Clinical toxicologists: the poison specialistsBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i4973 (Published 20 October 2016) Cite this as: BMJ 2016;355:i4973
- Henry Fok, specialist registrar, clinical pharmacology and therapeutics,
- David Webb, Christison professor of therapeutics and clinical pharmacology, British Heart Foundation Centre of Research Excellence,
- Euan Sandilands, consultant in clinical toxicology and acute medicine
Henry Fok, David Webb, and Euan Sandilands explain the work of clinical toxicologists and how to get a foothold in this research oriented career
Poisoning ranks among the top 10 reasons for hospital admission in the UK but, despite this, surprisingly little is known among junior doctors about the role of the clinical toxicologist.
Most front line medical staff would have used Toxbase, the online poisons information database provided by the National Poisons Information Service (NPIS), or contacted a clinical toxicologist through the 24 hour telephone advice service.
However, the day-to-day responsibilities of a clinical toxicologist are wide and varied and not only include the clinical management of poisoned patients, but also research into new and emerging treatments, teaching, pharmacovigilance, and providing medicolegal expert advice.
What is clinical toxicology?
Toxicology is a scientific discipline that is concerned with the management and avoidance of chemical and radiation injury to humans and the ecosystem. Clinical toxicologists specialise in the management and prevention of these insults in humans.
Within the UK, clinical toxicologists work as part of the NPIS and are predominately based in the four poisons centres in Birmingham, Cardiff, Edinburgh, and Newcastle, with additional posts in London and York.
All consultants provide a local specialist clinical toxicology service, often within dedicated poisons units. Most patients present acutely in the context of deliberate self harm so consultants work closely with liaison psychiatrists.
Consultants also contribute to a national on-call rota to give specialist advice to health professionals across the UK and the Republic of Ireland in the management of poisoning.
The majority of clinical toxicologists are accredited in general internal medicine and regularly participate in acute medical takes.
Clinical toxicology is a rapidly evolving field with new information emerging daily: be it novel psychoactive substances, household chemicals, poisonous plants, or even snake venom.
The NPIS, therefore, invests heavily in maintaining Toxbase as a source of up-to-date, evidence based information. In addition, a registry of the effects of drug and chemical exposures in pregnancy is provided by the UK Teratology information service.
Clinical toxicologists contribute to all of these roles, providing leadership within the NPIS, working closely with a multidisciplinary team of specialists in poisons information and specialist nurses.
Why choose a career in clinical toxicology?
Clinical toxicology is unique and offers a range of opportunities for career progression. There are many options for clinical research, suiting doctors who want to pursue a career as a physician scientist.
Clinical toxicologists are often invited by government bodies and organisations to advise on the wider impact of poisoning, including public health policies. Moreover, clinical toxicologists also act as medicolegal expert witnesses in legal cases.
What qualifications do clinical toxicologists need?
In the UK most consultant clinical toxicologists are accredited in general internal medicine and clinical pharmacology and therapeutics. Clinical toxicology is one of four advanced specialist area modules within the current clinical pharmacology curriculum and trainees wanting to pursue a career in clinical toxicology should undertake in-depth training at one of the NPIS centres. A postgraduate degree in medical toxicology is desirable but not an essential criterion for clinical training.
Clinicians from other backgrounds, particularly acute medicine and emergency medicine, may arrange short term experience within one of the four NPIS centres, but this requires approval from their training programme directors.
Clinical training fellowships are offered at the Royal Victoria Infirmary of Newcastle upon Tyne and St Thomas’ Hospital in London for specialist trainee year 3 and above who wish to gain 12 months’ experience.
These posts may require experience in emergency or paediatric emergency medicine.
Clinical toxicology offers a rewarding career with the chance to gain a variety of transferable skills during postgraduate training. The specialist knowledge and analytical skills gained are highly valued, which in turn opens doors to opportunities ranging from the management of acutely unwell patients to advising on national public health policies.
We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.