I was a research registrar in a department of chest medicine, but some of my research was supervised by a haematologist. He would often take me with him at the start and end of the day to see patients and then make or confirm a diagnosis after looking at the blood and marrow samples later. His enthusiasm and the integration of clinical and laboratory skills was inspirational.
Dr Tim Littlewood, haemotology consultant at Oxford Radcliffe NHS Trust, shares his experience of what influenced him in choosing haematology, what training involves, and what it is like working in the specialty.
What influenced you in choosing haematology?
What training do you have to do to get into haematology?
I qualified in 1978, and junior doctor training was different then. I spent 1 year as a house officer (6 months each in surgery and medicine), 1 year as a senior house officer (SHO) in accident and emergency and 1 year in cardiopulmonary medicine during which I passed the membership exam. I then worked for 18 months as a medical registrar with 12 months in general medicine and 6 months in rheumatology before taking my research post.
What rotations did you do in your training and what did you find helpful?
At the Hammersmith I spent 2 years training. The time was divided between laboratory haematology including coagulation and blood transfusion, and clinical haemato-oncology. I then moved to Reading as a senior registrar where I spent 2 years of training in general haematology. The consultants there were also very enthusiastic, hard-working and supportive.
I moved to Oxford after passing the MRCPath exam and a consultant appointment came up a few months later. I was told that I had no chance of getting the post but I should apply ‘to gain experience’. I think that I was lucky and have been there ever since.
Do you work closely with other specialties?
We are very privileged to have experts in renal, cardiorespiratory, gastrointestinal and hepatic disorders among others on hand to assist us with some of our very seriously ill patients. Some of our patients also require periods of time on the intensive care unit and we are provided with immense assistance from these very skilled doctors.
What are the best aspects of working in haematology?
I love all of it, with its mix of patients, laboratory work, teaching and research. I would not make a different career choice if I had my time over again.
Haematology involves looking after many seriously ill patients. Sometimes the outcome is good, sometimes it’s not. Whatever happens, it is very satisfying to try to provide excellent ‘holistic’ care to patients and their families. This would not be possible without very skilled supporting nursing teams, dieticians, pharmacists and more. I also still get much pleasure in the diagnostic side of my work which involves the integration of clinical and laboratory skills – one of the factors that initially influenced me towards a career in haematology. Teaching has always been a major interest for me, and working in a teaching hospital has also enabled me to pursue an academic career.
What are the main challenges of working in your specialty?
It is hard work and often emotionally demanding. If you feel that you could not cope with the emotional side of the work then this specialty may not be for you.
My role involves a huge amount of decision making. One very important example is the decision of whether to offer a patient potentially toxic chemotherapy as treatment for their disease. Trying to decide whether the risks of treatment outweigh any possible benefits and advising patients accordingly is one of the most demanding aspects of my job, but one which can provide a lot of satisfaction in attempting to deliver the most appropriate care.
What are your typical working hours?
From 8am to 6pm would be typical, and I often visit the hospital at weekends even when I’m not on call, to see particularly sick patients or to tidy up loose ends from the previous week. I have also had the opportunity to travel to many parts of the world giving talks and attending conferences.
Are there opportunities for teaching or lecturing?
This is a very important part of my job. I not only teach students about haematology, but I take my college students in Oxford weekly and teach them aspects of general medicine. I supervise 18 college students (six in each of the three clinical years) and have enjoyed the opportunity to provide both educational and pastoral support to them.
Because of my interest in teaching, I have a part-time contract in the Oxford Medical School. I also teach the laboratory staff once per week and the nurses once or twice per year. I recently set up a teaching committee of the British Society for Haematology in which I have developed student teaching days.
Are there opportunities for research?
I have published over 100 papers during my career, mainly based on collaborative clinical research. I have had a particular interest in anaemia and its management for many years and this has provided me with many opportunities for papers, lectures and travel.
Do you work closely with other healthcare colleagues or groups?
The in phrase is ‘multidisciplinary team’. We have known the importance of this in haematology for a very long time and we could not run a successful clinical or laboratory unit without excellence and commitment from nursing and laboratory staff among many others. Our dietician, for example, is an absolutely key part of the team and we are dependent on skilled scientific staff to help with the diagnosis of complex disorders.
What is the required mix of skills for this specialty?
Well, all the generic skills of any good doctor (for example communication skills, empathy, patience and a tolerance of hard work) are needed. We deal with a lot of sad as well as very happy outcomes. If you can imagine mourning with a patient and family in one room but then celebrating a successful outcome with a patient in the next room, you get some idea of the very up and down nature of being a haematologist.
What changes have you seen in haematology during your career?
I have seen dramatic changes in the diagnosis of haematological disorders (the molecular and immunophenotypic diagnosis of haematological malignancies being an obvious example) and similarly dramatic changes in treatment and outcomes for many illnesses. The development of imatinib for patients with chronic myeloid leukaemia is a very striking example.
What advice would you give to someone considering a career in your specialty?
I have loved my job and would recommend it to anyone, with some of the caveats described above.