Celebrating National Pathology Week: What is a clinical microbiologist?

This one’s a re-share of a post from last year but I thought it was still a good one to continue this weeks exploration of roles.

To celebrate this week being National Pathology Week , I thought I should take some time to post about what a clinical microbiologist is. I do this because, when I was at university, I really didn’t know that this career path existed. So here is a shout out to all those students who are trying to decide their next steps. You too will find your way.

When I googled microbiologist this is the first item that comes up

Microbiologists study microorganisms (microbes) in order to understand how they affect our lives and how we can exploit them

Prospects.ac.uk

This seems like a pretty good cover-all description. It goes on to discuss that there are microbiologists in many different areas:

  • medicine.
  • healthcare (I’m not sure how they differentiate this from medicine or visa versa).
  • research.
  • agriculture and food safety.
  • environment and climate change.

I must admit that when I was at university most of the options I encountered were linked to the food and drink industry or pure research. I think that their list missed things like Pharmaceuticals (although they may count that as medicine) and other forms of production, i.e. cosmetics.

At university I only did one module of microbiology (I was reading Zoology) and that module was about environmental bacteria and plating out bacteria onto agar plates to see what grew.

How did I go from Zoology to Microbiology?

I really wanted to work in an area of science where I could work to make a difference. I wanted to work somewhere that I could see that difference being made. Working in research felt too abstract to me. When I discovered, through a friend, that I could become a scientist in healthcare I knew it was what I wanted to be.

The National Careers service says you need to have two to three A-levels to become a microbiologist, plus a post-graduate degree. That is mostly true. However, in a world of apprenticeships and T-Levels, that is no longer the only route.

When I became a Healthcare Scientist I became a Clinical Microbiology trainee. So, what was the difference between that and what I’d done at University? The main difference with clinical microbiology is that I focus on organisms that cause infection: parasites, viruses, fungi and bacteria.

I also discovered that there was so much more to microbiology than agar plates. Although – don’t get me wrong – agar plates are still a mainstay of life within the bacteriology laboratory.

One of the techniques I learnt to love was polymerase chain reaction (PCR), which enables us to look for the DNA or RNA of a microorganism instead of growing it. Viruses and parasites don’t grow on agar plates and bacteria and fungi may not grow well if exposed to antibiotics or if present in low levels. PCR allows us to diagnose patients with infections that would not be diagnosed otherwise, or to speed up the process so patients get put on the right treatment faster.

Variable number tandem repeat typing of Klebsiella pneumoniae

PCR also enables us to do things that are harder to do using traditional bacterial techniques such as culture. The picture is of patterns that are like bacterial fingerprints so that they can be clustered into similar groups. This enables me, as a clinical microbiologist, to tell whether bacteria within the same species are the same or not. This is important when deciding whether a bacteria has spread from one patient to another. It helps in acting like a hospital detective, which is a lot of my work in Infection Prevention and Control.

As a trainee I spent four years rotating within laboratory settings. I spent one year in a molecular laboratory, diagnosing patients using PCR. I then spent six months rotating between benches (each sample type has its own laboratory bench) in bacteriology: wounds, respiratory samples, faecal samples, blood cultures, urines, fluids (cerebral spinal fluid etc.) and the primary bench where samples were put onto agar plates. Six months in virology, a year in research and time in food and water, parasitology and mycology (fungal) labs.

The diagnostic process is pretty similar in principle between the specialisms:

  • collect specimen from possible site of infection.
  • select the most appropriate test to detect any organisms (agar plate for bacteria, PCR primers for viruses, etc.)
  • evaluate whether the result (positive or negative) is accurate and whether there are other tests that should be done, i.e. further characterisation of positives such as antimicrobial sensitivity.
  • decide on treatment or management of the infectious cause, i.e. antimicrobials or non-antibiotic management such as surgery.
  • advise on infection control if actions are needed to investigate where the infection came from or to protect others from risk.

During my first four years I spent most of my time in the laboratory doing the first three bullet points.

Time goes on. I’ve been in the NHS for 17 years. Most of my time is spent at my desk in the on-call bathroom. Since 2010, most of my time has been spent either in Infection Prevention and Control undertaking the final bullet point or increasing my skills by gaining Fellowship of the Royal College of Pathologists to do bullet point four.

I still support the lab and, occasionally, get my lab coat on – but not as much as I’d like. It is, therefore, possible to be a clinical microbiologist and be anywhere on the spectrum. You can go as far as you’d like and do the type of work that makes you happy. It’s why being a clinical microbiologist is a great career!

Modernising Scientific Careers Framework

All opinions on this blog are my own

Celebrating National Pathology Week: What is a clinical academic?

We are working through an exciting time within NHS careers, especially as Healthcare Scientists. Training pathways are becoming more formalised and alongside this diversity of opportunities are increasing, allowing Healthcare Scientists to have not only more options for their individual careers but also to increase the impact of this workforce across areas including academia, education, leadership, as well as clinical specialisms. Following on from this weeks Guest Blog by Dr Claire Walker discussing the transition from lab to lectern and life working as a Healthcare Scientist within the academic setting I thought I would write something on what it is like to be a Clinical Academic (CA), working with a foot in both camps.

So what is a clinical academic? I suspect that all of you who read this blog regularly will be able to picture my face when I googled and the top entry is the one below from the NHS Healthcare Careers webpage:

what is a clinical academic? – healthcare careers search response

I believe it’s pretty self evident that I am not a medical doctor and that although this description may once have been true it is far from telling the full story.

So what is a Clinical Academic?

Being a CA is not in fact based on profession, or even % time splits. It’s based on the role that is occupied. One of the big distinguishing features is that a CA holds roles both within a University and within a Healthcare organisation, usually one honorary position and another substantive. Throughout the lifetime of a CA career the substantive post may switch between being within healthcare or a University, its the maintenance of both that is probably the most CA universal theme.

The amount of lecturing vs research varies by individual. Most of the CAs I work with tend to be highly engaged with research, especially if they are mainly based in healthcare, as this provides them with funding to buy out their time. In roles where clinics are routine however this provides a buy out route in the other direction. Despite being more research than teaching focussed I still teach on a number of master and undergraduate courses, as well as speaking at conferences etc.

Some typical academic tasks include:

  • Grant applications
  • Publication writing
  • Public engagement
  • Research supervision
  • Data collection (in whatever field that might be)
  • Teaching
  • Peer review (grants, papers etc)
  • Conference presentations
  • Other writing: book chapters etc
  • Guidance and strategic inputting

What are the routes into clinical academia?

On the Healthcare Scientist career chart below there is a box for CA pathways, but to me it still feels a bit ‘to be developed’. This isn’t unique to Healthcare Science but provides particular issues for my colleagues in specialist laboratories, especially within the UKHSA as they don’t have such a clear progression route laid out for them. It currently doesn’t really capture the whole situation as many of us in the Consultant Clinical Scientist box will also hold CA responsibilities and so the pathways aren’t as split as they appear.

There are a variety of roles into CA careers, both formal and informal. There is a fairly specific skill set you need to develop:

  • PhD (usually a research PhD rather than a tought/professional doctorate)
  • Some form of teaching qualification (as determined by your university). Not required for existing post but usually required for new
  • Funding track record – as you need to demonstrate to your employer you can assure an income stream
  • Publication track record – needed both for funding and dissemination
  • These days an interest in public engagement/involvement doesn’t hurt

The most established formal route into a CA career is via the National Institute of Health Research (NIHR) and the Integrated Clinical Academic (ICA) programme.

This is a programme that provides skill development and funding support all the way through from taster sessions to funding support for you to run your own research group. I wrote an article about this route in 2016 for the ACB and not much has changed in terms of the benefits.

The NIHR schemes are great, they match your current salary and give both great training and consumables support. This does mean these schemes are highly competitive (20 – 40% success rate, depending on level) however these days you need a level of research track record (publications and funding) to even enter at Doctoral level – demonstrating a pre-existing commitment to a CA career.

What about the informal routes? As I said the skill sets required are pretty standard and so can be developed piecemeal rather than through a structured programme. It is possible to get funding to do both a PhD and a teaching qualification by going through other routes (I have a post linked to PhD funding coming). The other components, funding and publishing, you will get by applying for funding for the qualification based aspects and during your PhD, it just may take longer. That said the NIHR route is time consuming and far from guaranteed, so both routes require you to know why you want to become a CA and an understanding of the fact that getting there is not a 9 – 5 commitment.

Why do Clinical Academic careers matter?

So having said that it can be a challenging route to go down why should you put in the effort?

There are numerous reasons why CAs are essential in healthcare. Let’s start with individual patient benefits. Research, especially translational research, is key to providing the best possible patient care. If we want to provide cutting edge care then we need to be engaged in the research that is developing that care – from clinical trials to diagnostic development. Getting results that diagnose patients faster has great individual benefits for patients, as they get on the right treatment more rapidly. Being engaged with clinical trials means that patients may be offered treatment or management that would just not be open to them otherwise.

