I knew I wanted to specialise in an area of medicine that dealt with complex multi-organ pathology. I had had experience of haem-oncology and infectious diseases as a house officer and junior SHO, where patients similarly present with complex diseases.
I didn’t make the link with autoimmune rheumatic disorders until I started nephrology in my second year as an SHO; here I was exposed to vasculitis and its association with rheumatoid arthritis, lupus, and pulmonary-renal syndromes. Patients were presenting with severe inflammatory arthritis, renal disease, lung disease, neuropathies, carditis, and skin disorders. At the time experimental biologics were just being tried, successfully, on our patients – I was hooked!
Biologics are now an aspect of everyday therapy for our patients, making my job more satisfying than ever. Little did I know at the time that I would later be exposed to so much more in the specialty of rheumatology that I have found equally rewarding in my clinical practice and research – hereditary disorders of connective tissue, metabolic disorders, bone disorders, mechanical degenerative disorders, aspects of sports medicine, soft tissue disorders, chronic pain and its associations with autonomic dysfunction.
I always wanted to maintain my general medical skills and not to sub-specialise to too great a degree. Whichever specialty I may have chosen I would have wanted to do acute medicine as well and work in a specialty that gave me the opportunity to practice general medicine. Rheumatology is a specialty that needs you to be able to do just that; and in every aspect of health; physical, psychological and social.