Chemical Pathology and Metabolic Medicine Career Story

What do you do? and what is a typical week for you? 

I am an ST4 doctor in Chemical Pathology and Metabolic Medicine. Most of my job deals with managing patients with metabolic disease (metabolic bone, lipids and inborn errors of metabolism (AKU)). In other rotations I will also cover nutrition, diabetes, renal stone disease, paediatrics and inborn errors of metabolism. 

Another major part of my job is spending time in the laboratory learning how different assays work and performing some of them myself, as well as to learn about lab management. One day a week I am also “duty biochemist” where I am the go to person in the hospital for any biochemical queries. I also authorise all abnormal results on that day and communicate any results to the requesting teams that I feel are worrying and need urgent action.  

I also cover the day ward about once a week – this is where patients come to have bisphosphonate infusions for osteoporosis or other infusion for various metabolic conditions (eg. Gitelman’s or homocystinuria). As there is quite a lot of new information to learn there is a strong programme of teaching and you attend the University of Manchester for about a month (virtually at the moment) in your ST3 year to learn about analytical biochemistry.  

The work varies slightly week to week and it also depends which hospital you work in, but in Liverpool a typical week is: 

Monday AM – Metabolic bone clinic 

Monday PM – Admin time (signing letters/lab projects/audits) 

Tuesday AM - Lab time (usually shadowing a BMS) 

Tuesday PM – Metabolic bone MDT 

Wednesday AM - Admin time 

Wednesday PM – Lipid clinic 

Thursday AM + PM – duty biochemist 

Friday AM – Trainee teaching from consultants + lipid MDT 

Friday PM – Ward cover (Metabolic Day Ward) 

Once a month there is also a week dedicated to Alkaptonuria (AKU). Liverpool is the national centre for AKU management and patients are in the department every day all day Monday – Wednesday of that week. We are responsible for clerking them and for helping organise some of their investigations. Its also quite an interesting opportunity to shadow the patients and see what kind of input the get (dietician review, psychology, cardiology, ophthalmology, ear biopsy). 

Other rotations you have a registrar include paediatric biochemistry (at Manchester Children’s or Alder Hey), Adult inborn errors of metabolism (Salford) and working in a district general hospital (Bolton). It’s a small and very specialised specialty so there is some travel involved between rotations but they are all either in Liverpool or in the Manchester area. 

What qualifications and experience do you have? 

I’ve also always been interested in biochemistry and metabolism, being a PKU patient myself, so I initially did a biochemistry degree at Lancaster University. After this I felt I wanted to apply some of this knowledge clinically, so I applied to medicine and completed my degree in 2016, also at Lancaster University. During this time I did an elective in Clinical Genetics and Paediatric Metabolic Medicine at Royal Manchester Children’s Hospital and found it fascinating and seeing loads of interesting and rare metabolic conditions definitely solidified my career plans. I then completed F1 and F2 at Chester and then Core Medical Training also at Chester and Liverpool. I completed MRCP during CMT (which is needed for entry to Chemical Pathology/Metabolic Medicine) and am now working towards my FRCPath.

What’s the most interesting aspect of your job? 

The most interesting aspects of the job are the seeing the huge variety of how metabolic conditions present and how the biochemistry relates to the pathology you see in the patient. Being able to offer treatments that reverse allow patients a normal life who have condition that were previously profoundly debilitating or shortened life expectancy, such as nitisinone for AKU or monoclonal antibodies for lipid disorders is hugely rewarding.  I also enjoy understanding the how the analysis of blood samples work and how you can use very subtle clues in a patient’s biochemistry to make a diagnosis! 

What one piece of advice would you give to someone seeking a career in Chemical Pathology/Metabolic Medicine? 

Contact your local biochemistry department. It’s a small specialty and we don’t have very many trainees so I can guarantee they will be keen to show you our specialty and arrange a taster week! Also having MRCP and doing some general medicine is really useful, but there are now other routes in through GP training, ACCS and core anaesthetics. Doing audit or QI projects in areas relating to metabolic medicine will also be helpful, but I think the main thing is getting a bit of clinical experience and seeing if you like it!