On a Trust scale research enables funding to support infrastructure or translation of new diagnostics/services that might just not be possible with normal budget constraints. I was recently the co-applicant on a grant which brought in over £500,000.00 of infrastructure funding, for both staff and equipment. This means that the initial financial burden of translating over something new is not placed on the NHS and the data to then support business cases for introduction can be collected with minimal financial impact. On a national scale this kind of funding also supports multi site projects which would be difficult to manage in any other way in order to support large scale changes within the healthcare system, meaning that the potential impact can be huge and provide wide scale change.

There are also so many benefits for you as an individual. My career and life changed the day I got my NIHR Doctoral Fellowship. It opened both my eyes and doors to paths that I could never have imagined. I wouldn’t be a Lead Healthcare Scientist now if it wasn’t for the NIHR. I’m not sure I would be a Consultant. I have travelled the world, given lectures to thousands of people, developed future CAs and been able to develop as a scientist and a leader thanks to the funding that was provided. Along the way I hope that I’ve also made a difference for patients both through being involved in national guidance and local change.

What does a day in the life of a clinical academic look like?

As with so many aspects of Healthcare Science no two CAs seems to be the same. The National School of Healthcare Science have a number of different profiles on their webpage which describe some of the different options.

For me my weeks are really varied, obviously for the last 2 years my clinical work has been a priority and so the academic side of my role has been less prominent. I’ve already talked about teaching but for instance this is what I will be doing this month:

  • Organising a specialist conference on Environmental Infection Prevention and Control
  • Reviewing papers for numerous journals
  • Reviewing a grant
  • Reviewing abstract submissions for a conference
  • Meeting with my PhD students
  • Editing a paper for submission
  • Meeting to review SOPs for a country wide clinical trial
  • Meeting to review data for an ongoing COVID-19 study
  • Meeting with the molecular team to talk about how we move our Gram negative typing forward
  • Carrying out an MSc viva
  • Attending 2 exam boards as an external examiner

As my clinical work is currently still pretty hard core a lot of this I’ll pick up for the moment in my own time. Also, none of it takes me as long as when I first started out and so it looks more overwhelming than it actually is – I hope you can see the variety however.

Photo credit – Rabit Hole Photography

There is no getting around the fact that being a CA is not a 9 – 5 post however, managing grant and other deadlines on top of clinical work often requires some significant juggling skills, and in my case a very supportive husband. It’s not something I would advise that people strive for if they don’t love research, if they don’t have so many ideas that they just need to do something with them, it is not a tick box career. You also have to grow to be comfortable with failure, only ~20% of grants are successful, paper reviewer comments can be harsh and your confidence will take repeated knocks. Every time this happens though I get better at what I do, I find the learning and try to make sure I do it better next time #lifeislearning.

Despite it’s challenges being a CA brings me untold joy, it provides me with an outlet for creative thought and means that even though I spend most of my days in an office not a lab, I still feel like a scientist. I get to collaborate with the most amazing people who are at the forefront of their fields to make improvements for patients that would either not be possible or would take years any other way. For me it’s been something that has more than repaid my investment in time, energy and creativity. It’s taken me to places I would never have imagined, introduced me to people that my life is better for having met and provided me with experiences that I didn’t think would ever happen to someone as normal as me. So if you love learning new things, making life better for patients and are happy to spend your weekends in front of a laptop then a Clinical Academic career may be the career for you!

All opinions on this blog are my own

Wearing My Quitter Badge With Pride: Why FOMO can damage your health

I have written lots of posts on this blog about being brave and saying yes to opportunities. For once I’m going to write about something that for me requires even more courage, and that is saying no. It’s not that I don’t stand by those previous posts, saying yes is incredibly important. The thing is we all need to know why we are saying yes (or no) and to make sure that we are choosing our responses for the right reasons. Neither response should be driven by fear. There are times that for our own health and wellbeing we need to know when to choose our responses in a way that isn’t about career progression or opportunities, and we need to acknowledge that that saying no is also OK.

I’m a FOMO (fear of missing out) addict.  I always want to be engaged, I want to both support and be seen to do so.  I’ve worked so hard to get into the room that I live in some level of fear about not being in it. I worry that if I leave the room I fought to get in, not only will I be forgotten, but I will be barred from re-entry.

Over the last year a number of things have happened which have forced me to put this fear into context. FOMO is a fear of missing out on the possible, but by not being present for my life I’ve been missing out on the reality of my life that is happening every day. Recent events have prompted me to send emails resigning from a couple of things. I thought it would feel awful (it might still at some point in the future) but it didn’t, it felt great. Not because I am not heart broken to step away from those roles but because of the removal of the weight of those responsibilities that I had not realised I was carrying with me.

I feel like not only am I happy that I took the plunge but in fact I want to Marie Kondo my diary i.e. look at each item/commitment and say ‘does this bring me joy?’. If the answer is no then I need to follow up with asking myself honestly ‘why am I doing it?’. Obviously there are many things in our day to day working lives that just need to happen, but I think you would also be amazed at how many of those things that we feel obligated to do are actually just a routine or something that we are doing because we tell ourselves we should. It is these things we need to interrogate ourselves over and ask what it is that they are giving us: joy, experience, contacts? Are they still giving those things to us or are we attached to the memory/habit. Are we just scared to face up to what it would mean to move on?

Reasons to regularly review

What this current experience has shown me is that I don’t review my working life. The last couple of weeks have taught me that I should. I’ve spent some time thinking about it and the thought that has struck me (and you probably all knew this already – I’m often behind) is that you have to let go of the things that no longer serve you to make room for things that will let you continue to grow. I’ve not been letting go of things. Partly because I’ve finally reached the goal I was desperate to achieve in my working life and to be frank I’m so happy about that I’m still scared someone will take it away from me. I’m so used to having to tick so many boxes, often driven by the check list of others, that I’ve stopped reflecting on what was on the list for me.

If you, like me, have fallen into the habit of just taking on more, of just carrying on without reviewing your why, this is my plea for you to take a moment to see whether this is something you need to change. We should take a moment to put a review date in our diaries – I’m aiming for once every 6 months – to go through my lists of committees and responsibilities to see whether they are still a good fit for me and for those I’m working with. After all, it’s not just about my needs but also about making sure that I still offer what was required.

Carve out time to maximise impact

For me its not just a review of task, it’s also a review of mindset that is required. It’s very easy to become a human ‘doing’ and not a human ‘being’. Due to the pandemic I feel I’ve got into the habit of being in responsive mode. Constantly responding to changing information, changing guidance and the hundreds of daily emails. Don’t get me wrong, this is where I think many of us needed to be for the last couple of years, but we need to break ourselves of this habit. It’s nigh on impossible to be strategic in responsive mode. It is also not good for our own well being – at least it’s not for mine. I know get stressed and twitchy if I don’t access emails on the weekend. I worry about being judged for not immediately responding to every demand. The problem is that after the last 2 years I am broken and I can’t maintain it. Not just that but whilst I’ve been taking the time to reflect I’m pretty sure that it’s not where I do my best work. Responsive mode is fine when in crisis. Crisis is time consuming however and leads to focus on specific issues. To work on how to improve services and identify where we can do better requires us to take the time to step back, calmly reflect and then make plans. Switching from responsive to strategic mode is therefore important not just for me as an individual but is also key to doing a better job for patients.

Interrogate your reasons for saying yes

Not only am I a FOMO addict but I’m also a people pleaser. I feel the need to get feedback from others in order to feel like I succeed (I have another post coming on this). This can be an effective driver but when it takes over it can become a really destructive trait. You do not need to say yes to everything in order to ‘show up’. You don’t need to work 12 hour days ever day in order to be successful, in order to be enough. In fact by working those hours and becoming so focussed on the minutiae you may actually be performing less well than if you did your 9 – 5 and had adequate time off to reflect and recuperate.

These are my reasons for over committing but your may be very different. All of the different drivers we have are both good and bad, it all depends on how they are balanced. In times of stress it can become difficult to find that balance – and we have all been mighty stressed over the last 2 years. Now is a good time to look at ourselves and our decisions to make deliberate and mindful choices moving forward. Our judgement of worth needs to be internal not external if we’re to get out of this loop.

Know your worth

Self worth is a tricky thing. As I said above I’m a people pleaser, my self worth is often therefore derived from pleasing others. It is also linked to success, and like many in my field I define that success linked to outputs – presentations, guidelines, grant funding, papers published. Like many others I have lived, breathed, and focussed on pandemic management for the last 2 years. Therefore my sense of self has become distorted and my self worth has become even more focussed on work.

The thing is there is way more to me than my job. I have passions and interests both linked to work (like writing and The Nosocomial Project) and with my family. It is my family that have paid the price for the shift in how I behave and determine my value, and it is my family that now need to be my focus in order re-establish the balance I need to move forward. As teams, as managers and supervisors we need to support each other in shifting mindsets post this unusual period, and remind them that it’s OK to leave on time, to have weekends and eat lunch. It is OK to be the fullest version of yourself.

