This is something I really have to stress. It is difficult to find in other countries, as I have found the attitude less welcoming. It is my experience that the UK is much more open to giving people the opportunity to study and they are very humble, to a level which is hard to find in other places. These are authors who have written many papers, etc., but who are willing to give opportunities to people to come and learn. In 2010 I returned to Queen Square. Professor Shorvon is one of the greatest because he is the epitome of what I was describing. He is well known all over the world, someone who has developed concepts in epilepsy and is really humble, friendly, and very generous in imparting knowledge. It seems in England, every time I have come or contacted people, everyone has been very generous with knowledge. The more important, the more famous, the more humble they seem. When I listened to him on the rounds, he had a unique way of transmitting knowledge and approaching the patient. 

How did the project of writing your book come about?
After coming back from Queen Square in 2011, I wanted to embark on this project, but I had to put it away due to my workload and the pace required to write a book such as this. The enemy of writing a book on neurology is that there are constant updates and new discoveries, so maybe you write a chapter and in three or four months it is out of date. So the difficulty is that you have to write in a very short time, and in order to do it justice when it's published it contains the information of one year. Anyway, I had my project on standby and two colleagues of mine, Benjamin Vera Barros and Juan Pablo Pettinicchi, had their own project. We had undertaken neurological training together and they were writing this book, but they were also struggling and asked if I wanted to join the project, which I did in 2015. The launch date should have been December 2019 but was postponed to 2020 and due to the pandemic it was pushed back to 2021. It was a long process, but very rewarding to publish.
The book is something of a curiosity.  It is in Spanish, but there is one part of it which is in English. For me, the foreword is one of the most important parts.  It was written by Professor Simon Shorvon and the authors decided to keep that in English and not to translate it. I felt that the meaning would not be the same if translated. We also had a foreword from the other Professor I told you about, who was the chief of neurology when we did our neurology training. The title is in Spanish, and translated it would be “Neurology without Secrets”. What we wanted to achieve was not the typical neurology textbook, and instead aimed it at residents of other specialities who require a certain amount of information to gain a good understanding. Of course, you have the classical textbooks, for example, Neurology: A Queen Square Textbook. As we were less well known, we tried to come up with a title that acknowledged people’s “neurophobia” and if you say the title is “Neurology without Secrets” it's to convey that actually neurology is not so esoteric and it's something that you could read and understand. I have seen that some clinical colleagues are a little scared or unsure; thinking that things are always a stroke, haemorrhage etc. In the UK you have GPs, and the GP manages a lot, but in Argentina, for example, people who are complaining of a tension headache go to the neurologist. This increases the burden on clinicians, even though many conditions can be dealt with in general practice rather than going to a specialist. It is not just with patients, as some clinical colleagues, even when they have conducted a very good physical examination and get the same history from the patient, will still recommend that the patient see a specialist because they have a fear of missing something.

Why do you have such a love affair with the UK?

This is a topic for another interview! The short answer: the country itself, for me, is one of the best. The history, the culture, the people, etc. The history is so interesting: how the UK was forged and the influence it had in the world. I'm very comfortable with the culture, the people, the language, even the food more or less!  In terms of medicine and especially in neurology, and this is something I would like to emphasise, because, of course, there are many other places like Salpêtrière, which is fantastic, the Mayo clinic in the US, Karolinska, etc, which are all great. The tradition that the UK has in neurology is one of the richest in the world. The other is the typical characteristic of the British neurologist, which is a model for me in many ways in terms of how they approach the patient: the clinical reasoning in how they treat and the relationship of respect between doctor and patient in how they interact. This is something which is difficult to implement in other countries due to the difference in culture. In general, patients in the UK are very well informed, and this is a great benefit. The UK for me provides the best model of how to be a clinical academic and, if I can use a football metaphor, at Queen Square it is like a team with many star players, but where all work as a team. In some other centres it can feel more like Hollywood and you have a star, and you have a feeling of competing for attention.  I know that sometimes people are a bit amazed when they see how I view the UK, but for me it is a perfect country and is the best place in the world for neurology, with great people who are humble and generous.