Metabolic Medicine
Metabolic Medicine is a sub-specialty allied to chemical pathology (clinical biochemistry). Doctors working in metabolic medicine combine an understanding of biochemistry and metabolism. They deal with adult patients where the chemical processes in the body do not function properly and may cause various health problems.
This page provides useful information on the nature of the work, the common procedures/interventions and other roles that may interest you.
Nature of the work
The work of doctors in metabolic medicine is very varied, but the overall aim is to improve the quality of patients’ lives and treat their metabolic health conditions. This is a relatively new specialty and helps patients both with common and rare diseases. The opportunities for pursuing research interests are excellent.
The range of work in includes treatment of:
- disorders of nutrition - includes patients with obesity and those needing parenteral nutrition (direct administration of nutrition into the bloodstream)
- disorders of lipid metabolism (which may involve cardiovascular risk assessment)
- disorders of calcium metabolism and bone – examples include osteoporosis vitamin D deficiency and kidney stones
- diabetes mellitus
- inborn errors of metabolism (IEM) in adults, such as phenylketonuria
Metabolic medicine is a sub-specialty, not a full specialty in its own right. It is possible to study it together with general internal medicine (GIM), but almost all trainees link it with chemical pathology. It has its own GMC curriculum, and in this way it’s different from other medical sub-specialties (except stroke medicine). The clinical work in metabolic medicine fits well alongside the laboratory work of chemical pathology. The biochemical investigation of patients with metabolic problems is intellectually stimulating and satisfying, and it is planned to incorporate the metabolic medicine curriculum into that for chemical pathology in the future.
The job varies according to the parent specialty that you decide on, although whichever specialty you chose, you’ll have very close links with the hospital’s biochemistry laboratory. Where chemical pathology is your chosen parent specialty, you will see patients in specific areas of metabolic medicine, predominantly in the outpatient setting. You’ll also probably lead the hospital’s biochemistry laboratory, and spend a major part of your working week ensuring a high-quality laboratory testing service and liaising with primary and secondary care colleagues about the interpretation of results.
You’ll typically hold between one-three out-patient clinics each week in a range of areas such as diabetes, cardiovascular risk or renal stone disease, and be a member of the hospital’s nutrition Team. You’ll work closely with colleagues in other specialties; for example with surgeons for management of parathyroid disease, renal stones or obesity. You may also pursue particular academic interests within metabolic medicine.
If you choose to combine metabolic medicine with GIM, you will generally work with patients who have metabolic inherited diseases. This is also open to those training in chemical pathology, although if you wish to specialise in this area, you may need additional post-CCT experience.
Common procedures/interventions
There are many different procedures and interventions in metabolic medicine and these include:
- drug treatments such as insulin and lipid-regulating drugs
- enzyme replacement therapies for inherited metabolic diseases
- bariatric surgery for obesity, such as gastric bypass surgery – where metabolic medicine physicians will work closely with bariatric surgeons
- provision of nutritional support via percutaneous gastrostomies (PEG, an endoscopic procedure) or parenteral nutrition (TPN)
- cardiovascular risk testing, eg for patients with high cholesterol
- use of new biologic treatments for cholesterol disorders
- dynamic tests (“stress tests”) for a wide range of conditions
Want to learn more?
Find out more about:
- the working life of a doctor in metabolic medicine
- the entry requirements and training and development
- two first-hand accounts of life:
- as a trainee
- as a consultant in metabolic medicine