Meet our members

Christina recently joined our H&T task force and attended her first session. We reached out to find out more about one of our newest committee members.

Why did you choose to specialise in Haematology?

I knew I wanted to be a haematologist from quite early on in medical school. I trained at Imperial and did an intercalated BSc in Haematology which is really what made me fall in love with haem. A big part of that was the amazing teaching from people like Barbara Bain, Mike Laffan and Jim Crawley – all of whom still teach on the course to this day.

What do you do during a typical working day?

I am currently out of programme in research so my typical working day has changed dramatically from being a haematology registrar! I am back to being a student at Imperial and undertaking a laboratory-based PhD in H&T. Most days I am tending to my cells in tissue culture, expressing and purifying proteins like FX, TFPI and FVshort or running western blots. These are all completely new skills for me – so there’s lots of mistakes involved! I do oncalls at Hammersmith Hospital on the weekend to support my research so I’m not completely removed from clinical work.

What do you wish you had known when you first contemplated this career?

That research requires a lot of patience and resilience – there is no instant gratification the way there is in medicine. Also, that there would be steep learning curve beyond what I was expecting in the transfer from clinical haematology, which is somewhat familiar, to laboratory science. Essentially I've had to get comfortable with being uncomfortable.

What is the most rewarding part of your job?

It still has to be the patients! I have a particular interest in the human patient experience and elevating the patient voice especially in sickle cell which I have noted has become increasingly represented at BSH in recent years which is fantastic.

That said, having the opportunity to come over to the other side and immerse myself in an environment of basic science and translational research has been invaluable. Another massively rewarding thing for me currently has been experiencing true mentorship from my supervisors Dr Josefin Ahnström and Professor Mike Laffan.

Why did you want to join the H&T Task Force?

The BSH has very much been a part of my medical journey from as early as SHO training and has been central to my development as a haematologist. I really wanted to work alongside the leading haemostasis experts in the field, have exposure to concrete evidence-based haematology and hopefully contribute in some way to the BSH.

What are you looking forward to achieving on the H&T Task Force?

I am looking forward to spending time in an environment of individuals who have shared enthusiasms to my own and hopefully build confidence not only for my role now but also for a future consultant role. I am particularly looking forward to the opportunity to experience and contribute to the process in which BSH guidelines, that are considered exemplary throughout the world, are created.

What would you say to other trainees looking at potentially joining a task force?

It will always be an exciting time to be a part of haematology in any sub-speciality given how rapidly advances are always coming along for us. But now more than ever – especially in red cell and H+T - we are really in an era of unparalleled new advances so it’s a great time to be in the thick of it. In the little time I have been on the H+T Task Force I have already experienced so much encouragement and guidance. As a trainee to be able to absorb wisdom from clinical and laboratory experts in the way you do in the task force is unique and invaluable.

Dr Mai Khalifa is a final year Haematology Registrar, currently working at Sheffield Teaching Hospitals. She will complete her Haematology training in February 2021 and commence her appointment as a Haematology Consultant at Chesterfield Royal Hospital starting in 2021. She also has a special interest in Global Health and recently participated in an 'improving Global Health' Leadership fellowship with Health education England.

Why did you choose to specialise in Haematology?

Many reasons!

• Haematology is dynamic and changing all the time, which makes it an exciting speciality.
• I like the link between the lab and clinical work and its positive impact on patient care.
• The liaison aspect of Haematology and the support and interaction we have with other specialties.
• I was inspired by some of the Haematologists when I did this job as a senior house officer. They are excellent role models and clinicians.

What do you do during a typical working day?

• A typical day at work would start with a board round going through ward patients, followed by a ward round.
• Sometimes procedures are needed for some patients after rounds like bone marrows or line removals. Reporting blood films in the lab.
• Mid-day, normally is the time for meetings- like morphology teaching, x-ray meeting, service improvement meeting.
• Afternoon, I see patients in an outpatient clinic - I see a mixture of patients on treatment or on monitoring.
• My day finishes with evening handover and last minute admin jobs.

What do you wish you had known when you first contemplated this career?

Nothing I can think of, I wanted to do it and glad I did!

What is the most rewarding part of your job?

The Long term relationships and trust you build with patients.

Do you think diversity & inclusion is important in haematology? If so, why?

Diversity and inclusion is important in all aspects of Healthcare, not just Haematology. The more diverse a society/ organisation or department is, the better understanding and ability we have to meet the unique social, cultural and linguistic needs of our patient population.

How has your role as a haematologist been impacted during the COVID-19 pandemic?

We have seen many changes to the way we work which happened at an exceedingly ‘fast pace’, something that we are not used to seeing in the NHS.  Some had a positive impact and some are challenging.

Positive changes:

• Telephone and virtual clinics in my opinion have proven to be suitable for many of our patients groups and actually seems to be a more ‘patient suited’ design for the service.
• Access to new drugs (which was not available pre pandemic)
• Virtual teaching made is more accessible and convenient for colleagues.
  

Challenges:

• Delaying and deferring treatments and risk assessing this
• Relative and family support for patient
• Escalation decisions with pressure on intensive care beds
• Thinking about long term provision of the service in the current pressures, taking into account patient safety, efficiency and sustainability.

What are you looking forward to as a new BSH Trustee?

I am looking forward to working with experienced colleagues across the country and learn from them.

Additionally, I'm looking forward to having a better understanding of the history of a prestigious, growing and developing society like BSH and its long term strategic goals for the future and work collaboratively with colleagues toward this. 

As the first Haematology trainee to become a BSH trustee I am enthusiastic to be able to make a difference at a wider level, bring the views of the trainee Haematologist, their ideas and opinions across and also represent BSH is the best way possible.  

What inspired you to start a career in haematology? 
I was attracted by the combination of laboratory and clinical work. When I first practised haematology these were well integrated. It has become more difficult in recent years.

You have expertise in diagnostic haematology, blood film and bone marrow morphology, haemoglobinopathy diagnosis & leukaemia diagnosis – Which one of these areas is your favourite area of expertise and why? 
I get most pleasure from looking down a microscope and solving diagnostic problems. This covers a large part of haematology but includes haemoglobinopathies and leukaemias.

What new advancement in haematology are you most excited about and why? 
The advances in molecular haematology are spectacular but I see my ongoing role as making sure this is grounded in the necessary clinical assessment of the patient (including family, drug and travel histories) and the basic straightforward laboratory tests including the blood count and film.

You were recently awarded an Australian honour in the Queen’s birthday honours list – would you describe this as one of your greatest achievements?
I don’t really grade the honours that I have been granted but I was pleased to be recognised by Australia when I have not lived there for forty years.

What has been the most rewarding aspect of your haematology career? 
I like the collaborative aspects, working with others and teaching trainees. Teaching others contributes to ongoing learning.

What do you get out of your BSH Membership, and what would say to someone who is thinking about joining BSH as a member? 
I think it is essential that all British haematologists and trainees are members. The society supports haematology, helps us to serve patients better and contributes to ongoing education and maintenance of standards. 

In our latest Meet the Member feature, we are shifting our focus to Haematologist & Champion for Flexible Working, Dr Rifca Le Dieu. She shares with us her journey into Flexible Working and its realities. 

What led you into a career in haematology?                                                                                                               

I did my clinical training at St Mary’s in Paddington. During my Pathology block I was inspired by the haematologists delivering the teaching - Barbara Bain stands out in my memory. I was particularly impressed by the fact that science really seemed to be at the core of the specialty as well as the opportunity to see complex medical problems. Once qualified, I did an SHO post on the Haematology Unit at Northwick Park under Cecil Reid. There I enjoyed the relationships that it was possible to cultivate with patients during the longevity of their inpatient stays. It really felt possible to get to know patients well and provide the support that they needed.

Why did you opt for LTFT (flexible) working?

