Dr Paul Chadwick
Consultant Microbiologist
Hope Hospital
Salford
How did you train to become a microbiologist?
As a medical Student I trained in Sheffield. I took the opportunity to take an intercalated B. Med. Sci. degree and a year out to study microbiology because I found bacteriology so interesting. I then had house jobs in Sheffield, in Infectious Diseases and in General Medicine. I completed six months A&E on the Wirral and then moved to Bangor to join the SHO medical rotation. All together I stayed in Bangor for eighteen months. More rotation followed in Manchester: six months in Infectious Diseases and six months in General Medicine again. I completed my MRCP and looked for a registrar post in an infection-related specialty. I was at a crossroads at this time and was shortlisted for two jobs: Manchester for Medical Microbiology and Oxford for Clinical Infectious Diseases. It was serendipity! The Manchester job came through first!
Because of the intercalated year I had completed as a medical student and my general medical experience, I was able to enter Medical Microbiology at registrar level. The old pathology multidisciplinary rotations have been axed now and the two routes available are via SHO in Medical Microbiology or SHO in medicine, preferably including infectious diseases.
My higher specialist training was completed in Manchester at Wythenshawe, Hope, Withington and North Manchester General hospitals. I then joined Hope again as a locum consultant for six months, before applying for the substantive post. Three years later I became Clinical Director in charge of 200 people within the laboratory complex!
What attracted you to Medical Microbiology?
Clinical Infectious Diseases was very enjoyable work for me. I am interested in bugs and infections. It is also a clinically rewarding specialty - patients come in sick and go out well. It is interesting also because there are tropical infections which are unusual and exotic. HIV patients can be similar in that respect - they tend to get unusual diseases.
The Medical Microbiology rotation in Manchester is systematic and structured and there is an excellent prospect five years on of being a consultant.
What is a typical working week like?
Ward work is an important component of Medical Microbiology. There are all sorts of infections and diseases that need to be diagnosed. Medical Microbiologists give advice on how best to investigate for diagnosis. We do a brief assessment with the patients and after tests and treatment go back to see whether or not they are improving. Infectious diseases doctors are not based in most hospitals - there are four Infectious Diseases consultants in Greater Manchester. If we need an Infectious Diseases consultant we speak with them or we ask them to come to see our patients or we transfer the patients, as necessary. The majority of specialist clinical infection advice in the UK is provided by Medical Microbiologists.
At Hope one third of the job is clinical work, not all in the ward - some in the laboratory. A third of the work is lab. management and direction - making sure that the right tests are conducted on the correct samples. This involves working closely with the technical staff. The other third of the work is infection control, for example, of antibiotic resistant bugs. I make sure that the right systems are in place - that patients with TB are isolated and that decontamination of instruments is properly carried out.
So, going back to the attractions of the job, one is the immense variety involved. I get into all areas of the hospital and talk to surgeons, ICU staff, GPs, nurses. There are also Estates issues - maintaining the systems for keeping buildings clean and free from such organisms as Legionella.
Are there any myths or stereotypes about the job that you think should be addressed?
Work in pathology labs has been seen as living in the back office and looking down microscopes. I liaise with a whole variety of people all the time. Apart from the clinical and lab staff, hospital managers come to me for advice over policy matters and look to me for solutions. Medical Microbiologists have a high profile amongst hospital administrators.
Are there any advantages or disadvantages to the job?
It is varied work and it is reactive work. I have to respond to events. Other plans sometimes go out of the window! But the counter side of that is the surge of adrenalin in working to control and overcome the infection. If there is a big outbreak of infection there are daily outbreak meetings. There is also the press interest in a big outbreak, which has to be handled carefully. There are good opportunities for research and writing papers.
What about on-call and flexible training?
Together with 3 other consultants, I provide out of hours advice (almost all by telephone), on a 24 hour basis. We work on-site on Saturday mornings when on call.
Flexible training is possible, although it will take longer to get through the training, of course. We have recently had a flexible trainee, who is now a consultant in South Wales.
We would be very happy for interested trainees to come and spend a day with us.