Real-Life Story- Dr Kate Earp
Dr Kate Earp is towards the end of her training in chemical pathology (metabolic medicine). She describes her role and the reasons she went into it.
How I got into the role
I always wanted to be a doctor from an early age. As a child I was fascinated by the human body and loved to read books on the subject. I also played games where I pretended to be a doctor, making my grandparents be my “patients”. At school I particularly enjoyed biology and also liked the idea of doing a job which involved helping people. There aren’t any doctors in my family, but my dad works for the NHS, so I was able to see what working in a hospital was like.
I first came across chemical pathology when I was at medical school at Leicester University, in a teaching session we were looking at blood test results and using them to make a diagnosis. I found this fascinating. We now know that pathology is involved in around 70% of all diagnoses made in the NHS.
When I started work as a foundation doctor, I opted for a rotation in chemical pathology. There aren’t many such rotations, so I was really pleased to be able to get this opportunity as an F2 doctor. During the rotation, I found the scientific aspects of looking at test results in detail very interesting. I was intrigued as to how that knowledge could be used to find out how the body works and to diagnose what was wrong with the patient. The variety of the work was something I really loved, both the aspects of looking at test results, and seeing patients with lipid disorders in clinic. It was then that I definitely decided to go into the specialty.
Originally I thought that I might go in straight into specialist training at ST1, as there are a few run through posts. However I was advised that it would be advantageous to obtain more general experience, seeing patients in various medical clinics. I therefore completed core medical training (CMT) for two years first and then went into metabolic medicine at ST3. Looking back, I do agree that it is useful to gain some experience before specialising in chemical pathology.
What I do
My role is very varied, which makes it extremely interesting. I typically spend one day a week as “duty biochemist”.. When I’m the duty biochemist I look at abnormal test results and receive phone calls from GPs and hospital doctors asking for my expert opinion on results
Trainees in metabolic medicine must have experience in five different outpatient clinics, as set out in our curriculum. The clinics are:
I usually do two clinics a week and we have target patient numbers set out by our curriculum for each of these clinics, but have to see more patients in lipids, metabolic bone and diabetes.
At present I’m working in metabolic bone and patients that come to this clinic mostly have osteoporosis, though some may have rare bone problems. Our work on osteoporosis is to prevent fractures. Before I see each patient, they’ve already had bone density scans and blood tests, and I’ll have a half-hour appointment with them to review these and to speak to the patient, taking them through any concerns.
I see patients of all ages. In diabetes clinics, for example the youngest are 16. Patients with inborn errors of metabolism start their treatment during childhood and so are seen by paediatricians. We see them from age 16 onwards.
My job also involves taking part in audits, writing guidelines and (local and national) teaching.
At the moment I teach undergraduates in their first year of medical school, giving them a chemical pathology lecture. I also teach small groups of fourth and fifth years who come to our department.
Some trainees carry out research. It depends where you work and how much opportunity there is. There may also be the opportunity to take some time out for research, if that interests you. I don’t carry out a lot of research, however I attend journal club meetings where we look at academic papers and I also go to conferences to hear people presenting research. There are lots of opportunities to become involved in societies and you can take study leave to go to conferences.
In the first two years of higher specialty training (ST3 and 4) we also have time in the lab, understanding how tests are done. They are mainly processed by biomedical scientists and we take over once the result has been processed.
As chemical pathologists we also play an important role in the management of the laboratory. We ensure quality of results, understand how technical aspects of the laboratory will affect a patient’s results and make sure that the laboratory is cost effective. I’m learning about these aspects during my training by shadowing senior managers and consultants.
The best bits and challenges
I find the role really exciting. It’s a good balance between seeing patients and thinking about the scientific details of the tests. You need to be detail-orientated and quite analytical.
We are also involved in exciting new developments, such as new tests being introduced and advances in technology. It is nice to be involved in these improvements to patient care.
Work doesn’t get too stressful, as there are few emergencies and we work mostly Monday to Friday. Some registrars don’t have any on-call commitments, and if you do, it’s mostly from home, answering enquiries over the phone.
It’s difficult to juggle all the different aspects of the role sometimes, as there’s always a multitude of different projects to work on, so you need good time management and organisational skills.
Another challenge is that chemical pathology is not a well-known specialty. Other hospital doctors are sometimes not aware that they can call upon us for help.
Life outside work
At weekends I enjoy gardening and walking. At present I am trying to learn Korean, as my sister-in-law is from South Korea. I love spending time with my family and friends
Over the past few months I’ve had to study for my Royal College exams, so I am reclaiming my weekends now!
Career plans and top tips for others
I’m towards the end of my training, as next year I will finish ST7 and will gain my CCT. I have enjoyed all my sub-specialty areas and usually, when you fully qualify, you specialise in one or two, so I need to make that decision, though it will also depend on service needs. I have just started a Postgraduate Certificate in Medical Education as I am very interested in teaching and would like to continue to be involved with that.
- contact local chemical pathology departments to learn more about this career. Chemical pathologists are all very friendly and approachable!
- try to do a rotation in this area. If that’s not possible (and it isn’t always) then you could try to do an audit or project. If you show an interest and why you want to do the specialty this will help you succeed at the interview stage. They will usually ask you whether you know what the role involves
- the Royal College of Pathologists and the Association of Clinical Biochemistry have lots of useful information on their websites