I did a phD at Barts Hospital under John Gribben towards the end of my training. At the end of this, I found I was pregnant with twins. I was extremely keen to do the stem cell transplant coordinator role at Hammersmith Hospital following my maternity leave but realised that the intensity of this role full-time would be untenable with year old twins, a husband who is a partner in a law firm and no grandparents on hand. However, I had previously worked at the Hammersmith for a year and had developed good relationships there. At interview whilst pregnant, I was fortunate enough to be offered the post on my return from maternity leave part-time and on a supernumerary basis. Once I had done this post for a year and the time came to apply for consultant posts, I realised that it would be too difficult to increase to full-time, particularly as it was becoming apparent that one of my boys had developmental difficulties. I was aware that being full-time did not mean Monday to Friday 9 to 5 and part time working would mean I would actually get to spend time with my children. I’m not a believer in the concept of quality over quantity when it comes to time spent with your children. Nonetheless finding an LTFT consultant post was a real struggle. I looked for advice from existing consultants and was told that part-time working was not possible. I was told not to turn up to interview for several jobs having been short-listed once I made them aware of my need to work part-time. Finally a clinical senior lecturer post became available at Barts. John Gribben was incredibly supportive but I was advised not to mention my need to work part-time until I had been offered the job. Once I did, I didn’t hear back from them. It required 6 months of negotiation to get agreement to my appointment part-time. Over the 9 years I have been in post, my role has changed significantly, again not without much trauma. I now do undergraduate teaching rather than research; my only clinical commitment is a lymphoma clinic and I have developed a significant role as a Champion of Flexible Working and SuppoRTT Lead. At the start of my training, I would never have predicted that this is where I would end up. Nonetheless, I love the variety and stimulation my various roles provide. Both my boys have now been diagnosed with high functioning autism and I also have a daughter 4 years younger. The decision to work LTFT remains absolutely the right thing for me and my family.

What advice would you give to other clinicians who wish to also engage in LTFT working?

Currently 23% of consultant physicians work LTFT and this increases year on year. So don’t take ‘no’ for an answer. But do your homework and be proactive. Know what the department needs and make suggestions as to how you can deliver this LTFT. Find examples of others who are doing what you want to do successfully.

What has been the most rewarding aspect of LTFT working?

My work-life balance. I have been able to be there for my children and spend the majority of my week with them but equally I have been able to retain ‘me’ and gain immense amounts of satisfaction from my job.

What are the challenges of LTFT working?

Delivering high quality continuity of care. However, I really believe that with good handover practices this should not be problematic.

Mission creep – or working when you shouldn’t be…: I am dreadful at this. I don’t put an email Out of office (OOO) on the days I am not at work and always check and reply to emails as appropriate. However, this works for me and allows me to feel in control of my work.

Always feeling you have to apologise for not being there: changing the script is so important. I am not paid to be at work and so why should I apologise for that?

Money: so many talk about the fact that they work just to pay their nanny. I have been in the fortunate position of having a well-paid partner so this has been less of an issue for me. There is also much debate around whether being LTFT makes it harder to get CEA awards. Many consultant bodies are asking Trusts to provide more clarity on the distribution of awards.

How does your expertise as a haematologist contribute to your role as a Deputy Director in the Medical Workforce Unit?

Haematologists are unique in the RCP as spanning both medicine and pathology. It is all too easy for the voice of the RCP to be dominated by the acute medical specialities so it is useful to be able to provide the viewpoint of a non-acute specialty.

What does being a BSH member mean to you?

Great guidelines and a good journal!

In our latest Meet the Member feature, we are turning our focus on the Physician Associate role as we spoke with Jamie Saunders – Physician Associate in Clinical Haematology at Guy’s and St Thomas’ NHS Foundation Trust. He is also a current member of the BSH Communications Committee.

Jamie told us all about the PA role, its importance in the delivery of excellent patient care as well as his career so far in haematology.

Can you tell us how a little about your career so far, and how you came to specialise in haematology?

I graduated as a Physician Associate in 2017 and was lucky enough to gain my first job as a PA in haematology and I haven’t looked back since. When I was looking for a job as a student PA I wanted to work in a speciality which had it all; academically challenging, complex, highly specialised but also contained a lot of general medicine (a very important part of being a PA). Haematology ticked all of those boxes for me.

I joined Guy’s Hospital in November 2017 as part of a three-year training programme in haematology, developed by my consultants. I spent the first year working as part of the inpatient haemato-oncology team, looking after patients with leukaemia, lymphoma, myeloma and amyloid. I am now in my second year and work in outpatients, covering our haematology day unit and conducting outpatient general haematology clinics alongside my consultants. Next year I start my third year and will work as part of the inpatient sickle cell/general haematology ward team and start outpatient clinics for patients with haemoglobinopathies.

I work closely alongside our core medical trainee doctors and haematology registrars day-to-day, reviewing and managing patients and discussing cases with my consultant where I need. Over the last year and a half I have grown enormously, in both my general medical skills as well as in my haematology knowledge. It’s nice to be the stability in the department, supporting our CMT doctors in learning haematology at the ward level as well as being able to support our haematology trainees in allowing them to attend training days as well as increased access to morphology, as I can cover the ward/outpatient day unit and review patients.

Can you tell us a little about the Physician Associate role?

Physician Associates complete a two-year, intensive, masters level postgraduate degree leading to the award of PGDip or MSc in Physician Associate studies. Prior to this PAs need to have completed an undergraduate degree in life science or healthcare for entry to a PA course. Upon graduation they are then expected to sit the PA National Certification Examination at the Faculty of Physician Associates, Royal College of Physicians, to be deemed safe to practice. 

PAs are generalist medical healthcare professionals who work alongside doctors in the diagnosis and management of patients. They are termed dependent practitioners, which means they work under the delegated supervision of a named medical or surgical consultant. In practice PAs work autonomously, diagnosing and treating patients with appropriate support from senior doctors where needed.

PAs are eternal medical generalists, meaning that we do not specialise. We work as part of the speciality team but must maintain our general medical skills and knowledge. To ensure we remain generalists we have to re-sit our exams every 6-years, called the PA National Recertification Examination. Of course, after time spent in a speciality, we gain the knowledge and skillset of that speciality and take on greater responsibility and autonomy for patient care within the speciality we work.

Why is this role so important in the delivery of excellent patient care?

For me I chose to study to become a physician associate due to the flexibility and general medical nature of the role. As we are eternal medical generalists, we get to work within the speciality team and still be involved in general medicine. I often find that patients are admitted under the haematology team with general medical issues which need managing alongside their haematological diagnosis.

I often conduct asthma/COPD reviews for our patients attending the haematology day unit and liaise with the relevant speciality/GP for advice and update them where needed. When patients are admitted to the haematology ward, I am not only able to assist in the management of their primary haematological diagnosis, but also advise on optimising and managing their general medical issues without the need for routine consultation of other specialities.

PAs also provide continuity of medical care. Unlike doctors in training, who change specialties every 4 months to every year, PAs stay in the same department and do not rotate. This means that I get to know my patients very well, from both medical and social/psychological aspects. Additionally, because PAs typically form part of the “SHO level” team, we often the first point of call for acute deterioration reviews or clerking. Patients, as well as their families, have fed back to our department that they appreciate a familiar, trusting face every time they are admitted to the ward and knowing the patient for the entirety of their care makes caring for them more streamlined.

What are the main rewards and challenges of the role?

As a PA the learning curve was very, very steep. Haematology is a complex and an ever evolving and advancing speciality. There are multiple sub-specialities and on the whole, we are working with patients with rare conditions and in some cases with a relatively limited evidence base. Working within haematology requires constant reading, investigating and discussion with my supervising consultants and senior registrars around the fundamentals, evolving diagnostics and management strategies.

But getting to see my patients come in very unwell, explain to them their diagnosis and then continue to support them during their journey through treatment and watch them come out the other side is so very rewarding. The relationships we make with our patients in haematology is truly lifelong, and I feel privileged to be able support them in every way I can during their time of greatest need and beyond.

Explain how you think the role will develop in the future?

The PA role is now well established in the UK (with the profession being more than 60 years old in the USA), and with the recent announcement of the introduction of statutory regulation of PAs by the General Medical Council (GMC) in the future we will be able to work to our full potential. This will include ordering investigations that involve ionising radiation, authorising blood products and prescribing medications.