Give yourself permission to say no

So moving forward I am going to give myself permission to not just review options and step away from projects, but also to say no to new ones. If I lose traction, if I lose opportunities because I say no on occasion and if I’m not ‘always on’ then that is a price that I have determined I’m willing to pay. Those people who know me and have supported me will not disappear overnight just because I take more time to focus my energies on being the best person I can be.

Opening doors for others

I’m also not going to feel guilty about stepping back. This feeling of guilt has been difficult to manage but it’s not well founded. By stepping back from positions I’ve done for a while I’m opening up progression windows for others to make connections and gain experience in exactly the same that I did. By learning to say ‘no but have you thought about’ I am making opportunities for others and hopefully lifting others up by putting their names forward. Realising this has been crucial to me not feeling guilty about saying no. My saying no means that others can say yes and that is nothing to feel guilty about.

Situations change and the thing that was right for you 2 years ago may not be right thing for you now and that’s ok. Fear and guilt shouldn’t prevent us from letting go of things in order to grow and learn. So as much as I’m an advocate of yes I am also learning to become more comfortable with no. Find your joy, say yes to putting yourself first and know that by doing so you will become even better tomorrow than you are today!

All opinions on this blog are my own

If Not You Then Who? Why seizing the opportunities that come your way is so important

We’ve all had the emails arrive with requests. We are looking for a new member of X committee, a training rep for X group or would you like to give a lecture to Y. For many year when these dropped into my inbox I ignored them. They were being sent to everyone and so ‘they’ weren’t actually looking for someone like me. I wasn’t experienced enough knowledgeable enough, connected enough to ever find success in replying to something like this. Then one year I took a chance and replied. I volunteered to become the HSST lead for the Microbiology Professionals Committee of the Association of Biochemistry and Laboratory Medicine (a LOT of letters I know). They couldn’t reply fast enough with how happy they were I’d replied.

Don’t get me wrong, the ACB weren’t particularly excited that I’d replied……..more they were excited that anyone had. What I’ve learnt since from sending out these emails myself, is that hardly anyone does. The world is full of people who doubt that they would succeed and so don’t put themselves out there and give it a shot. So today I want to talk about all the reasons why, when that email arrives, you should click reply, open the next door in your career and step through it boldly.

You never know where these things will lead

When I sent that email I had no idea where it would lead. Now I know it was the first in a series of steps that took me from where I started to being considered a leader within my profession. At each step I never could have predicted what the one a couple of steps down further down the road would involve. What I do know is that each one I took, I took with purpose. Sometimes I wanted to give back, sometimes I wanted to increase my skills and sometimes I wanted to gain experience. The choices are your own but also not taking those steps and being purposeful is also a choice.

What I hadn’t realised back then is that people frequently ask people they know to get things done, not necessarily because they are the best person but because they are the person they can identify. This means that visibility and being part of networks is key to getting some of the opportunities that would benefit you and your profession.

In my case, that application to be a HSST rep emboldened me to apply for a bursary to attend my first overseas conference in Denver (see pic). After attending my first SHEA conference I was encouraged to apply to their international ambassador scheme, and became the first UK Ambassador. That then led to them paying for me to attend a conference at Disney in Florida, which was not only amazing, but meant I made the connections to sort out a 2 month sabbatical at Boston Childrens Hospital. This helped my NIHR Clinical Lectureship application. That progression helped give me the confidence and experience to apply to become Trust Lead Healthcare Scientist and to become a Clinical Academic.

Gain experience you won’t get in the day job

There are many reasons why it can be difficult to get the kind of experience that volunteering for professional bodies/guideline groups/any external responsibility can provide:

  • Sometimes its hard to be seen in a different way if we’ve been in post for a while, and therefore it can be hard to get identified for opportunities internally
  • Internal committees may find it difficult to accommodate extra people under existing terms of reference
  • Concepts linked to hierarchy may matter more for exisiting structures versus new groups/committees
  • External groups are often specifically looking to engage new people, garner new views and so it can be easier to align personal desires to be exposed to new experiences with the needs of these groups
  • Experienced provided by external groups may just not be provided internally i.e. experience of being a charity trustee

The activities linked to these groups may provide a lower stakes way to get experience. This can include chairing your first meetings, making decisions linked to the success of small pots of grant funding, inputting into a strategic plan. When doing this as part of our day jobs this can feel high stakes and be daunting. If you can gain experience of similar processes in a lower stakes environment you can participate in the learning without some of the stress and anxiety which might otherwise be present.

Often the experience isn’t limited to the activity itself but the experience of working with new people from different backgrounds. This experience helps make us more rounded professionals as well as supporting us in expanding our networks.

Progression is a series of steps

As I described in ‘not knowing where things will lead’ it is often hard to see where taking a series of these smaller steps will take you to. Frequently engaging in these activities is not about ticking off part of a big life plan but about making small progressions that support the whole. If you are a trainee it can be a really nice way of ticking off competencies, if you are already registered it can bring some variety to your CPD for the year. Meeting new people and making new friends is a benefit in itself.

One of the wonderful things about seeing these encounters as small steps is that you don’t have to feel overwhelmed by the big picture, in fact you don’t have to know what that big picture will look like. I talk a lot about having goals in mind, and I stand by that, but there is also joy in taking small steps into the unknown where you just enjoy and value the step in itself. Where you focus on the learning and the experience of that encounter for what it’s offering you in the moment. Taking multiples of these small steps combine to lead to big changes but the little steps have value in themselves and should be appreciated as such.

Don’t be afraid to be seen

I think on some level we all fear being visible, of sticking our heads above the parapet. It feeds into imposter syndrome and our fear that we aren’t ‘enough’. Fear of failure, of not getting chosen, is embedded in most of us from standing in lines to be picked at school if nothing else. I know and understand these fears. Fear is OK, it’s natural, in some cases in the right amount it can even be helpful. The problem comes when it overwhelms, or when we pay it too much heed and therefore we let it stop us from becoming all that we can. I feel this is especially true if it stops us learning, either from the experience itself or from even engaging in the opportunity to start with.

I often sit in my fear for a bit when I’m trying to move forward. This may sound like a strange phrase or a strange thing to do, but sometimes I need to experience the fear to understand it. I don’t dismiss it as I’ve never been able to make that work, instead I allow myself to feel and to ask myself ‘if this fear is real what is the worst that will happen’. What are the worst case scenarios. Then I ask myself, ‘what does this worst case scenario actually mean for me?’. Is the worst case that someone doesn’t pick me? In which case I’ll be a bit bummed out for a few days but there will be more opportunities. Is the worst case that I will make myself look like a bit of an idiot? To be honest I’ve been there before and whether its for this specific reason or not I am likely to be there again. One thing I’ve learnt it that you and your behaviour/embarrassment has way more longevity in your mind than in others. To be frank you are simply not important enough to most other people for them to remember a stupid comment in 6 months time, and those that you are important enough to probably won’t care. Most of the time when I do this I realise that even in the worst case scenarios the event would have little meaning in my life a few months down the line. Therefore the potential cost is still worth it. I don’t talk myself out of fear, I embrace it and that way it doesn’t control me.

Help your community

Finally, and I think this is so important. Our communities survive because of the fact that we engage as part of them. Guidelines don’t get written if people don’t volunteer to write them, events don’t get organised, outreach doesn’t get undertaken and manuscripts don’t get published. It really is a case of trying to make the sum greater than the parts.

As well as learning experiences in themselves, these opportunities are vital for both our profession and our patients. So much of what we do isn’t ‘paid’ as such, so much of our impact is based on the community choosing to engage and work together towards making things different, and hopefully better than they are today. We reap the benefits from the work of this community whether we volunteer or not, but we benefit so much more if we are part of the process. As each one of us steps forward to support our communities the output benefits, as the contribution comes from a more varied group of people and stands a better chance of therefore representing the society/community it is linked to. So instead of seeing your application as a way to benefit you and feeling stressed or worried about how it is received, see it for what it is, something that will benefit those receiving it and something they will be grateful to open.

Since sending that first email asking to be considered I’ve travelled the world, met amazing people and opened up a world of opportunities I just couldn’t have imagined, just because I hit reply and YES. So give yourself the gift of believing in yourself the way that you believe in others, you deserve it!

All opinions on this blog are my own

Conference Season Is Upon Us: Top tips for anyone who struggles with networking

Firstly apologies, this post was supposed to go up before ECCMID as I was hoping it would help others attending. Work was just too full on and I didn’t have the headspace to get it written. As there are still a lot of events yet to come I’m hoping it will still prove useful however.

We all know how very important networking is, especially at conferences. So much of a career that makes a difference in science is based on who you know and who you collaborate with. The problem is making those connections and getting to know people, especially in the early part of your career, often requires taking the plunge and being the one to open a conversion with someone you’ve never met.

I have an amazing friend called Diane who is a wonder to behold in these setting. She happily goes up to talk to people who she’s never met and just starts talking to them with great enthusiasm. Shes fearless and draws the best out of those she engages with. If you are a Diane you probably need read no further. For me however, there is little worse than that moment when you enter a room at a meeting/event, get your cup of tea and survey the 100s of people before you. In this moment you know that really now is the time, you HAVE to find someone to talk to. How do you choose who? What on earth do you say that means you don’t come across as an idiot? The very thought of it gives me palpitations. So here are some things I’ve learnt that take some of the stress out of networking at conferences.

