Intended for healthcare professionals

Careers

Life as a haematologist

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m248 (Published 07 February 2020) Cite this as: BMJ 2020;368:m248
  1. Jacqui Wise
  1. London, UK

Haematologists are specialist doctors who look after and investigate conditions that are associated with blood and bone marrow problems, including diseases such as anaemia, haemophilia, and leukaemia.

The specialty offers a unique split of laboratory work and patient care. Haematologists take an active part in every stage of patient management, from initial patient visit to laboratory assessment and diagnosis, and finally to treatment. For example, haematologists carry out bone marrow biopsies and interpret the morphology. They also perform diagnostic lumbar punctures and give intrathecal chemotherapy.

Blood transfusion is an important responsibility of haematologists. Some have expertise in blood and marrow stem cell transplantation to treat a range of life threatening malignant and non-malignant disorders. Modern genetic testing is also a major feature of all branches of haematology. For example, haematologists’ work on leukaemias and blood cancers help guide decisions for chemotherapy and other treatments.

A typical day

The working day will vary depending on the sub-specialism of the haematologist. A typical day for a general consultant haematologist working in a district general hospital will be 9 am to 5 pm, although they may have to work longer hours on occasion.

Haematologists divide their time between the ward, outpatient clinic, and the laboratory. Overall, the split is around 80% clinical work and 20% laboratory work which would include looking at blood film or bone marrow aspirates under the microscope and generating reports on the results.

In the laboratory environment, haematologists work closely with diagnostic laboratory scientists and biomedical scientists as well as with clinicians in other pathology disciplines.

The consultant-led ward round would usually be twice a week. The consultant haematologist may also have to visit patients on high dependency and intensive care units. There will also be regular multidisciplinary clinical meetings.

Typically, a consultant haematologist would have three outpatient clinics a week. These may be general clinics or in a particular field, such as sickle cell disease. The number of patients seen each day depends on the location. Outpatient clinics would usually include new referrals and follow-up patients.

A large number of patients need long term follow-up in the specialty clinic—for example those with haematological malignancies, congenital bleeding disorders, and haemoglobinopathies.

For most haematologists, over half of their work would involve haemato-oncology patients. This would include patients undergoing chemotherapy, follow-up of patients after chemotherapy, and new diagnosis of blood cancers.

Haematologists would also deal with new referrals for patients with abnormal blood counts or who need specialist thrombosis input. Part of the day may be spent giving advice and guidance to GPs about abnormal blood results. Haematologists would also deal with queries from other specialists, for example over blood results or clotting problems.

Most consultant haematologists would work a one in five on-call rota as many inpatients have critical illnesses that demand specialist care and laboratory services must be available on a 24 hours, seven days a week basis.

Best things about the job

  • The holistic nature of the job is rewarding. For example, you may see a new patient with leukaemia, examine their blood sample under the microscope, make a diagnosis, treat them, and carry out follow-up

  • There is a balance between looking after patients and spending time in the laboratory

  • You can build up long term relationships with patients, from birth throughout life

  • There are a number of exciting innovations in haematology. It’s easier to work on blood and bone marrow samples than solid tumours, so haematology is often at the forefront of oncological research

  • Haematologists are very much involved with the increased use of genomics, such as the 100 000 Genomes Project and the upcoming whole genome sequencing

  • There is a wide mix of patients with some fairly well and others very sick

  • The hours are fairly regular and predictable

  • The job is amenable to part time working

  • There are a lot of women in the specialty—women make up 42% of the consultant workforce and 65% of the higher specialty trainees in the UK

  • Other specialties rely on haematologists for advice so you can know nearly all the other doctors in the hospital, making it quite a sociable specialty

  • The job can be challenging and mentally stimulating, for example if a patient presents with unusual symptoms or where the diagnosis is not entirely clear

Worst things about the job

  • A lot of people don’t understand the specialty

  • You get to know patients very well which can be emotionally exhausting if they don’t do as well as you had hoped

Skills needed

  • An excellent scientific mind to understand the science behind blood disorders and the list of available treatments

  • An eye for detail

  • Good problem solving ability

  • A love of looking down a microscope as this will form between 10-20% of the job

  • Good communication skills

  • Compassion and empathy as you may be providing care to patients who are very ill

  • Flexibility—haematology is very varied

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