There is a lot of scope for the development of the PA role, particularly within haematology. We follow a similar training/development pathway to doctors post-graduation. For example, since starting in my job I have learned to perform procedures such as bone marrow biopsies and femoral line insertions, to running outpatient clinics alongside my consultants and in the future potentially providing evening out of hours support for acute referrals from other specialities.

I strongly believe that PAs are well suited to practice within the haematology team. With an ageing population and increasing scope to treat patients previously deemed unfit for treatment, a joint specialist and general medical approach to patient care is vital, particularly in haematology. The value of a general medic PA within the haematology team will not only benefit patients, but also the haematology team and other specialities.

How has BSH Membership supported you in your work?

BSH is one of the first societies to recognise the important role that PAs will play in the future of modern medical care with a distinct membership category that welcomes and encourages PAs (I believe that BSH is the only society in UK to do this). The online resources are useful for my learning and enable me to develop as an individual. Access to BSH courses and the ASM is also fantastic, allowing me to network with current and future haematologists across the country as well as share my research nationally.

There is also scope to become involved in BSH activities, for example, I am member of the communications and education committees at BSH, representing PAs in haematology and providing advice and support to the BSH from a PA/junior medical team perspective.

In our latest Meet the Member feature, we are turning our focus on haematology nursing as we spoke with Bethan Ingram, an Advanced Nurse Practitioner at Cardiff and Vale University Health Board. In November 2018 Bethan's work was recognised as she won the RCN Wales Advanced and Specialist Nursing Award at their Nurse of the Year Awards. Bethan told us about the project that helped win this prestigious award, as well as more about her career in nursing.

Can you tell us about the project that you implemented that led to you winning the Advanced and Specialist Nursing Award?

I was nominated for my work in developing a nurse-led haematology ambulatory chemotherapy and transplant service for patients being treated in Cardiff. I had seen this model of care work very well in other parts of the country and felt that our patients would really benefit from receiving their treatment in this more normalised way. It has allowed them to spend as much time at home as possible, with their families, rather than being admitted into an acute hospital bed to receive their elective treatments.

Why was involving patients in this project so important to its success?

Throughout the project we have tried to capture the patient voice to learn from their experience – this has been key. We have held workshops for patients and families, undertaken patient stories, really sought any opportunity to learn from their experience and refine our process. Our ambulatory model is very similar to what other haematology centres do but we have further developed it to reflect the needs of our patients within South East Wales.

Can you give any advice to those who wish to introduce a similar service at their institution?

It was critical for us to understand from a patient perspective what we did well and what we could do differently with an ambulatory model of care. The patient voice has had a great influence on the service but also on the broader team and bringing them on board with the project.

Secondly, the whole multi-professional team has been essential to make the project a success. Our dieticians, pharmacists and physiotherapists have contributed to the project alongside the medics and nurses. Each professional brings something new to the table to learn from and contribute to developing a rounded model of care. 

Finally, use your local improvement teams. Having someone outside of the speciality to bounce ideas off and help facilitate patient and team events has been incredibly useful and offered different perspectives on what we wanted to achieve.

What led you to a career in haematology nursing?

I was rotated to haematology as a student nurse and found somewhere that I was supported and promoted the nursing role, challenged me and allowed me to think, and offered continuity of patient care – something that I personally find rewarding. I had brilliant role models to aspire to and over the years have worked with many supportive teams who have developed and educated me. Personally, I have always felt stimulated and challenged within the speciality. Within my career, I have become particularly interested in young adult care and haven’t looked back since!

Why is this role so important in the delivery of excellent patient care?

I think increasingly the haematology nursing role is adapting to meet the needs of the ever-growing services. We have taken on training and developed our clinical and leadership skills. We are pushing the boundaries of nursing but remaining true to our profession. I think the nursing workforce offers a continuity with skilled, expert and holistic patient care. This doesn’t just have benefits to our patients but also supports our teams to deliver excellent patient care.

Can you give 3 practical pieces of advice for haematology nurses in delivering excellent patient care?

1. Learn from your patients and champion their voice
2. Don’t be afraid to take the lead
3. Introducing different ways of working does take effort and time, but the rewards are worth it. Engage the teams around you in your project or idea.

What are the rewards and challenges of the role?

The patients are the most rewarding. I feel privileged to support patients and families, especially through difficult times. It is particularly rewarding when you see patients who are now in remission and moving on with life – back at university, buying a house, just doing the things they want to do.  I also really enjoy service improvement and there have been many opportunities for me to be involved in this within haematology. Finally, developing other staff - I have always been so fortunate to learn from other brilliant and inspiring colleagues. To positively contribute to someone else’s development is very rewarding.

This biggest challenge is when things do not work out as we would hope for some patients and families, which unfortunately is part of this role. Another challenge is defining and championing advanced practice roles – I think sadly they are still not widely understood.

What does BSH membership mean to you?

BSH has given me an opportunity to meet other similarly minded people, share ideas and network. I have enjoyed the mixture of professions and backgrounds; the collaboration. This has been particularly prevalent for me within the Teenage and Young Adult Specialist Interest Group. I am also very grateful for the educational opportunities and expertise that BSH provides.

 What led you to a career as a Clinical Scientist?

The short answer is the ESR test!

Following a childhood accident, I spent a long time in hospital and needed many blood and plasma transfusions (clearly worked well as I’m here writing this!) I found the whole process amazing. Some tests were carried out at the bedside and I have a clear memory of being very impressed as the skilful technician mouth pipetted the blood up a 20cm glass tube. The tube was placed in an ornate wooden rack and placed on the window sill – the measurement of uncertainty clearly was not considered important back then – spending an hour watching the red cells drift and settle was very entertaining. My paediatric nurse was related to the laboratory technician (official term back in the day) and when I started to recover she would allow me to come to the laboratory and count the cells down the microscope, these were the days before automation. This early fascination with blood stayed and I decided early on that I would be a blood scientist. So public engagement does work! Another factor was my Uncle was a research scientist working in NIH in America – he worked on leukaemia and cancer projects using cell lines and early culture experiments. My Uncle used to visit us regularly in Ireland as he flitted around the world attending meetings – scientific work appeared very glamorous.

Why are Scientists so important in advancing the field of haematology?

Haematology is a fascinating pathology specialism and incorporates a wide range of sub-specialisms. My particular area is lymphoma and leukaemia genetics - because blood is a liquid tumour it is very accessible and it means that haematology has led the way in the field of cancer genomics. One of the first proteins to have its molecular structure determined was haemoglobin, this work was carried out by Dr Max Perutz in Cambridge University in 1959. I was very lucky to cross paths with Dr Perutz during the 1990’s when I worked at Addenbrookes Hospital. The hospital was on the same site as the laboratory of Molecular Biology (LMB) and there was a lot of cross sharing of facilities and ideas. It was very exciting to be in at the beginning of molecular haematology. Now 20 years later, and having just attended the myeloid leukaemia multi-disciplinary team (MDT) meeting we are using high-through put sequencing (HTS) and quantitative PCR and SNP array in conjunction with more traditional morphology and multi-parametric flow cytometry to classify disease and risk stratify as well as direct treatment. My scientific job remains as exciting as the day I started work.

What advice would you give to someone considering a career as a Scientist practicing in haematology?

Go for it! I have never been bored in a 35+ year career in haematology. It is constantly changing and moving forward.

What is the most rewarding part of your job?

Ultimately I love teaching trainee scientists and medics so that they have a strong foundation in basic haematology before progressing on to the more specialist laboratory skills. Seeing the trainees understand some essential concepts.

It is also rewarding to make a correct diagnosis rapidly to enable treatment to start in clinically urgent diseases such as acute promyelocytic leukaemia (APL) - from receiving a sample in the laboratory we can provide a genetically confirmed diagnosis in approximately 2 hours (in most cases.)

What is the most challenging part of your job?

When you cannot carry out the work needed as the sample quality is too poor - that is so frustrating.

What does being a BSH member mean to you?