Find an in

There are some moments and set ups at conferences when it is easier to start a conversation than others. There is always the chance that the person next to you in an interesting session will strike up a conversation to help them process what they’ve heard but in general they will be doing the same as you, ducking into and out of sessions that trigger their fancy, meaning they will be you focused on what comes next not starting a chat.

I find however there are two key moments when people are available for the cold start up conversation.

The first is at food breaks/receptions. During these moments there will be people who are there solo and also looking to develop their networks. I find the best thing to do in these situations is to get there early. There are always a limited number of tables where people can put down drinks, if you can find one and hold a place then people will effectively come to you. If this fails and there are no tables, just being close to the source of the refreshments often does the same job. Food and drink are great removers of hierarchy and being somewhere visible means that those in a similar position to you will be able to see you and hopefully will head your way. Worst case you make some small talk to the group that comes to your table and you can politely extricate yourself if it all feels too weird by saying you’re popping to get another drink.

The other place where people will be desperate to speak to you is during poster sessions. So many people will be waiting at their posters for an hour in the desperate hope that someone will come and show an interest. This is often a great time to make connections/exchange contact details (see NB below) If you scope out the listing you will know you are speaking to people who are interested in the same kind of work as you. This can shortcut some of the small talk you might otherwise need to make. It also enables you to know whether you are making a connection with a peer or whether you are connecting with a potential mentor/future employer.

The other thing to think about prior to these conversations is what you can offer, what is your unique selling point?

  • Knowledge (technique, setting or organism)
  • Access (organism, patients, research equipment)
  • Support (mentorship, peer-peer)
  • Collaboration (shared goals, shared research, shared implementation)

NB one of my biggest tips for all of these situations is to make sure you have some business cards printed – even if you print them yourself – this means that you can have something easy to hand out or pin to posters if you want authors to get in touch

Find your tribe

Anyone who reads this blog regularly will know that I’m a bit of a twitterholic (@girlymicro if we haven’t met). One of the many reasons that I’ve stuck with twitter since I initially signed up is that it has transformed my networking experiences. Twitter has offered me a way to circumvent the cold start up conversation by allowing me to find my tribe.

These days every conference/meeting has a hashtag. By following this hashtag you can find people who are interested in the same things as you, people who are in the same sessions or who even have shared connections. In many ways its an improved version of doing the poster walk.  Not only does this give you a conversational in but also by tweeting yourself linked to the thread before you ever meet in person it allows you to have a low stakes initial introduction.

One of the things I also love about twitter is it enables me to find and arrange to meet up with people who I primarily know online in order to strengthen my networks by getting to know each other better. It also gives me the chance to arrange collaboration events, like podcast recordings, when we just happen to be in the same place for a limited time.  Both of these can obviously be done by email but can be much easier to arrange when at an event when you suddenly have half an hour free. Especially at big conferences you could wander the halls for 4 days and not meet anyone you know, this way you can make the most of every second.

Take a study buddy

I absorb my learning best when I have someone to talk through my thoughts with. I have a couple of trusted study buddies that I will by preference attend events with. These guys help me get the most out of any event by:

  • Encouraging me to be braver – ask those questions I might talk myself out of, talk to that person that I should really try to connect with
  • Providing me with a sounding board for ideas when I’m in the moment
  • Enabling us to divide and conquer – there are often multiple sessions I want to be in at the same time, this way we can split up and meet at whichever session is actually proving most appropriate
  • Knowing me well enough to give me space when I need down time to re-energise
  • Crucially for me they are also there so I can feel safe from a health perspective if I have issues. They’ve helped me manage severe reactions, broken limbs etc and I trust them to get me where I need to be and give healthcare workers the right info if I need care

Mel and Lena have been my colleagues for years and they can not only get me out of a shame spiral if I do something stupid but also, by having them available to have conversations all together with new collaborators, we can make much more rapid progress on projects from the very start.

One of the other great things about going with a great study buddy is that you can also achieve other goals whilst at the conference. You can start to get papers drafted, do that research return or catch up about PhD students. If you do have supervision responsibilities whilst you’re away, as you have trainees with you, you can also share the load in terms of ensuring you have downtime. A lot of my most creative breakthroughs have happened with these guys whilst we’ve been away, surrounded both by new science and the time to reflect on how we could encorporate new thinking into our work.

Do some pre-work

I can get really insecure when going to high stakes meetings, like some of the ones I’ve been to at the House of Commons. I never really feel like I fit in and I have been known to hide in the bathrooms there until 5 minutes prior to an event start so I don’t have to face the ‘meet a stranger’ chit chat. In recent years I’ve learnt the value of doing some pre-work ahead of these meetings. This has taken different forms:

  • Reaching out on social media to see if any of my connections are attending
  • Approaching a professional body, especially if I’m on their guestlist, to find out who else they are sending so I can pre-arrange meeting at the session
  • Researching the event to look at speakers and attendance list (if available) so I can pre plan who I might want to speak to and what I could start a conversation with

In these events part of the value is in expanding your network and so really thinking about why you are going and what you hope to achieve is really worth it. Then you can match your elevator pitch (who you are, what you do and what you can offer) to your goals to help you achieve them.

Become the person others come to speak to

One of the things that has become lovely in recent years is that I’ve realised if you are presenting/organising/chairing people come to speak to you. This removes a whole lot of the stress of networking. As I mentioned above, people will often come to you even when you are presenting posters. Its always worth submitting work therefore to events you are attending, not only to get feedback on get science, but also to support you in developing your networks.

Even if you are not in a position to submit work then you should think about offering to support the organisation of events. Meetings are frequently looking for individuals who are happy to support the event organisation, both ahead of time and to do things like man the desks during the event itself. This will mean that you get to know other people who are supporting event delivery with you and give you an opportunity to network with delegates and speakers in a supported way. These connections can be transformative in terms of giving you further opportunities down the line.

Know your self and your limits

Most people assume I’m an extrovert when they meet me and I definitely have a lot of those traits. The things is, I can only manage networking for a fixed period of time. I’m good for a couple of meetings but then I need to retreat back into my bathroom office and answer some emails, otherwise I just feel progressively drained. The older I get the more I need my own space. This is usually fine but presents a real problem at places like conferences where I may need to be in full on extrovert mode for 16 hours a day. I find it exhausting.

One of the things that I’ve discovered about networking is that I therefore have to schedule it in a way that works for me. I can’t agree to go to lots of dinners on top of full day events, either from a health or a social resource point of view. I therefore pick the moments that work best for me and don’t over commit. This does mean I sometimes worry about missing out and not making the most of every opportunity but it also means that I put myself and my wellbeing first. It means that I don’t leave a conference unable to engage with work when I get back as I’ve already used up all my resources. Therefore my top piece of advice is to understand that networking is key but find a way to do it that works for you. Pick your key moments and do them well, rather than trying to be all things to all people.

All opinions on this blog are my own

FRCPath Notes: Some notes on organism identification and antimicrobials in case useful for others

In 2015 I put a note on twitter offering to share my FRCPath notes if anyone was interested. No one replied and so I assumed that (understandably) that everyone was focussed on making their own. Just recently however someone responded to ask if I still could. Long and short I’m delighted to share, mostly because they took me forever to put together and so them having a life after FRCPath gives them even more value as far as I’m concerned. These notes were put together for my FRCPath lab folder but the individual components may be useful to anyone interested in organism identification.

Note of caution, these notes are from 2015 and they were made for my personal use. They therefore may need updating and sense checking if being used by other people. The images are taken from publicly available sources and so despite the note saying they belong to me they only do in the sense that they were combined by me into their current form.

I have included a couple of blank templates I used as structure for revision notes and short questions. These are in word. The rest of the documents are in PDF. I know that some people may prefer word versions so they can update and edit. If you’d like these in a different format please DM on twitter @girlymicro.

Again, I make no claims that these are amazing, only that they were useful to me

Antimicrobial therapy

A table listing types of antibiotic, target and interactions

A table of treatment options and durations for infections caused by atypical mycobacteria

A table of typical antimicrobial therapy durations by broad condition type

Table of typical antimicrobial therapies listed by micro-organism

Notes on antiparasitic therapy listed by parasite

Gram negative bacterial identification

Identification notes by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Gram positive bacterial identification

Identification notes by organism

Identification notes by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Fungal identification

Plate appearance, identification and Gram stain info by organism

Parasite identification

Vector, identification and common presentation info by organism

Viral identification

Vector, identification and common presentation info by organism

Note templates

Example of note templates and completed organism notes in case helpful in terms of headers for other

All opinions on this blog are my own

Girlymicro’s 100th Post: What I’ve learnt in my 1st year as a consultant

It has kind of snuck up on me, but this is the 100th blog post on Girlymicrobiologist.com. I’ve had such tremendous fun and learnt so much about myself writing them. Talking to people about them has also been an unanticipated joy. I don’t therefore think I’d realised how many posts had happened over the last 18 months or so. To mark the occasion I thought about writing some top tips and discussing the things I’d enjoyed most, but I cover a lot of that in my 1 year anniversary blog. Serendipitously this post coincides with me having been in a Consultant post for a year this week, so I thought instead I would share what it’s been like………….

