Andrew Hutchesson
Consultant Chemical Pathologist
Royal Bolton Hospital
Bolton.
How did you train to become a Chemical Pathologist?
It was slightly drawn out. At the very beginning of my medical studies I had an intercalated year when I was studying Natural Sciences at Cambridge, which included physiology, neurophysiology and neuropharmacy - the substance of pathology. As a new SHO in my first job I looked at Anaesthetics and General Medicine. Chemical Pathology being a mix of science and clinical work, I decided to do a Pathology rotation. This enabled me to spend three months in each of Chemical Pathology, Haematology, Histopathology and Microbiology. I then went back into General Medicine, took the MRCPath and became a SpR in Chemical Pathology. Chemical Pathology was very well taught in Clinical School and I enjoyed it.
As a Registrar in Sheffield I spent 6 months in the Children's Hospital and then in the University Hospital, Hallamshire, split between daily nutrition prescribing, working in the medical clinic and in the diabetes clinic. As a Senior Registrar I moved to Birmingham and rotated through all the major teaching hospitals, spent another 6 months in the Children's Hospital there and one year attached to the West Midlands Regional Poisons Unit working in lipid and endocrine clinics and laboratories. This was when I was working for the MRCPath and it includes a research project so I developed a lipids related project concerning calcium and inherited related disease in children.
The multi-disciplinary rotation for SHOs has disappeared now. Instead SHOs major in one area of interest. Metabolic medicine also requires the MRCPath. This is not the only route into Chemical Pathology, however. The MRC Child Health is equally useful if there is interest in Paediatric Medicine. It is also possible to come via the PhD route.
What is your normal working pattern?
20% - 30% laboratory work, 30% management and the remainder is direct patient contact and clinical liaison.
About one and a quarter days a week are spent checking abnormal results from the lab, commenting on these and contacting the clinicians to discuss the results and other tests which may be required, and visiting the patients. The clinicians need to know what the results mean so that they can discuss what action to take.
A ward round is conducted once a week. This is a teaching round and we may visit the Special Care Baby Unit, the Intensive Care Unit and other wards if we need to see a patient. There are also two outpatient clinics we look after: the Diabetic Endocrine Clinic and the Metabolic Clinic. About one third to one half of those attending have a thyroid problem and one third have a calcium problem; the remainder has problems to do with inherited metabolic diseases.
As manager of the lab I deal with staffing problems, purchasing equipment and arranging the protocols for tests taken outside the hospital. The Unit has one Chemical Pathologist SpR, one fellow consultant who is a Biochemist; there are two other Biochemists and 15 Biomedical Scientists who undertake routine analysis and the day to day on-call duties. The consultants provide the back up on-call.
I also hold the Directorship of Research and Development for the Trust. Currently I am writing a paper in conjunction with a Paediatrician at Wythenshawe Hospital and I am involved in a research study with Oxford.
What attracted you to Chemical Pathology?
My interest in physiology and the opportunity it gives to combine basic science and lab work with clinical aspects. In Chemical Pathology one is able to see every aspect of patient care. There is also the opportunity to develop outpatient care. There isn't much opportunity for private medical work, but I do supervise the local private hospital laboratory and conduct the external quality assessment scheme. I am also available to answer questions that their clinicians may have.
There is a broad vista in terms of choosing which way to go within the specialty. I chose paediatrics and inherited diseases. Other paths include epilepsy, medical ethics, poisons unit. I know of one Chemical Pathologist who became a coroner and now continues his career as a chemical pathologist.
What do you see as the best aspects of the work?
The flexibility that enables me to pursue my own interests within the specialty and the ability to make as much of it as I can. It is not as pressurised as general medical work. It is a small specialty with a good network between hospitals in the region and a good network nationally, too.
What about the worst aspects of the work?
The pressure of resources and the central dictates with continual change.
What personal qualities do you think are most necessary for a Chemical Pathologist?
Patience! And the ability to work with other people and listen to others' points of view. There are many different specialists in the lab: medics, scientists, biomedical scientists, administrative staff, secretaries and unqualified staff. We work with clinicians about 50% of the time.
Is flexible training possible? Does training affect family life?
As a family man with school aged children it can be difficult to find the right job at the right time in the same region. So there is a need for flexibility to move, or to be able to wait for a vacant post in the same region.
Flexible training is certainly possible. Three out of four of our trainees have worked to a flexible training programme.