I have been a BSH member for 20+ years - it gives me a sense of pride to be a member. I have not managed to attend all the annual meetings but I remember my first meeting which was in Cardiff in the late 1980’s or early 1990’s. I have seen the meeting grow from a few hundred attendees to a few thousand. Having working in a few major centres around the UK attending the meeting also has a social aspect as I can meet up with colleagues. I enjoy the mix of scientific and clinical talks and I always make a point of attending educational sessions in general haematology and haemostasis to keep fairly up to date in non-malignant haematology.

What do you plan to do next in your career?

I’m at the stage of my career where I need to think about skills transference! I am doing a lot of teaching within my department at present for haematology and cancer genomics trainees.

What led you to a career in haematology?  

I qualified early in the spring of the final year as a medical student, by doing the “Conjoint exam”, which I don’t think is possible anymore. This meant I could do locum house officer jobs while everyone else was studying for finals. My favourite locum was covering “Tropics”- a ward where patients with tropical illnesses and haematological disorders had beds and run by Professor Alaistair Bellingham (later President of RCPath), who was a mentor and an inspiration to me.

I was also a House officer for Professor Bellingham on 7Y ward at the new Royal Liverpool Hospital at a time when 120 hours a week was the norm. One Saturday morning aftera near sleepless night I overslept my alarm and came late to the ward to find “Prof “ had come in and done all my jobs - all the phlebotomy for the ward, and given all the cytotoxics and antibiotics to the patients.

After house jobs I spent many years in general medicine and gradually realised Haematology was my favourite subject - the ability to do the laboratory diagnosis as well as clinically manage the patient seemed a very holistic approach so I finally chose specialist training in Haematology.  

Can you tell us more about how you came to specialise in thrombosis?

I spent my time in London rotating between a specialist hospital such as the Royal Postgraduate Hospital and district generals. I found the emotional trauma of caring for patients with leukaemia very harrowing. I was intellectually drawn to non-malignant haematology and spent a sabbatical organised by Professor Dame Marcela Contreras, looking at haemolysis in patients after solid organ transplantation.  

It was here I met Professor Sir Magdi Yacoub who offered me space and funds to look wider at unstudied field of haematological issues in solid organ transplantation at the NHLI/Harefield. I jumped at this unique chance and can remember the exciting day when my very own Portacab (my future lab and office) was craned into the Harefield grounds! I got sucked into solid organ transplantation care and studied thrombotic, bleeding and transfusion problems in my lab.

I became interested in the basic haemostatic mechanism of the endothelial response to rejection and Prof used to call me to surgical theatre when a patient was bleeding, asking me to “sort it out”. Crazy but happy times, although I was a lone Haematologist in a world of Immunologists and Transplantors & had to learn to talk their language as they could not speak mine. Eventually I realised the science of thrombosis and haemostasis was the area where I wanted to spend a lifetime’s work.  

What advances have you seen in the delivery of care to thrombosis patients during your career?

Where to start!

As a house officer we used to give bleeding patients with Haemophilia A transfusions of cryoprecipitate, then we had Factor VIII concentrates and then recombinant Factor VIII which was used to prevent bleeding and now we have a successful programme in London where patients are producing their own Factor VIII again through gene therapy.

In thrombosis we have enormous understanding of who gets venous thromboembolism (VTE), notably 60% are due to hospital admission and we can prevent much of this by giving thromboprophylaxis.

Tranexamic acid. My favourite drug. How many hours of my life have I spent working on it - incalculable! But it must be mentioned on World Thrombosis Day because nearly a million patients have been in studies of tranexamic acid and it reduces bleeding and bleeding deaths WITHOUT increasing with venous or arterial events - the near perfect haemostat.

Of course I can’t forget to talk about Thrombosis UK. In 2002 I was working on a new technique to diagnose DVT (now known as MR direct thrombus imaging) with Professor Alan Moody. We applied for grants to advance the technique, but no one would fund us. To paraphrase the responses: “this is a good grant but we don’t fund work on venous thromboembolism. So we set up Lifeblood: the thrombosis charity – now known as Thrombosis UK to increase awareness of VTE and raise research funds. Alan subsequently emigrated to Canada and I was left to soldier on and the charity slowly grew on. We all worked hard out of hours for free, and I can remember the multi-tasking we did, for example one summer I actually wrote all the content for our website.

Thrombosis UK campaigned on the postcode prescribing of thromboprophylaxis in the UK and precipitated a Health Select committee in 2005 with many experts giving evidence. One of my suggestions was that each hospital had a “thrombosis & thromboprophylaxis committee” which was one of the recommendations when the report was published. But the biggest demand of the final report was to mandate VTE risk assessment. This took another 4 years campaigning with many health professionals and the All Party Parliamentary Thrombosis Group. This became a reality in 2010 in NHS England when they introduced a target of 90% risk assessment with a financial penalty if Trusts did not reach it. and a fresh infrastructure developed with NICE guidelines and Quality Standards and the Exemplar network. This radical change led to a reduction on VTE events and a 9% reduction in death due to pulmonary embolism.

In 2018 Thrombosis UK has grown to a medium size charity with multiple functions including office staff supporting patients and their care.

But it doesn’t stop there, because the International Society of Thrombosis & Haemostasis on the back of the success of Thrombosis UK have set up World Thrombosis Day to increase global awareness of thrombosis. World Thrombosis Day is on Virchow’s birthday - the 13 October and is now in its 5^th year. Last year we had 2.7 billion hits on social medial and thousands of events globally.

Part of World Thrombosis Day’s agenda is to improve global thrombosis care and engage with the World Health Organisation especially as regards to patient safety and the need to reduce thrombosis deaths. I currently lead the latter and am using the NHS England’s systematic approach to VTE prevention as a model of how other countries could go forward. 

What advances in our understanding of thrombosis and delivery of care do you expect to see in the future?

Genetic engineering in the next 10 years will hopefully “cure” many of the rare bleeding and thrombotic disorders - from Haemophilia to antithrombin deficiency.

The hunt for the perfect anticoagulant will continue.

What advice would you give to someone considering a career in haematology?

Do it! It is such an exciting time, and the ability to run a laboratory to support clinical work is very seductive.

What is the most rewarding part of your job?

Patient contact always has been and will remain my number 1, but doing a study or clinical trial to answer a research question and campaigning to improve thrombosis and haemostasis care nationally and internationally, are tied jointly as number 2.

What is the most challenging part of your job?

Admin, bureaucracy and IT. Our IT systems are so clunky, they use up energies that would be more profitably spent elsewhere.

What do you get out of your BSH Membership, and what would say to someone who is thinking about joining BSH as a member?

As a British haematologist the BSH is your organisation and wants to support you in your training and education. It’s also a great place to meet like-minded people.

To commemorate both the spotlight on cancer awareness as part of the NHS 70 celebrations and Blood Cancer Awareness month, we interviewed BSH member Dr Graham Collins who told us about his time working in the NHS, and how the treatment of haematological cancer has changed during his career. Dr Collins, a Consultant Haematologist at Oxford University Hospitals, also gives advice about those wanting to pursue haematology as their specialty of choice, and the rewards and challenges that it brings.

What led you to a career in haematology, and to your specialist area of work?

I didn’t want to be a haematologist at first. Infection and autoimmune disease were my main areas of interest so rheumatology or infectious diseases appealed. However as I went through my junior doctor training and came across haematology patients, the concept of immune system cancers (which lymphomas and leukaemias basically are) and transplanting immune systems seemed very interesting. So I applied for an SHO job in haematology at UCH for 6 months and absolutely loved it. I really enjoyed the day to day management of patients who were often very sick, but could sometimes be cured of their disease. Lymphomas in particular I found to represent a very diverse group of diseases some of which were very aggressive and others were extremely indolent. The range of management options was also huge: from watch and wait, to haploidentical allogeneic stem cell transplantation. So once I was coming to the end of the registrar training I decided to sub-specialise in lymphoma medicine.