Everything I thought and more

I’d worked with a fairly single minded focus to get here. At some points it really felt like it was never going to happen. The wonderful thing is that it has been everything I hoped for and more, something that isn’t always true for dreams and aspirations.

The interesting thing for me is that the core of my job isn’t really that different from my job before, I kept waiting for it to change but it hasn’t really. The biggest change I think is the weight of responsibility I feel for my team and that, for some of the big decisions, I end up advocating on my own. I am aware some days that I’m on a trapeze without a safety net. That said, as the Consultant Nurse for IPC/DIPC and I talk every day we always have each others back. I can’t imagine having spent the last year in a pandemic doing this solo, and so this relationship has been a god send.

I must however talk about the thing that has been strangest to me. I left work on a Friday and came back on a Monday as a Consultant. From one day to the next a lot of people changed the way they interacted with me. People who had known me in both roles. On the Friday they would challenge me routinely and call me Elaine. When I came back on the Monday, the same people called me Doctor and just agreed to things. When I sent emails that I anticipated would come back with nit picking or challenge from some medical colleagues they just responded with OK thanks. Don’t get me wrong there have been plenty of difficult conversations but far fewer than I had anticipated. Anyone who believes hierarchy doesn’t exist in the NHS should experience this transformation by just sticking Consultant into their job title. I still can’t quite get my head around it.

The other thing that I’d been really fearful of when I switched was using the Infection Control Doctor title and having people telling me I couldn’t as I wasn’t a traditional medical doctor. I agonised about having it in my signature and putting people’s backs up. You know what…..not a single person has mentioned it, let alone said anything bad. I can’t tell you how grateful I am for this. It was that title more than any of the others that held real meaning for me and I was so scared of being rejected in that post. The fact that people haven’t rejected it but in fact embraced it means so much. As someone coming from a different place via a different route it is hard to quantify how much that has meant to me and given me hope for how we embrace change/difference in the future.

The whole truth and nothing but the truth

Now I’d be lying if I said the joy and acceptance described above hasn’t come with a whole of heap of challenges. I’m going to talk about the challenges of becoming an IPC Consultant in the times of COVID-19 below, and some of the bits I’m going to cover here I don’t know whether they are the same or worse because I started in a pandemic. It is worth stating that most of these existed before the big P, but that like many things in a period of change they may have been exacerbated.

I talked about about how much the IPC Doctor role has meant to me, its been the goal for 16+ years afterall. I think because I assign so much mental value to it that I doubt myself and fear that everyone is going to realise the horrible mistake they made on a pretty much daily basis. The shoes I’ve had to fill are massive ones left by such an impressive and knowledgeable individual, you can’t help but worry you will disappoint. Taking over at this point is therefore challenging when there have been big decisions and big changes every week it feels. I’ve talked before about how failure is key to learning but every action right now feels like it is too important to fail. That fuels my inner perfectionist and means I have a tenancy to spiral. Deep breaths and ‘faking it until I become it’ have definitely been my survival tools for my first year in post. I’ll let you know when the ‘become it’ happens.

The acceptance has been great, I’ve been incredibly lucky but on some level I still know I’m never going to be part of the club. My micro consultant colleagues go for coffee and lunch together but I can’t join them. I’m the person setting the guidance that says you shouldn’t mix, even after work. They will always spend more time with each other in hand overs etc which means they have enhanced relationships with each other. This isn’t a bad thing. I have relationships that they don’t have and my job role is different. I guess it’s human nature to want to be accepted and part of the group however. The strength of my position is that it is different and in many ways my strength is that I’ve always followed my own path. There have been times over the last year that I’ve needed to remind myself of that. They have been nothing but supportive and inclusive when I’ve reached out and so it has been a lesson to me that if I need help I just need to ask for it.

This leads me onto the next thing. I’m a stand alone Consultant Clinical Scientist within my department. I have nursing and medical consultants that I work with but no one like me. This has meant that sometimes it requires specific focus for both myself and others to remember the scientist part of that title. Being a scientist is a huge part of who I am and my concept of self. It’s understandable that others may not always remember that. Doing the bits that mean I am still a scientist is hugely important to me, things like undertaking research and advocating for my professional group. Some of this is tied in to re-discovering my identify full stop having focussed for so long on reaching this point. I’ve crossed the finish line and so what does the next goal look like, how does that fit in with my scientific identity. How do I ‘fit’ whilst still maintaining that of which I am proud and makes me different. This one is definitely a work in progress and as I learn more I’ll share whatever conclusions I come to.

Here’s the one that will surprise none of you = the to do list never ends. I feel like I’m constantly running to stand still, working weekends just to keep sight of what’s going on. Some of this I think is linked to me wanting to do my best and being anxious about it, some of it is because I don’t want to let go of some things I used to be involved with, but to be honest I think a LOT of it is trying to do all the pre-pandemic work on top of a pandemic work load. The ever changing guidance and the constant messaging required to keep people safe. If life is like this three years from now I will definitely need to drop things that I would love to still be engaged with, for right now I’m mostly taking each week at a time and hoping at some point to see what a consultant post in non-pandemic times might look like.

IPC doctor in the time of COVID-19

Until that day arrives when SARS CoV2 doesn’t control my every moment I continue to spin that one enormous plate on top of everything else. One of the biggest things I’ve learnt over the last year is that leadership, in all its forms, could not be more important. There have been some pretty tough lessons about seniority that I’ve had to learn as well.

I’m used to being able to make decisions, decisions based on evidence. If the data is sufficient I’m not used to people challenging or not engaging with those decisions. I’m going to post about this more in a future blog I think, but one of the lessons I’ve had to learn is that my ability to influence has limits. That the risk assessment others are making is not necessarily the same as the one that I am, and the weighting of the different factors within it are not necessarily the same as mine. Sometimes my role is to advise but if that advice is not taken up because that risk assessment is different it is not a failure of me in the role that I hold. It is the reality of advising on a single part of a much greater puzzle. Try as I may therefore I have had to acknowledge that this isn’t a battle for an outcome, but a collaboration where the outcome may or may not be the one that I would have chosen. As long as I advocate to the best of my ability, live up to my values and embody the leadership I want to see, that is all I can do. If I see it as a battle we all lose, if I see it as co-production we all win. Changing my point of view on this has been key to my surviving at certain points, especially linked to Omicron.

Talking about leadership, I don’t think embodying that leadership has ever been more important. Everyone is tired and everyone has gone through a period of extraordinary stress. I’m still asking staff to behave in ways that add to that stress i.e. by not having lunch or even drinks with their teams together outside of work. This means that a key way that we normally support each other is no longer available. We haven’t been able to celebrate or commiserate with each other for over 2 years. I’m a really strong believer in not asking others to do what I’m not prepared to do myself. Over the last year that has included me leading the way with opting in openly and discussing the pros and cons of routine asymptomatic lateral flow testing. Being open with people about my reactions to the vaccines and booster but how I went ahead and had them for the protection of myself, my colleagues and my patients anyway. It has also included me missing out on that same support I have deprived others of by reducing their contact with colleagues. To me its about fairness and showing with actions rather than words that we are all in this together.

The importance of paying it forward

There are some people in my world who went all in to get me this post, people who I will never be able to thank enough. Mentors who have been with me every step of the way and who put their names and reputations out there vocally to support me, fought battles for me that I know no detail about. Those people have changed my life. So now it’s my turn. My turn to fight for others. My turn to act as a shield and as a mega phone. I have thanked those that helped me but I don’t think they will ever really understand the difference they made, so now I honour that by vowing to make that same difference to those who follow behind.

So here I am (successfully?) having broken my way through that glass ceiling. If anything this last year has shown me that this isn’t the end of the journey but the start. If I want others to not have to have the same fights as I did, then I have to work to make sure I keep that hole open and drop a ladder through it to help those who want to follow. Those coming after me will have different challenges but it’s important to share what I’ve learnt to help them where I can along the way. It’s one of the many reasons this blog is so important to me. So as a fitting message in this 100th post I wanted to say that for as long as you guys keep reading, I will keep sharing. Sharing so we can rise up, sharing so we can make change and sharing to make sure that we are seen and to help us all work every day to leave the world a slightly better place than we found it.

All opinions on this blog are my own

Healthcare Science Week 2022 – Join us on Friday 18th March to talk about blogging, communicating and the importance of drama

Healthcare Science Week performance based on the weekly ‘Girlymicro’ blog by Dr Elaine Cloutman-Green, followed by a discussion on blogging

“So, this is my first ever blog post. Bear with me as I don’t really know what I’m doing. I’m what is known as a Clinical Scientist and I work in Infection Control.”

