Profile: It's infectious
Smallpox, anthrax, ebola, and severe acute respiratory syndome--the diseases that most people would choose to stay clear of are some of the infections that Nick Beeching deals with on a daily basis. Ellen Welch finds out why
Between writing articles and books, chairing various committees, and helping with the plans to prepare the NHS for a possible bioterrorist attack, Nick juggles his posts as a senior lecturer and honorary consultant in infectious diseases and tropical medicine. He divides his time between teaching and research responsibilities at the Liverpool School of Tropical Medicine and clinical work on the regional infectious disease unit at the Royal Liverpool University Hospital.
He admits, "I feel privileged to enjoy all aspects of my career. Nowadays I'm based primarily in hospital in Liverpool, but have had the opportunity to work all over the world and I still have many contacts overseas."
Nick exudes enthusiasm for his specialty, "I've got a fabulous job and I think I'm fantastically lucky. I work with a great group of people and I find the day to day practice of clinical medicine fascinating. When I first started in this field, HIV and hepatitis C were just emerging and their prognosis was poor. Ten years later, many patients with these infections can have a good quality of life--those improvements have been very satisfying." He continues, "Infectious disease is always presenting new challenges."
The threat of bioterrorism is another challenge. For the past few years, Nick has been involved in the national preparations against biological warfare, advising the Health Protection Agency on diseases that can potentially be used as weapons, and training emergency doctors, general practitioners, and students to recognise the signs. As a regional clinical lead in the plans for smallpox vaccination, he has been revaccinated against the disease, along with a small number of colleagues. Nick believes the NHS is preparing well for a potential biological threat: "New infections are emerging all the time and the principles of dealing with a bioterrorist outbreak are similar to those in place for coping with new infections such as SARS. Good collaboration is needed between many sectors such as the police, the Home Office and disaster planning coordinators--it is not just a medical issue."
So how did he get here? Medicine is the only career path Nick ever gave serious consideration to after an interest in biology was increased by an inspiring school teacher during his A level studies. He remembers teacher Joe Talbot showing remarkable enthusiasm for the subject, "He got folk interested--about 15% of our school went on to do medicine as a result of his teaching." Nick had originally intended to study biochemistry at university, but was encouraged to pursue medicine by a family friend who also happened to be a doctor in the navy. "My experience as a naval dependant got me accustomed to regular travelling," said Nick, "I saw medicine as a passport to travel." He gained a place to study medicine at Oxford and once on the wards found the clinical contact far more interesting than the laboratory work.
"The pure sciences taught during the first few years at Oxford shaped my attitude to medicine and significantly improved my ability to read journals and synthesise data, but it was the clinical contact that I found most rewarding." An elective in Bangalore, India, sparked off his fascination with tropical medicine, exposing him to a range of colourful diseases. The tropical diploma he took some years later in Liverpool confirmed his interest in the whole area. "Infectious diseases are a major cause of morbidity and mortality in the developing world and yet they are intrinsically treatable--or if not, there is the potential for a cure. One of the challenges of working in the developing world is the extreme lack of resources--most can be controlled by simple public health measures."
Once fully qualified, medicine fulfilled its promise and became his passport to the world, taking him to jobs in Saudi Arabia, New Zealand, and Australia, experiencing everything from paediatrics and cardiology to microbiology and gastroenterology. His first consultant post at The Armed Forces Hospital in Khamis Mushayt, Saudi Arabia, gave him "excellent experience of tropical medicine" and it was here he took on a role equivalent to that of a postgraduate clinical dean and his love of teaching was confirmed. "I take a great pride in teaching and think it's a shame that academic institutions cannot place enough emphasis on ordinary everyday teaching achievements--the ones that don't pull in the big grants."
With only 110 consultant posts in the UK and 70 specialist registrars in training,1 infectious diseases is a competitive specialty to excel in. Nick's advice to those with an interest in the specialty is to, "Go for it. It's unfortunate that consultant positions are so few in Britain, but this shouldn't put people off. I would strongly encourage medical students to make the most of all possible elective opportunities and get different perspectives in different centres to make sure that it is definitely the specialty for you."
Many doctors are attracted to infectious diseases by the opportunities to travel, and supportive consultants who encourage junior staff to gain experience by practising abroad. To get your foot in the door as a specialist registrar, Nick's advice is to spend at least two years in approved posts doing general professional training. Passing the Royal College of Physicians' specific experience in infectious diseases at senior house officer level is beneficial but not essential, and many applicants take the diploma of tropical medicine and hygiene at centres in Liverpool or London. Training in infectious diseases is usually combined with training for accreditation in general medicine, requiring a minimum of five years' training at specialist registrar level, four of which are spent in infectious disease.2 Before applying for consultant posts it is advisable to undertake research towards either an MD or PhD and this can be combined with a period of training at an overseas centre.
According to Nick, "Many infectious disease consultants have had an unconventional career pathway. People have told me that I'm crazy to leave a perfectly decent job to experience something new elsewhere, but I think, within reason, you should do what you want to do--try not to be constrained by the system."
Ellen Welch, intercalating medical student, University of Westminster.
Email: welchellen@yahoo.co.uk
studentBMJ 2003;11:263-306 August ISSN 0966-6494
- Thomson G, Bonington A, Beeching N. Infectious diseases and tropical medicine. BMJ 2002;324(suppl): S193. bmj.com/cgi/content/full/324/7352/S193a
- Joint Committee on Higher Medical Training (JCHMT). Curriculum: infectious diseases. London: JCHMT, 2000. www.jchmt.org.uk/curricula/curr_infectious.htm (accessed 8 Jul 2003).