I’m largely known in the field for an interest in Hodgkin. This happened rather by accident. When I was looking for a PhD project, a supervisor basically had one all lined up looking at the molecular biology of the Reed-Sternberg cell. Once I had embarked on the project, colleagues started treating me as an expert in Hodgkin lymphoma so I started behaving like one! When I became a consultant I joined the NCRI Hodgkin study group which has been a really wonderful experience, working with enthusiastic and committed collaborators.

What advice would you give to someone considering a career in haematology?

It’s unusual to come across a haematologist who regretted their choice of specialty. The training is challenging and the exams for FRCPath are difficult. But the career itself is endlessly fascinating. Haematologists have the reputation of being ‘nerdy’ which is probably true and a lifetime of learning is important in any specialty – haematology being no exception. Many will opt to do research as part of their training, but this is not necessary by any means. There is also increasingly an appreciation that clinical research (which usually gains an MD) is just as valuable as laboratory research (which usually gains a PhD) and many centres are now able to provide clinical research options.

What is the most rewarding and most challenging aspects of your job?

The most rewarding aspect by far is having the privilege of seeing a patient through probably the most harrowing period of their life – the diagnosis and treatment of a blood cancer. It is also fantastic to manage these patients as part of a wider team with dedicated consultant colleagues, specialist nurses and pharmacists to name but a few.

The most challenging part is wading through the ever increasing bureaucracy without becoming too frustrated.

How has your specialist area of work developed and innovated in your time working in the NHS?

There have been lots of developments in the lymphoma field. Some are due to new therapeutics. Ibrutinib and other BTK inhibitors are game-changing medications when it comes to treating relapsed mantle cell lymphoma and Waldenstrom macroglobulinaemia. Working in early phase trials I’m also aware of a number of other very active therapeutics which I’m confident will benefit patients and improve outcomes in the field. CAR T-cells also are a very innovative development although it’s a shame that the UK has not been involved in the development of these products to any great extent. It will be interesting to see how the NHS enables provision of these treatments.

There have also been significant changes in the way we work. Due to bed pressures, much more of our work is now aimed at delivering day treatment, or ambulatory care. I see this as a great benefit to patients as hospital admission is rarely welcomed.

Finally – I welcome the emphasis the UK government are putting on clinical trials. Although the government no doubt has financial reasons for this, I do see trials as the only way our field will develop and trials also offer an excellent way to access new lines of treatments for patients.

How can the NHS ensure that it continues to be at the forefront of your specialist area of work?

Whilst there is an emphasis on trials, the UK is still behind in its ability to deliver. Sadly the UK has a reputation for being slow to open trials and that is my experience. There are multiple layers of approvals in the UK which are not all needed in other countries and this means pharma are not always keen to bring their trials here. A focus on how we can cut down unnecessary red tape and regulation around trials would be hugely helpful.

I have been impressed recently with how NICE seem to have speeded up their single technology appraisal process meaning we’ve had fairly rapid access to drugs such as PD1 inhibitors in Hodgkin lymphoma. However with the number of agents in trials, this will represent a considerable challenge for them to maintain this output. Rapid assessment is vital to translate the results of trials to patient care.

What does being a BSH member mean to you?

BSH to me offers a community of likeminded professionals who are interested in haematology and are keen to improve patient care for haematological disorders. The newly formed lymphoma Special Interest Group (SIG) chaired by Kate Cwynarksi is a fantastic forum providing clinical update and discussion of areas of debate within UK practice. The annual meeting is a real highlight offering not just a chance to update CPD but more importantly to meet old and new friends and to form or strengthen scientific collaboration.

What led you to a career in haematology and biomedical science?

I hold a Bachelor and Masters degree in Medical Biotechnologies, and a PhD in gene and stem cell therapy. During my PhD I developed an interest in the mechanisms that transform a healthy bone marrow stem cell into a cancer stem cell and decided to re-train in this field. I joined as a post-doc at the lab of Professor Eric So at King’s College London where I had the opportunity to work on leukemic stem cells and learn in vitro and in vivo models of acute myeloid leukaemia (AML). My research led me to identify a new therapeutic approach for patients affected by some forms of AML. Unfortunately, the treatment would not work for all patients affected by AML and in particular for those characterised by mutations affecting the gene KMT2A, that represent a particularly aggressive subgroup. This is my current area of research.

I now hold a position of senior lecturer in biomedical science at the University of Roehampton. I teach cellular, molecular biology and haematology and lead a team of a PhD student and post-doc that applies cell and molecular biology techniques to understand mechanisms of chemotherapy resistance of leukaemia. This research is funded by Leuka through the John Goldman fellowship scheme for translational haematology, the Institute of Biomedical Science and the University of Roehampton.

Why is biomedical science such a vital area of healthcare?

Biomedical science is fundamental for the routine delivery of lab results as well as for the development of new diagnostic and therapeutics. Over 70% of medical decisions are based on lab tests. These tests are run by biomedical scientists that perform all the operations from the pre-analytical stage (checking the sample is correct and preparing it for the test), analytical stage (running the test) and post-analytical stage (analysing the results and running quality controls). Moreover, biomedical scientists working on research contribute to develop new diagnostic tests, i.e. finding new biomarkers for cancer and novel therapeutic approaches i.e. immunotherapy.

What advice would you give to someone considering a career in biomedical science?

I would recommend first to reach out for a biomedical scientist to ask about their job to understand if this is something that the candidate might like. The STEM network provides a fantastic opportunity to schools and pupils to connect with STEM professionals, including biomedical scientists. I volunteer as STEM ambassador in careers fairs and I also offer shadowing opportunities in the lab. The path to becoming a biomedical scientist is smoother for those holding a degree in Biomedical Science approved by the Institute of Biomedical Science, as is the one we offer at Roehampton. The following step is to complete a registration portfolio which certifies a year-long laboratory training in a hospital. The completion of the portfolio is essential to register with the HCPC, Health and Care Profession Council and practice as a Biomedical Scientist.

What is the most rewarding part of your job?

I enjoy the excitement that comes with research. When I am doing an experiment, I cannot wait to see the result and when I see the result for the first time I feel thrilled by the idea that I might be the only one or the first one to know the result.

What is the most challenging part of your job?

The most challenging part of my job is juggling my different roles, lecturer, scientist, supervisor, team leader as well as my external roles, for example as a member of the Communications Committee at BSH. I have learnt that the knowledge, technical skills and maniacal attention to detail are fundamental to become a biomedical scientist but the soft skills, the organisational skills, the ability to listen to others, to communicate and motivate your team members and collaborators are essential for career progression.

How do you see biomedical science and haematology changing in the future?

We have been moving towards a full integration of molecular biology and genetics in haematology. Leukemic patients that have gone in remission are monitored thanks to very sensitive molecular techniques such as qPCR, able to detect very few leukemic cells in blood and inform whether or not the patient is at risk of relapse. We hope that new technologies such as high-throughput sequencing will enable to identify rare mutations and identify those leukemic patients that are most likely to benefit from a specific treatment, the so called “personalised medicine”.

What does being a BSH member mean to you?

I feel lucky to be part of an association that has the ambition to be more inclusive and is working hard to give a voice to non-clinical professionals working in haematology, including biomedical scientists, lecturers and nurses. There is a tremendous potential in the collaboration among these professionals. 

The inaugural ‘Crucible Session’ at the recent BSH Annual Scientific Meeting in Liverpool was won by Dr Sonia Wolf and her 'Young, Black and Stigmatised' presentation.

The aim of the session was to encourage reflection amongst haematologists on their practices with a theme of ‘How do haematologists do most harm to patients?’ The five best abstracts were selected for presentation, with the trainees then being questioned by a panel of experts.

We interviewed Dr Wolf to find out a little bit more about her journey in haematology and her Crucible Prize success.

What was your Crucible session presentation about?

My presentation was called 'Young, Black and Stigmatised' and was about how haematologists harm patients with sickle cell disease (SCD). I focused on three main areas: hospital admission, opiate use and lack of psychological input, but these come on a background of socio-economic deprivation, institutional racism and lack of research funding. 

Why do you think your presentation theme on ‘how do haematologists do most harm’ is so important and why? 