Thus began the first blog post by Dr Elaine Cloutman-Green, Lead Healthcare Scientist at Great Ormond Street Hospital, in December 2015. It would be five years and one pandemic before her second post, in October 2020, began her weekly blog as ‘Girlymicro’ (‘scientist changing the world one swab at a time’).

Girlymicro blogged at first about the job, to promote Healthcare Science, offering professional exam or interview advice for HCS trainees, before ranging more widely, into women in science, the challenges facing HCS, exploring the limits of what overstretched teams and individuals can achieve, saving lives in labs through insight, accuracy and interpretation.

Each blog written in a snatched hour, Girlymicro became a mental space populated with personal reflection, meditation on loss, favourite microbes, special guests, puppet shows, and… zombies; always with Elaine’s trademark humanity and humour.

‘All Opinions In This Blog Are My Own’ is a showcase of a devised work in progress based on the Girlymicro blog by The Nosocomial Project, adapted by Nicola Baldwin, performed by two actors, Becky Simon and Peter Clements, and two Healthcare Scientists, Anthony De Souza and Dr Elaine Cloutman-Green.

The short performance will be followed by a conversation on writing and blogging. Why blog? What might you learn along the way? Does writing create a safe space for reflection? Or create new pressures? To blog or not to blog…. That is the question.

All welcome

Date and time

Fri, 18 March 2022 15:00 – 17:30 GMT

Location

South Wing University College London

IAS Common Ground, South Wing

UCL Gower Street London

London

WC1E 6BT

please register to attend on this link, please take a lateral flow prior to the event and wear a mask

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Two Years On and Responding to Changes in SARS CoV2 Guidance: What can you do now to impact your transmission risk

Its pretty much 2 years today since a pandemic was declared. A lot has changed since then and there are very big other things happening on the global stage. Its tempting to think that with so much going on that COVID-19 is effectively over. I don’t want to be the voice of doom and gloom here, but I do wanted to take a moment to point out that just because the legal situation has changed it doesn’t mean that the pandemic is over.

For us working in healthcare actually nothing has changed at all, I had to do a briefing last week where I basically said the phrase ‘nothing has changed’ on repeat for 45 minutes. In fact although the legal side of things have changed in the community the actual guidance hasn’t changed at all, it’s just its no longer a police matter. The government website still says:

Although nothing has changed, apart from not being fined for non compliance, this doesn’t seem to have been the focus of communication. SARS CoV2 levels are still high in the community, in fact they are likely even higher than being reported as many people aren’t reporting positive lateral flow tests and so these aren’t included in any numbers. The latest ONS survey numbers are looking like ~1 in 25 people are back to bring positive, with the numbers much higher in some regions.

What Can We Do As Individuals to Prevent Spread?

As the government have decided to make the political decision to remove legal measures and the communication strategy in terms of maintaining public health measures is poor, what can we do to have an impact and reduce risk to ourselves and others?

Know the current symptoms

I have regular calls with people who aren’t aware that the omicon symptoms are pretty different, even when speaking to healthcare professionals. The current  variant often has much more generic symptoms associated with it than those seen when we first encountered SARS CoV2. This means that we need to change our risk assessment and also be much more aware of what to look out for, rather than relying on the triumvirate of Anosmia (loss of taste and smell), temp >38 and new onset cough.

I know how tricky this is because actually so many respiratory viruses have similar symptoms. In many ways its starts more like a general ‘flu like’ illness. Using testing to support making decisions is therefore still going to be really important in working out the cause.

Ensure you have capacity to test

Sadly we are losing the ability to access the more sensitive and specific way to test i.e. PCR, as you can’t order these in advance, store and keep for when needed. Even the free provision of lateral flow kits (LFTs) ends at the end of the month, but for right now you can still order a new 7 day kit every 72 hours.

https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests

Make sure that you have ordered enough for you and your family. How many depends on your circumstances, which drive your need to test (see list below).

Being able to test is important for a few situations:

  • Enables you to test before you see people who are vulnerable, regardless of whether you have symptoms
  • Supports risk assessment by enabling you to test if you get generic symptoms so you know when to self isolate
  • Helps you know when you are safe to see others again if you test positive. Your risk will be lower (though not non existent) if you are lateral flow negative. I would also advise being symptom free.

NB I am not supporting stock piling here just being sensible.

https://www.gov.uk/coronavirus

Remember that if you test positive you should (under guidance but not law) be undertaking daily LFTs to reduce your risk to others and you will need enough in case this happens to you.

Having testing supplies is especially important if you are a healthcare worker. Currently if you are a SARS CoV2 contact you still need to get an exemption to work and LFT test daily. You should also still be testing twice weekly and I haven’t heard how these will be supplied post switch from .Gov ordering.

Remember that not socialising with others when you feel unwell is key

Visualising how viral spread works can sometimes be tricky, afterall viruses are invisible to the naked eye. Most people can imagine coughs and sneezes spreading as we’ve all been in a room where a cloud has been visible when someone has sneezed. I think its harder with Omicron, where you might just have a runny nose and sore throat, to imagine how it could spread so far. Myth Busters have done a great job of this in the video below. They set up a 30 minute dinner party and show just how far the virus could spread.

It’s really important that we are all sensible about how we interact and what we do if we have symptoms. Top tips from this video include:

  • Remember to undertake regular hand hygiene
  • Limit touching:
    • Don’t share cups or other high risk items
    • Be aware of face touching and the need for tissues etc to minimise the temptation
    • Limit physical contact (if appropriate for the scenario – hard to do this with your kids)

Make sure you still have a plan

My vulnerable mum and brother have just caught COVID-19 for the first time. Something I definitely blame on the change in guidance BTW. They had been prepared in terms of a plan but even they have struggled because they weren’t as prepared as they had been as they had avoided it for the last 2 years. Like them a lot of us had plans early on but have let them lapse. Now with the switch from public health to personal responsibility it is important we prepare for what the means for us as individuals and dust off those plans.

If like me (and until recently my close family) you have managed the last 2 years without catching SARS CoV2 and it all feels a bit inevitable now what can you do?

  • Have a plan for getting food brought to you, either via a support network or via delivery
  • Have pre-planned what that food might look like. Easy food that can either be put in the oven without further prep or food that doesn’t require cooking. COVID-19 brain is real and you may struggle to make decisions whilst unwell
  • Ensure you have all the medications you might need (both for COVID-19 and otherwise) for 2 weeks. Think symptom relief paracetamol/lemsip etc
  • Plan for distraction, especially if you have children. If you have a short attention span and are bed/sofa confined how will you distract yourself. Personally im planning to re-watch the whole of the Golden Girls on Disney Plus. I’ve deliberately held off 😁
  • If you have to split your household into exposed and non exposed how could you do it – the answer may simpky be that you can’t but its worth some thought

Keep risk assessment in your mind

Most of what this post is about is linked to risk assessment and risk control. If you work in healthcare should you be having that lunch with your colleagues? If you are going to see your grand mother have you recently been to a night club? If you’re commuting in an area of ever increasing prevalence i.e. London should you be wearing a mask on the tube? If you haven’t found time to get that booster, now is your moment!

The decision to move to personal responsibility is just that, it’s about every one of us thinking about our own risk and choosing to take responsibility to protect both ourselves and others. We can’t be passengers in this, the govenment change doesn’t mean there is no longer risk, just that it is our risk to own and control. We can only do that by working together. So listen to the science rather than the politicians and make sure we continue to protect those who are most at risk. After all that is what a civilised society is supposed to do.

All opinions on this blog are my own

I Rarely ‘Feel’ Well: Let’s talk about health privilege in the time of COVID-19 and why SARS CoV2 solutions are not ‘simple’

Firstly let’s get out of the way. This isn’t a pity post, I live a full and amazing life and can achieve anything I want to achieve. It’s just sometimes I achieve it in a different way or I accept there might be some health consequences if I choose to do so – much like other people accept the possibility of a hang over if they open a second bottle of wine. I don’t have a severe condition, I’ve not got cancer or anything major but I have a mild auto immune condition that means I rarely feel ‘well’. Most days I have at least some variety of discomfort, swelling, mild temps, bad chest, sore throat, nausea. On bad days my limbs and face swell and I can’t eat or sometimes drink. This is just life, it doesn’t stop me living and as I said it’s mild and hasn’t hospitalised me in my adult life.

If it is not a show stopper then why am I posting about it? I’ve noticed a lot of healthcare colleagues posting in recent times about the problem of presenteeism and that we should just switch to symptom based isolation for SARS CoV2 and do away with testing outside of healthcare. They make these tweets as if this is the simplest solution and is completely logical. The thing is this choice might be both the simple and logical thing IF you make it from a position of health privilege. What I mean by that is that this is simple IF you are fortunate enough to be a position where 5 days out of seven you don’t have to manage your symptoms, and IF you don’t not have to worry about how you feel on any given day as you find it easy to tell when you’re sick. For someone like me who can’t readily differentiate from the list of SARS CoV2 symptoms and my everyday life you would make my life and existence even harder.

