Case study

Chemical pathologist — Dr Shivani Misra

Shivani works as a consultant in chemical pathology. Find out how her training has prepared her for this role

How did you get your job as a trainee pathologist?

I chose medicine, as I really liked A-level biology. I studied at St Barts and Royal London Medical School and particularly enjoyed completing my intercalated degree (this is where you take a year out of your degree to study for an additional degree). I spent this time researching molecular endocrinology in a laboratory. In my final year, I took this research further and spent two months in a lab in New York.

As a doctor I enjoyed the puzzle of diagnosing and completed two years of core medical training. I then chose metabolic medicine, a sub-specialty of chemical pathology, after speaking to someone working in the area. It suits me as I'm very detail-orientated and enjoy problem solving.

I chose to work in an academic role, which means I combine research with clinical work.

What's a typical day like?

I have clinics in the morning, which focus on diabetes, lipid disorders, metabolic disorders or obesity. Over lunch I might have a multidisciplinary meeting (where different professionals meet to discuss the diagnosis and treatment of patients).

In the afternoon, I look at test results and provide GPs and other clinicians with an interpretation of them. I also carry out nutrition ward rounds. Some evenings I might be on call in the biochemistry lab.

What do you enjoy about your job?

I really enjoy the clinics and getting to know the patients. About 30% of my week is spent seeing patients and the rest of the time is split between laboratory work, teaching and research.

I also love working with the NHS staff - the scientists I meet are really talented and I enjoy being part of a specialist clinical team.

What are the challenges?

It's hard work passing the exams to become a fellow of the Royal College of Pathology.

Another challenge is being the interface between the laboratory and the clinical setting. It's fun working between the two areas but it can be difficult managing expectations. There's a tendency to think every test result is perfect, but part of my job is ensuring clinicians know the limitations of the results they get.

How is the role developing?

I love the breadth of knowledge that encompasses the chemical pathology specialty. I have been able to complete a PhD and carve out a specific expertise in unusual forms of diabetes.

I am now at the end of my training and I've recently been appointed as a consultant, so it's a very exciting time.

What's your advice for someone wanting to get into chemical pathology?

It's important to reach out to the clinical biochemistry laboratory - most hospitals have one. If you're a medical student or trainee ask whether a consultant or higher specialty trainee could mentor you.

Also, make sure that you choose a good training programme. I found that core medical training was a great general pathway into metabolic medicine.

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