I think it’s important because although sickle cell disease is the most common disorder 'caused by a single inherited genetic mutation in the UK, we still don't really know how to treat it. I think patients with sickle cell disease are stigmatised, partly due to their age and ethnicity, and this directly impacts not only on their hospital care and ability to lead normal lives when they are well, but also leads to a lack of advances in the disease. I wanted to highlight this and start a conversation about how we can improve things for these patients.

​What are three practical steps that can be taken to ensure this isn't reality for people with sickle cell disease in your organisation?

1. Examine your own prejudices. 33% of haematologists think over 10% of patients with SCD are addicts and 5% think it's over 90%! Is this you? If so, why? Is it based on your experiences or is there an underlying element of racial bias there? We cannot be effective advocates if we do not get our own house in order first. 

2. Call out others. The language and behaviours used by staff to describe these patients is often pejorative. It can be seen across all staff groups, from the most junior member to the most senior. If you witness this behaviour, challenge it and ask the speaker to review their own beliefs about patients with SCD. 

3. See the person, not the disease. Does your patient really need to be in hospital today? Maybe they have studies to get back to, or a partner, or children. These patients, who are mostly in their teens and twenties, are at the point in their lives where they should be building their educational and social futures. If we try to take their care out of the hospital as much as possible, we allow them the same opportunities that everyone else at that age has, and let them define themselves by their hopes and dreams, not their disease. 

What led you to a career in haematology?

I graduated from Imperial College, London in 2008 not intending to do Haematology at all, in fact I wanted to be a Psychiatrist! I first encountered Haematology patients as an A&E doctor looking after patients with sickle cell disease at Guys and St Thomas hospital. This led me to want to know more so I spent a year in the green rolling hills of the Waikato in New Zealand where I did 6 months Haematology and fell in love with the specialty. What I loved best was the variety of patients, the liaison with other specialties and the problem-solving approach to diagnosis. 

After Core Medical training back in London I started Haematology training in the North East Thames deanery in 2013. I am currently an ST6 trainee having had 2 babies along the way!

What advice would you give to someone considering a career in haematology?

Spend some time in the lab. If you enjoy looking at cells and trying to match it to the clinical picture, you'll enjoy haematology. Haematologists love to sit down and think about complex problems - we're not really adrenaline junkies - but if you like taking all the evidence and working it out from patient to lab you'll love haematology. It's a brilliant career and I am very happy with it as my choice of specialty.  

What is the most rewarding part of your job?

Spending time with patients and seeing them through their journey - whether that's diagnosis of leukaemia to remission or getting to see a family with a new diagnosis of haemophilia gradually adjust to their disease. You end up building really strong relationships. When I think of my patients I like to remember things like the fact they played their guitar on the ward, or the fact they plan to go travelling after they finish chemotherapy, rather than just what disease they have. 

What is the most challenging part of your job?

Seeing patients die, especially young patients, is hard. But it does make you realise that life is short and, although this is a cliché, you should live it to the full. 

What does being a BSH member mean to you?

An opportunity to hear about and meet other inspiring members of the haematology community and their work.

What do you plan to do next in your haematology career

After finishing my maternity leave, I am going to start a PhD back at Imperial College in October.

What led you to a career in haematology?

Haematology was my first clinical attachment as a medical student and turned out to be love at first sight.  From Day 1 I loved the fact that we could look at our patients’ blood under the microscope and I have always enjoyed the mix between the lab and the clinical work.  I decided to focus on red cell haematology because I like having a life-long relationship with these patients and there is so much potential to improve their outcomes by providing better care and being involved in research that will lead to novel therapies.

What advice would you give to someone considering a career in haematology?

I would plead with them to consider red cell haematology!  Unfortunately there are too few specialists in this field and we are in great need of enthusiastic and committed new consultant colleagues. Now is a particularly exciting time for red cell disorders due to unprecedented new advances in diagnostics and therapeutics.  It’s a great time to join us!

What is the most rewarding part of your job?

It’s always the patients.  I am continually amazed and inspired by how they deal with their life-long illness.  I find it particularly rewarding when patients come away from a consultation with a better understanding of their condition and treatment, and when I have better understood how the medical aspect of their condition fits in the greater context of their life.  Sometimes it’s up to us to find new ways of organising their care that means it will fit better with their life and therefore improve compliance with key medications.

What is the most challenging part of your job?

At the moment, it is dealing with the uncertainty brought about by pathology reorganisation.  The reconfiguration nationwide of all pathology services means that there will likely be a lot of changes in the laboratory. Until we have a clearer idea of what these changes are likely to be, it is difficult to prepare adequately.  However, change is an intrinsic part of life and I look forward to finding new and better ways of working once the parameters are more clearly-defined.

How do you see your specialist area of haematology changing in the future?

I am particularly interested in red cell haematology - both the haemoglobinopathies and rare inherited anaemias. I am actively involved in the diagnosis of inherited red cell disorders and the current move from targeted next generation sequencing to whole genome sequencing that will be commissioned by the NHS is one of the most exciting changes coming. However, there are equally many changes in therapeutics, from novel drugs for sickle cell disease and thalassaemia and PK deficiency, to the advent of genome editing which will revolutionise how these disorders are treated from childhood onwards.  Importantly, though, haematology is moving towards a more patient-led model of care and I am excited to be part of new initiatives using patient reported outcomes and recognising that patients are best placed to tell us how we should organise our service.

What does being a BSH member mean to you?

I very much enjoy the annual scientific meeting where I get to hear thought-provoking talks and connect with colleagues and form new collaborations. I also get a lot out of the regular update bulletins, which help to stay up-to-date.  The haematology community as a whole is both productive and inclusive, and it is a pleasure to be able to work alongside like-minded colleagues.

Tell us about your involvement with the General Haematology Taskforce.

I am a fairly new member of the task force but it is a pleasure to be able to get involved in the process of writing guidelines.  We all use these guidelines regularly in our clinical practice and it gives me a chance to use skills acquired as part of my academic work to help sift through and assess published evidence.

What is your current role and background?

I am a BSH Trustee. I was co-opted initially during Graham Jackson’s presidential term, when The Shape of Training became a focus and I was co-opted as SAC Chair to be involved in the discussions at Board level, then nominated in 2015.

I have been actively involved in PGME for 20 years. I am passionate that we ensure training in a rapidly changing world is delivered to the highest standards possible. We want to enable the development of capable haematologists, to achieve their maximum potential in the workforce, whilst achieving job satisfaction.

I was a trainee rep initially, then appointed as in the first formal TPD role in my Consultant post in 2003. I have been a member of the London STCs in their various reincarnations over the years. Member of the SAC since 2007, in the curriculum committee from 2009 – 2015 and quality assurance I held the position of SAC Chair from 2011-2015, navigating changes in recruitment and the Shape of Training amongst the usual business during my tenure.

I am an FRCPath examiner. I hold the post of Deputy Head HEE LaSE School of Pathology and have been a member of the executive board since its inception in 2008. I am involved with Professional and Faculty Development and the development of a virtual learning platform.

What has your role in postgraduate education and training brought to the BSH?

I hope it has brought the SAC into the BSH ‘fold’. The SAC works under the umbrella of the RCP. The TPDs / education supervisors (all BSH members) work hard to ensure operational training on the ground is delivered within the programmes as best as it can be, and mapped to the curriculum within the constraints of service delivery and changes within medical education. Currently the SAC reports to the External Affairs Committee.

I hope that by giving the SAC BSH representation this will firstly recognise the work being done, and secondly allow collaboration and dialogue to take place across the whole of the education platform - from school to consultant, so there is a more joined up delivery of haematology training.

Can you tell us about the Shape of Training review, its purpose and what the long-term impact will be on postgrad haematology training in the UK?

The Shape of Training Review is looking at how to manage and develop the challenges in the healthcare delivery landscape in the UK and what the future multi-professional workforce might look like.

The initial driver was the crisis in general medicine. Although a simplistic overview, the reality is that we do not have the workforce we need in the NHS to deliver healthcare in the way we wish.

There was a view that training time in higher specialist training may be shortened with extended CMT and FY training.

How does the work of the BSH around the haematology curriculum tie into the future of haematology training?