Turning up for work

Every day in Infection Prevention and Control (IPC) we make calls linked to new staff positives so we can make risk assessments linked to patient or staff exposures. Every day we get people who find that they have been at work whilst symptomatic and every day we sigh and roll our eyes, even I do it. We top up on caffeine and wonder why it is so hard for people to recognise when they have the below symptoms and why they don’t just stay off work if the answer to any of the below is yes:

Imagine what it’s like therefore to work and be implementing guidance linked to this knowing that if you obeyed the letter of the law I would effectively be taking PCR tests every 3 days on top of daily lateral flows just to navigate getting to work. I of all people should not therefore roll my eyes but should demonstrate some compassion. If its is hard for them then I need to demonstrate both compassion to them and to myself by recognise how challenging this is. Symptom based detection has become especially an issue during Omicron with the very generic symptom list, people have pretty mild symptoms at the start and they are no where near as identifiable as the alpha symptoms. It’s much harder therefore, especially in winter respiratory season, for people to clock that they have symptoms they need to act on.

People put a lot of emphasis on presenteeism being an issue in the NHS and that that is the reason why people are attending. I think that’s true, everyone feels the pressure to be available right now. In some ways being able to work remotely and therefore being ‘always on’ has made this even harder. I also think it’s not just that. Everyone I know at work is physically broken in some way or other after 2 years of this, even if they don’t have an underlying condition. Therefore it is just harder to know when feeling physical symptoms are linked to just being a heathcare professional during a pandemic or because this is something different.

I’ve been working in Infection Prevention and Control for 18 years now and I can say that the last 2 years have been incredibly challenging. That’s not to say it hasn’t been hard for everyone. For me it’s been 2 years of constant change, long hours and weekends, challenging conversations and continuous decision making. I know IPC colleagues who haven’t had a day off in 2 years. That’s just isn’t sustainable even if you don’t have something already going on, for people like me who have conditions exacerbated by tiredness and stress the miracle would probably have been if I didn’t feel this way. I for one am so far away from ‘a two week holiday will make this better’ that it’s sometimes hard to imagine ever feeling like me again. Yet we turn up, because that is what is needed of us and that is what we require of ourselves. Let’s just acknowledge that it’s more complicated than any of us are talking about in the context of symptom based diagnostics.

Its unpredictable and so I can’t work from a baseline

If you are a healthcare worker exposed to SARS CoV2 in the community or in your household the rules are different to those if you are not. Working in healthcare if I am exposed I need to get a negative PCR test before I return and lateral flow test every day for 10 days. I then need to submit a declaration daily that I am still symptom free and upload my lateral flow test result prior to attending to work. Whilst at work I need to take all my breaks alone so that I don’t risk exposing my colleagues and I can’t take off my mask around others (I obviously would never take my mask off around patients at any point – for their protection and for my own). Again, this seems really straight forward and super sensible. It is, I’ve done a lot of work with implementation on this and it’s a sensible system that prevents chains of transmission and ensure safety. It’s also really hard for people like me. I’m not in a position to be able to declare symptom free and therefore I’m not in a position where I can be granted an exemption. That means that if I’m exposed I have to work from home. Although it is theoretically possible for me to do this for chunks of time it leaves my colleagues unsupported and therefore I don’t feel like it’s something I can risk. I therefore have spent most of the last 2 years as a hermit, not just to protect myself, but because I don’t want to place additional strain on an already stretched system because I decided to have a life. If I was in a position where I could say what my baseline symptoms are and could therefore detect a change it might be different, but I can’t, every day is different and so there is a constant choice about how much life I live and how much exposure I can risk.

One of my colleagues this week asked me why I don’t just remove the COVID tracker app. I said it’s for a couple of reasons:

  • I think that we have a responsibility to walk the walk, it is the safe and responsible thing to do in terms of public health and how can I expect others to do it when I’m not prepared to do it myself
  • I keep it precisely because I can’t easily detect if I have symptoms, when I get alerted I switch from screening every other day to daily in order to manage the increased risk. This means that there will be a shorter period of me putting others at risk if I do become positive. I also ensure I take a PCR test, which I don’t do routinely as symptom based triggers don’t work for me
  • I’m theoretically at higher risk if I do get sick, even though I’ve been vaccinated, the earlier I know the sooner I can try to ensure I manage my safety and the risk to my household

What will happen if I do get sick?

I was ventilated for acute viral respiratory illness as a child, I’ve done the waking up in intensive care as I posted about before. I have some lung damage which means that I get respiratory symptoms and chest infections easily. These also make auto immune condition worse and so all in all I’m not looking forward to my (inevitable) COVID-19 experience. I’ve spent the pandemic working myself into near exhaustion and there is always that part of my mind that worries about what would happen when my number comes up. I’ve been extremely fortunate to not have caught SARS CoV2 so far and I feel better about my risk now having been triple vaccinated. I also know that I don’t mount a good vaccine response and that 2021 was the first year I was so worn down that I got shingles, which probably doesn’t reflect that I’m in a massively good place immunologically.

At work my health is a bit of a running joke as I’m always symptomatic. When people hear me hacking it’s a running gag that people can always hear me coming and my standard response of ‘having functioning lungs is over rated’ is probably well known. I don’t really know if my fear ever really lands with others as I try to ignore it, but it’s definitely there. I also worry that I wouldn’t be able to step away from work and would therefore make it worse. I never give myself the time to be ill because in my head ‘I’m the sick girl’ and therefore I feel I always have to drive myself harder and prove myself more. This is definitely a ‘me’ thing and fighting through when I should stop is how I’ve managed to get where I am instead of spending my life on the sofa under a duvet, but not knowing when and how to stop is something that means I break myself further when all I needed to do was rest. We work in an NHS that drives these bad traits, between the Bradford Score that determines whether I can be sick and the 600 emails a day, stepping away feels nigh on impossible.

Not just about me

I have the best family, we have each others backs, but we have suffered some real loss and a lot of it is based around our collective health. When I talk about how health privilege and comments linked to symptoms not being simple, it’s not just I’m a healthcare worker. My husband and brother both have ulcerative colitis (their own auto immune conditions) and my mum has similar infection issues to me. We are just one family and there must be thousands like us. We have avoided getting COVID-19 by stopping our lives and relying on public health measures to protect us. With the government moving away from stopping that protection we feel more at risk than ever. Even if symptom based diagnosis worked how many people would adhere to them? I’m lucky, for all that I’ve talked about I have a job with sick pay, I’m not on zero hour contracts where if I don’t work I don’t pay my bills. There are huge groups within our society who will feel true pressure to attend work and leave the house if we change away from diagnostics and isolation supported by sick pay, even more than they already are. That pressure then moves risk onto people like my family who are potentially being condemned to continue to have restrictions on their every day life long term. There are no easy answers to this, as I said in my IPC post someone always has to pay, but as healthcare professionals please lets stop claiming that this is straight forward.

So I will do a better job of managing my condition, I will try and not work weekends, I will leave on time and try to get some sleep. In return if you could try to remember that none of this stuff is ‘simple’ or ‘easy’ and that it only feels that way to if you are fortunate enough to not realise that feeling ‘well’ is a privilege that not all of us are fortunate enough to enjoy.

All opinions on this blog are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues on projects nominated for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

So how our male colleagues can help? This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

I’ve been asked to write a number of blog posts this year for International Day of Women and Girls in Science. I wanted to write an extra one that wasn’t so much a career guidance document, but more to celebrate some of the great approaches I have seen as a woman working in science. This post is based around some of the points that came out of a twitter conversation last week.

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues to nominate work for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

Some of the comments on my twitter feed were about how our male colleagues can help. This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

50 Shades of Grey: The realities of working in Infection Prevention and Control

It’s another early start in the world of Infection Prevention and Control (IPC) following on from another rather restless night. The thing that has been playing on my mind a lot lately is the perception of vs the reality of IPC, and medicine in general.

Some of this has been sparked by seeing the discussion, opinions and commentary by medical colleagues on twitter linked to IPC response. I’ve been trying to read them as a member of the public would on this public forum. The thing that strikes me more than anything is that it is no wonder people are confused, we all post from a position of absolutes, often from very contrary stand points. What we do very poorly is communicate the nuance, discuss the technicalities and travel any middle ground. Possibly because its so hard in 240 characters, but also I think because we work with an implicit understanding that we know that nuance exists. On the face of it these conversations therefore come off as black and white positions, when in actuality IPC is very much 50 shades of grey, where there is accuracy in many of the positions in between.

So why is IPC not clear cut? Why might you get a different set if rules and experiences from one Trust to another or even one phone call to another? Well the fundamental tool of IPC is risk assessment. Every scenario includes slightly different exposures, different organisms and different patients, all of which will impact on that risk assessment. Just as no two scenarios are ever really the same therefore, no two risk assessments look identical. This also leads to disagreements on things like social media, as the experience, setting and drivers of those commenting are also just as varied.

What Do I Mean When I Talk About Risk Assessment?

