Real-life story - Dr Joanna Lukawska
Find out more about the life of an allergy medicine consultant.
Like many doctors in allergy I “got” into the specialty “accidentally”. In 2005, which is when I joined the Department at Guy’s Hospital, nobody had heard about allergy. By nobody I mean people I worked and played with. The specialty had only been in existence for 4 years then.
I graduated from Bart’s and the Royal London Medical School. I did my house jobs there and then worked at Chelsea and Westminster for one year, only to come back to Bart’s and the London to finish my SHO training. Post MRCP I worked in St John’s Dermatology at St Thomas’. This is where I heard about the job in allergy. I still remember the awful feeling in my gut on my first day at work, worrying that I may have made a terrible choice. After all I enjoyed working at St John’s and I have made some good friends there. One of them said to me that my decision was inexplicable and thoroughly baffling. Six years later we still keep in touch and he has warmed up to my career move.
For the last six years I have been very lucky to have a job, which is both interesting and challenging. I know this is such a cliché and it is what most medics say about their specialties.
For me, the interest in allergy comes mainly from the variety of patients we see. We deal with conditions involving almost every part of human body, literally from heads to toes, and often the psyche too. The presence or absence of allergy (in almost equal measures) is the common denominator. The specialty is clinic based and in a single clinic you may be examining your patients’ abdomen, assessing their skin, looking up their nose, percussing their lungs or just listening to their story.
There is a lot of crossover with other specialties: ENT, dermatology, gastroenterology, respiratory medicine. But don’t worry you will not be stepping on anybody’s toes. These patients are usually referred to us by their respective specialists. Within the wider field of allergy there are several sub specialties such as: food allergy, immunotherapy or drug allergy.
Drug allergy is a new and exciting discipline. Here we deal with allergy to general and local anaesthetics, antibiotics and many other drugs. Have you ever looked after a patient labelled as penicillin allergic? Have you considered the restrictions this diagnosis puts on you and your patient? We are able to help by either refuting the diagnosis or confidently confirming it and offering safe alternatives. Have you ever dealt with a patient who became allergic to a life saving /prolonging drug such as rifampicin or platinum based drugs such as carboplatin. Did you know it is possible for these patients to undergo a process of desensitisation in order to continue with the treatment. It is in areas such as these that our expertise lies.
We are still learning about allergic diseases, discovering new allergens and possible ways we may be able to treat our patients. A lot of emphasis is put on research and if you are at all interested you will be encouraged to contribute, formally while studying for a research degree such as MD or PhD or by conducting an independent project.
The challenges in allergy are somewhat unique in that the specialty is still very young and trying to establish itself, mostly in the consciousness of other medical practitioners. The patients often seem far better informed as to our existence and practice. This is reflected in the competitiveness of the specialty and I believe the speciality offers an opportunity for anyone forward thinking and looking for a young and fast developing niche.
There are only a few training posts available per year and most are associated with major teaching hospitals. However as most junior doctors are not aware of the specialty; the ratio of applicants to training post is very favourable and hence getting a number in Allergy is less competitive than most other non acute, 9 to 5 specialties. Once you have joined you will spend 5 years training, based mostly at your training centre, but encouraged to attend relevant clinics (ENT, dermatology, immunology, paediatrics). In keeping with most other medical specialties there is likely to be an end of training exit exam, however for anyone who has been through the MBBS, MRCP etc this is unlikely to pose too great a problem.
If you are still not convinced, but think you may have an interest in allergy and would like to know more before you commit, you could attend any of the Allergy Academy seminars or courses. Allergy Academy is an educational establishment within the King’s College London. Their vision is to provide a comprehensive educational programme in allergy for generalists and specialists alike. Their seminars are exceptionally well run, practical and inspiring.