Over the last 4 - 5 years the Haematology SAC have worked closely with the RCP. This is to ensure that haematology is understood as a specialty which develops consultants and physicians who integrate pathology knowledge, to deliver care to haematology patients in the various sub specialities, as well as the NHS healthcare system as a whole. This makes us a unique and much-needed workforce.

The most recent iteration has shown no decrease in the length of higher specialist training or dual accreditation. However, we acknowledge and recognise that the changes in the healthcare landscape require us to look at how we will need to adjust training and deliver care long term to a changing population.

In order to do this, we need to be asking questions like: How will our future haematology consultants be working in 2020 - 2030? What will the service delivery look like? What might the mix of the workforce be? How many super sub-specialty posts might we need? In what areas are these needed? All sub-speciality areas of haematology are important in delivering patient care.

How does the work of the BSH around the haematology curriculum tie into the future of haematology training?

The BSH can be used as a platform to shape the curriculum. We need to identify and agree on core haematology knowledge and specialty specific knowledge before we can make any meaningful changes in the delivery of training for the future.

Our broad-based training has held us in good stead so far and as a discipline has enabled some plasticity in the workforce, but it will not be sustainable as we need depth and breadth of knowledge in developing areas to be at the forefront of excellent patient care.

It is the most pressured time in the NHS since I have been qualified, with constant changes and a lack of funding. Now more than ever the BSH needs to bring together its trainers, trainees and specialties to support and facilitate this important piece of work.

I cannot think of any other specialty that is so diverse, interesting with exciting innovative treatments for patient care and it is our duty to make sure it stays that way for the future.

Meet Dr Guy Pratt, the marathon-running consultant who is not only a trustee, but also sits on the finance committee and the Haemato-oncology Task force.

Dr Pratt has been a BSH Trustee since April 2015, and will be completing his term in April 2018.

What made you interested in applying for the role of BSH Trustee?

I am always trying to be productive and improve haematology generally, both at a local and national level. I think this is a great opportunity to get involved. It was a big step, because I had never been a trustee before and it gave me insight into the society. It has been very interesting, very educational and I would highly recommend it - you get the opportunity to make a difference.

What challenges have you faced as a trustee?

There are two obvious things, one is the lack of knowledge. It does take you a while to understand the processes and history behind various things such as the Annual Scientific Meeting, Guidelines or British Journal of Haematology.

The other major challenge is your time. Our NHS jobs are so busy now, it is quite hard to find time to do things, like be a trustee.

So how do you make that work?

It is a challenge, but you have got to manage your time.

Has it been worth it?

Definitely, yes.

In terms of rewards, what do you bring with you from this role?

I think there is a pleasure in being with likeminded people who have great abilities and work in a positive organisation. Then there is also a purpose, a meaning to it. You see things like the Annual Scientific Meeting (ASM) develop this year, which was excellent. You could see that there has been progress made and you get great happiness from that.

What exciting changes are the society facing going forward?

There were several areas highlighted during the board retreat in June, such as continuing to develop our membership offering and Annual Scientific Meeting.

We will also collaborate with other grant bodies and support younger members with the grants.

What kind of skill/expertise do you think the board needs?

I think it needs somebody with experience of haematology in Britain. Probably someone who has been a consultant for a while so that they are aware of the issues around haematology. It would also be good if they had a particular area that they would want to focus on.

Nominations for new trustees will open later in the year. As per our articles this process will begin when we send out the nomination documents.

If you are interested in becoming a BSH Trustee – keep an eye out for the forms in the post.

Andrea Harris - Professional Nursing Lead – Diagnostic and Therapeutic Services, NHS Blood and Transplant

What led you to a career in haematology?

I qualified as a Registered General Nurse in 1990. After a short stint in Rheumatology and General Medicine, I ‘discovered’ haematology. In all honesty, this discovery started with a vacancy on the haematology unit, and I was encouraged to apply for it.

I immediately recognised that there was something different about haematology nursing which is difficult to explain. There was special sort of team work which involved the extended multidisciplinary team, including the patient, their families and significant others.

In 2003, I moved into a career in NHS Blood and Transplant, supporting the implementation of Patient Blood Management and the safe and appropriate use of blood. I also have a keen interest in leadership and supporting professional development.

What advice would you give to someone considering a career in haematology?

As a nurse, it can sometimes be difficult to know what career pathway to take. If haematology is an option you are considering, it can have many benefits. You will learn a wide range of extended nursing skills which you will be able to take with you wherever your future career lies. It’s challenging and demanding work (what practice setting isn’t?) but is also extremely rewarding.

What is the most rewarding part of your work on the Transfusion Task Force?

I have been a member of the Transfusion Task Force for a number of years. Transfusion is a multidisciplinary speciality, and the Task Force membership represents this. I have had the opportunity to provide a nursing voice to several BSH guidelines. I believe that this is vitally important, as nursing has specific considerations and viewpoints. I feel privileged to have helped to contribute to the multi-professional expert opinion which helps contribute to the evidence base for transfusion.

What is the most challenging part?

At first it was very daunting to sit on a Task Force as a nursing representative, and to contribute to discussions or to differ in opinion to others. I soon learned that other Task Force members were keen to hear my views, and so whilst challenging this also became very rewarding.

How do you see your specialist area of haematology changing in the future?

Whilst blood transfusion is inherently very safe in the UK, and saves and improves many patients’ lives; new and emerging infections are a constant concern, and there is ongoing evidence to suggest that blood transfusions are sometimes given inappropriately.  The way we use blood is changing, with a general consensus that where possible, alternatives to transfusion should be considered and utilised. Historical and outdated clinical practices need to be constantly challenged as the evidence base grows and changes.

What does being a BSH member mean to you?

BSH offers members a unique opportunity to keep up to date with the latest news, education and guidance. It provides a portal to all healthcare professionals for all things haematology, helping to transform the care provided to patients.

Dr Mark Thomas Shaw Williams, Lecturer in Cell and Molecular Biology at Glasgow Caledonian University and Paul O’Gorman Leukaemia Research Centre Affiliate at University of Glasgow

 What led you to a career in haematology?
I chose to pursue a career in haematology for a variety of reasons. First of all I am fascinated with blood cancers, and have spent the last seven years conducting research into Multiple Myeloma, Acute Lymphoblastic Leukaemia and Acute Myeloid Leukaemia (AML). Secondly, ever since my PhD studies I have gravitated towards patient-centred research which makes Haematology an ideal field to carry out such studies. Ultimately I am contented with the knowledge that findings from these studies will potentially have a direct impact on improving blood cancer patient outcomes, as such survival and quality of life. Additionally, I have a passion and educational background in Immunology and enjoy performing research, which encompasses both haematology and immunology.

What advice would you give to someone considering a career in haematology?
The best advice that I could give would be to encourage young researchers to network with established researchers. To ensure that they surround themselves with a supportive research team, including PhD students and mentors. I have been fortunate to work closely with excellent clinical researchers, such as Dr Yasar Yousafzai, Assistant Professor at the Khyber Medical University in Pakistan, and through invaluable advice be guided by highly supportive haematology mentors, such as Dr Christina Halsey, Senior Clinical Research Fellow at the University of Glasgow and Professor Mhairi Copland.

What is the most rewarding part of your job?
The most rewarding part of my job is having the opportunity to interact with and get to know researchers and clinicians from all over the world. Particularly as I enjoy learning about different cultures and different career paths that individuals have followed. Also, I’m fortunate to be conducting research in Glasgow, which has a network of friendly and approachable basic scientists and clinical researchers dedicated to both paediatric and adult patient-orientated haemato-oncology research.

What is the most challenging part of your job?
Like most other academics I dedicate the majority of my time to teaching and research, as I find it satisfying having a positive influence on student learning. With regards to my research, striving to perform studies, which have direct clinical implications for blood cancer patients. However, as a consequence I tend to not spend a lot of time with close family, such as my wife and son, and my friends, and thus have to make a conscious effort to achieve that work/life balance that I have heard rumours about.

How do you see your specialist area of haematology changing in the future?
I’m interested in how cellular elements of the bone marrow microenvironment protect AML cells from chemotherapeutics. This area is continually evolving, in which we will see the emergence of more accurate multicellular 3D model systems to study bone marrow-leukaemia interactions. I remain hopeful that this will lead to the development of novel therapeutic agents in AML, and other blood cancers, ultimately leading to improved clinical outcomes for these patients.

What does being a BSH member mean to you?
I’m proud to be a part of the BSH community, and being an early career researcher I have found that the society is particularly supportive of its younger (research and clinical) society members. The BSH have supported me for many years, enabling me to attend national and international conferences and provide me with useful advice.

Why did you choose to specialise in Haematology?

I chose to specialise in Haematology for a number of reasons. Firstly, I enjoy the mix of clinical and laboratory medicine and the opportunity to undertake both clinical and basic research. Secondly, it is a very rewarding specialty and you are able to build really excellent relationships with patients over many years. I think clinical Haematology is quite a holistic specialty as you look after patients from making the diagnosis all the way through their treatment journey. It is also a very fast moving field with new drugs and other therapies frequently becoming available, improving outcomes for patients.

What is the most rewarding part of your job?

The most rewarding part of the job is seeing patients who are in remission after intensive treatment getting back to living their lives, returning to university or work, and enjoying time with their friends and family. However, I also enjoy the research aspects of my job, and seeing your work presented or published is a great feeling.

What are the toughest problems you have to deal with?

The toughest problems are having to break bad news to patients and their families. Unfortunately, although treatments continue to improve, not all patients are cured and many patients relapse or have refractory haematological malignancies.

What advice would you give to your younger self at the start of your career?

I have given this a lot of thought and I’m not sure I would change very much. I think it’s important to get a broad range of experience in different medical specialties before entering Specialist Training. Early in my Haematology training, I would say, try to take as many educational opportunities as you can and enjoy it.

How do you see the field of Haematology (or your specialist area) changing in the future?

Increasingly, we will see more personalised medicine with the introduction of novel agents for different subtypes of AML, for example. Next generation sequencing is going to have a major role in developing these personalised or ‘precision’ medicine approaches. In addition, I think immunotherapies are going to have a major role to play over the next ten years or so and we are only beginning to see these agents improving outcomes for patients – there is still a long way to go. With an ageing population, people living longer and with multiple therapies now available for conditions such as CML and myeloma, clinics are going to get much busier and I think there will be an increasing role for clinical nurse specialists in managing these patients.

What was the most influential session for you at this year’s BSH ASM and why?

There was a great session on acute lymphoblastic leukaemia. It covered all aspects of the condition and highlighted the new immunological therapies which are becoming available.

If you could travel anywhere, where would you go and why?

I would go back to Central or South America. I am really interested in the ancient meso American cultures such as the Maya and the Inca and I’d love the opportunity to spend more time there.

What interests you about Haematology?
It is one of the fastest paced specialties in terms of research. Watching how fast advances in molecular biology translate into clinical practice is really incredible. Similarly the opportunity to form long-term relationships with your patients is something that really appeals to me. Plus, whenever you mention that you like Haematology to another medical student they immediately think you must be clever (how wrong they are!)

What would you say to other medical students interested in learning more about Haematology?
It’s great! It can be really daunting as a specialty, but haematologists are lovely! There are so many opportunities to get involved in the specialty; local audits and research projects always seem to be in abundance, and that’s a great way to learn more about the specialty. For Med students who want to learn more for exams and build their confidence in Haem, the BSH education days are where I started – they made exams a lot easier!

What would be the highlight of your time as the BSH Student Representative on the Education Committee?
Having the opportunity to present at the British Society for Haematology's ASM. It was a great experience to be able to attend, and I learnt a lot while being there. 

Which opportunities do you find offer the greatest opportunity to learn a great deal?
Getting involved in an audit with the Haematology team as a medical student really opened doors, and I found so many more opportunities to get involved in projects – that was when I thought the specialty might be for me.

What was the most influential session for you at this year’s conference?
Tim Littlewood’s Gold Medal Lecture, 'Teaching Haematology: Art, Science and Humanity' was absolutely brilliant and inspiring stuff - one of the best 45 minutes you will listen to.

If you could witness any event of the past, present, or future, what would it be?
Nirvana’s Live and Unplugged in New York in 1993 (I was a little young!) 

Why did you choose to specialise in Haematology? 
I chose to specialise in Haematology as it offered a varied clinical experience from specialist areas, such as the treatment of cancers, to more generalist areas such as the assessment of anaemia or the management of problems associated with haemostasis and thrombosis. This combination is the perfect mix of active patient contact on the ward, outpatient and academic laboratory-based roles. No other specialities offer all of these under one roof.

What do you wish you had known when you first contemplated this career?
I had been a junior doctor in Haematology in very busy centres and as such was aware of the general pros and cons. If you’re simply based on the wards, your perspective can be limited to patients with a poor long-term outcome. It was reassuring to find that there are so many patients who are doing well in the long run despite having a haematological diagnosis. This came to light once I started training in the speciality.

What personal qualities or abilities are important to being successful in this job?
Always putting the patient at the forefront of everything you do. I also think it’s important to be a team player and to value the opinion of all colleagues who you work with, whether they’re medical or non-medical, as well as being able to admit when you don’t know something, and being able to learn from others.

How do you see the field of Haematology (or your specialist area) changing in the future?
A few things come to mind, such as the centralisation of laboratory functions for diagnostics, a move away from toxic chemotherapeutic agents to less toxic alternative drugs and an increasing focus on strengthening infrastructure based on how various MDTs function. A lot of newer agents, available for treatment in the setting of relapsed CLL, Myeloma and CML setting, are showing promise. Furthermore, there is a greater emphasis on spreading haematological education and awareness, with the BSH's recruitment of regional Education Leads playing an important part.

Which opportunities offer the greatest opportunity to learn a great deal?
I think that listening to and working closely with both our colleagues, patients and carers offers opportunities to better our practice. This can be strengthened by adopting an evidence-based approach to our practice through accessing the resources available such as peer-reviewed journals and, of course, through societies such as the BSH.

What was the most influential session for you at this year’s conference and why?
It has to be the BSH Medal Lecture by Dr Tim Littlewood entitled 'Teaching Haematology: Art, Science and Humanity'. The take home messages were very pertinent to current haematological training in the UK, which is to teach the curriculum before possibly more esoteric topics, and to use every contact with a student or junior doctor as a learning opportunity, which I absolutely believe in and actively practice myself. What I found most interesting was his use of video recordings of patients to teach about the impact of disease on the patients themselves and the importance of proper communication putting it all in perspective. I feel very passionate about education myself and thought his presentation was heartfelt and extremely inspiring.

What was one of your most defining moments in life?
That’s easy…the birth of my children!

If you could travel anywhere, where would you go and why?
I’d choose Kolkata in India. The fact that the streets are so vibrant and buzzing irrespective of the time of day is so endearing to me, not to mention my mum’s home cooked curry!

Why did you choose to specialise in Haematology?
I chose to specialise in Haematology because while in medical school, I naturally had a flare for the subspecialty. I loved it and understood it quite easily. Also, here in Nigeria, it is a subspecialty that is not yet being explored, and is less populated. With my special interest in blood transfusion medicine, I see it as a privilege to contribute and help develop the blood transfusion service in my country. 

What do you do during a typical working day?
On a typical work day, we schedule a ward round which begins at 8am, after which we proceed to the laboratory to review some slides on peripheral blood films with the residents. This creates discussion and inspires teaching sessions. At other times we run an outpatient clinic as well.

What do you wish you had known when you first contemplated this career?
Nothing at all, because I love and have always wanted to be a haematologist.

What is the most rewarding part of your job?
The most rewarding part of my job is saving lives in respect to blood transfusion.

What are the toughest problems you have to deal with?
The toughest problem I have to deal with is in the management of haematological malignancies in a resource-poor country where many patients cannot afford most of the chemotherapeutic agents required for managing these malignancies. Availability is also a big challenge. Most of the drugs are not available to us.