Risk assessment is the process we go through to identify what risks are present to patients, and from patients to staff, visitors and carers. It also includes the things we do to control those risks, things called control measures. I want to start out by saying that I believe we are all aiming for the same goal i.e. providing safe high quality clinical care. Like many things there are often multiple options to deliver this goal and individuals may use slightly different processes in order to achieve it. The below is an example of the way that I structure my thinking.

There are 2 main aspects to risk assessment:

  • For the patient – if an organism is detected in a site on a patient what risk does that pose i.e. an E. coli urinary tract infection if not managed well in certain patients is a risk of progressing to E. coli blood stream infection
  • For other patients, staff and families – what does the detection of an organism mean for others, what counts as an exposure, what would the clinical consequences of acquisition mean for those exposed?

At some point I’ll do a fuller post on risk assessment in IPC and what different options there are for creating your risk assessment tool, but for now these are the kinds of things I consider when putting together risk assessments:

  • Routes of transmission – how do infections spread? Water/Surfaces/Contact/Air
  • Patient loads – when someone has an organism how much do they have, viruses usually higher numbers than bacteria
  • Environmental persistence – how long can an organism survive in water/air/on surfaces
  • Infectious dose – how many copies of an organism does it take to give an infection
  • Colonised/infectious state – can I carry an organism without harm or does it always make me unwell MRSA vs measles for instance
  • Patient susceptibility – is the patient immune i.e. vaccination/prior infection, are they more at risk if they get infected because they have no immune system?
  • Timing of infection (community vs hospital acquired)
  • Endogenous vs exogenous – is the infection spread from one site to another in the same patient i.e. from nose where doing no harm to a surgical wound? Or has the patient got it from outside?
  • Surveillance programmes in place – what kind of searching for organisms is being undertaken i.e. within the environment/based on symptoms, or as part of routine regular testing

When I’m talking about risk assessment for the rest of this blog I’m also going to be including what we call control measures which are linked to that risk assessment. These are things you do to prevent or reduce risk i.e. wearing personal protective equipment, putting patients isolation, prophylaxis etc.

I think we need to acknowledge that as well as different information, there is also an impact from the person handling that information and making the risk assessment. As a Healthcare Scientist I tend to feel much more comfortable focussing on the organism aspects and on control measures such as ventilation. Some of my colleagues will feel more comfortable in other aspects, especially in terms of scenarios such as surgical site infections and dressing management for instance. We all cover the same ground and should have the same core fundamentals, but we should acknowledge that different people will handle information in slightly different ways. This can be a strength, as long as it’s acknowledged.

So Why Do Risk Assessments Change?

As you can see from above, risk assessments are anything but straight forward. They include a lot of information, some of which you won’t always have at the start. There are some scenarios where we have quite a lot of information where responses are pretty much standardised and you would think everyone would do very similar things i.e. detection of MRSA in a surgical patient. Even for something like this that happens often and we have quite a lot of good information about what the risks and the control actions might be, there isn’t a one size fits all approach. In paediatrics we manage these patients differently to how they might be treated when they become adults. This is because their risk of continuing to carry MRSA as they interact more with people and the environment means that trying to remove it with antibiotics and chemicals (decolonisation) may be less effective and they may also have delicate skin which means using these chemicals may cause skin problems. So even in a straight forward situation, setting and scenario matters.

We often get asked why the way we manage something in my hospital may look different to how it might get managed somewhere else, even at another children’s hospital. This can be for a number of reasons. I may have access to resources in terms of cubicles or diagnostics that enable me the option of managing a scenario differently. My Trust is in England and the guidance in other parts of the devolved nations may be different i.e. Scotland and England don’t always do things the same way. Finally, my Trust also looks after children who have complicated conditions and who may have little to no immune system, so the consequences for patients if I get it wrong may be higher than somewhere seeing other types of patients. Setting, not just organism matters.

The other thing is bear in mind is that information and settings are not static. Often in medical dramas something is either X or Y, all of the information comes at the same time. This isn’t how things work in real life, information comes in pieces and the decisions you make about the next question you ask are actually as important as how you manage actions based on the data already in your possession. In some ways House was right…….it could be Lupus.

Although I don’t want this post to be about SARS CoV2, it is a good example of the fact the more information you have the more your decisions might change and you know more about where your risks are. Omicron has led to different risk being recognised when compared to Delta, because of impacts such as staff shortages, but also because of the amount of it that is currently circulating. This has impacted testing decisions and risk vs benefit discussions linked to patient harm. This is particularly challenging as these judgements about risk are actually being made with incomplete data sets as we don’t have the luxury of waiting it out. This makes at least this IPC professional uncomfortable, as lets be honest you are unlikely to love IPC if you aren’t in someway risk averse as a personality type. You don’t always have the luxury of time however and therefore we need to act, do the best we can with the information we have and make sure we also capture the learning as we go to enable improved decisions next time.

Who Pays?

So, resource matters. Everything about IPC comes with a cost. The thing is not all of those costs are financial.

Some examples of when even interventions, like putting patients in isolation can be challenging or have adverse consequences for everyone involved:

  • Its hard to know once you put someone into isolation when the right time is to take them out
  • Putting patients into isolation has been linked with decreases in staff time, increase in perceived concerns over care, and increase in prescribing errors
  • In paediatric patients isolation can affect inpatient developmental milestones. 
  • In adults isolation has been linked to increased levels of anxiety and depression 
  • Isolation can negatively impact on staff caring for patients due to isolation from colleagues and strain of dealing with sick patients single handed

Risk assessments therefore are influenced by who bears the cost. Individuals often pay the price of keeping others safe. This is a social contract that we see playing out on a much larger scale during the pandemic. Other methods to impact risk assessments, such as installation of mechanical ventilation, have a high financial cost that not all centres are able to afford. It is naïve therefore to say that any of these choices are easy, someone somewhere always bears the cost and the impacts of decisions.

After all of the above what is it that I want you take away?

  • Firstly IPC is anything but easy or straight forward, no matter what some of the reporting or social media commentary makes it appear. Decisions are complicated and every single one comes with impacts, be it for patients or budgets.
  • Secondly, the right decision for one centre may not therefore be the right decision for another. Comparison between one centre or one set of scenarios and another are not always valid, as the needs of the patient population or risks involved are unlikely to be identical.
  • Lastly, risk assessments change, they change as scenarios change, they change as more information becomes available. This isn’t a failing, this is responding to evolving situations and although difficult this is a strength

IPC is not black and white, it is 50 shades of grey and dealing with this is both the strength of the amazing people working in this field and the daily challenge they face, embrace and respond to!

All opinions on this blog are my own

Time for Some Real Talk: I have the best job in the world & even I don’t know how much more I can take

Let me start with the positive and please bear this is mind as you read this post. I adore my job, I can’t imagine doing anything else. In a way that is probably a little unhealthy, it is a lot of what defines me. I found my place and my calling and I’m not going anywhere. That said the last 2 years have been filled with extremely long days and unpaid weekends leading me to be more exhausted and broken than either a PhD or FRCPath exams achieved, partly because for both of those you knew when it would end. So I want to shine a light on how I feel in order for others to feel less alone if they are feeling the same way, and to remind us all that, despite how it feels right now, it has not always been like this and that this too shall pass.

Last night in a press conference our Prime Minster uttered the words ‘extraordinary effort’. It wasn’t in praise, it was a request for all of us in healthcare to make one more effort, to step up to the plate yet again and give it our all for the sake of the country. The thing is, phrasing a request like this doesn’t feel like a call to action to me anymore, it feels more like an insult. Although I acknowledge people’s experiences of the pandemic have been vastly variable, for most healthcare workers we’ve been making an ‘extraordinary effort’ for almost 2 years. Two years of changing guidance, 2 years of practically no down time and in recent times, experiencing both abuse and bad temper, alongside belittling of the things we are doing to find a way out of this i.e. requests to wear masks and to get vaccinated.

Given it is undoubtedly hard right now what can we do to get each other through this (other than make press conference statements – yes I may be a little bitter). This post isn’t based on evidence, I’m just going to talk here from personal experience. I know this is what I tell others off for as anecdotes aren’t facts. However as this is about feelings I can only truly tell it from my perspective.

Acknowledge all burdens are not equal and any single solution won’t fix everything

As a lot of people have pointed out, we may be in the same storm but we are all in very different boats, our experience and well as stressors throughout this aren’t the same. As leaders, colleagues and friends it therefore crucial that we take time to understand the things that are adding to stress levels and impacting our colleagues. For instance, because of my health it is easier for me if I can work from home a couple of days a week. It saves me a 3 hour return commute and gives me space to mentally focus on tasks without interruption. For someone else however, they might find working from home in itself a stressor, they may wish to have distinct work and home separation, they may have a lack of space or family reasons why this makes it harder for them not easier. We need to work on how to check in with our colleagues about what it is that they find difficult and then, where possible, customise our approaches to support them. It takes longer and requires more resource, but if we’re serious about helping each other through this than that is what it is going to take. I believe we should be finding equity rather than equality in our solutions, although fairness is important:

  • Equality is providing the same level of opportunity and assistance to all
  • Equity is providing various levels of support and assistance depending on specific needs

A little respect goes a long way

At times of stress and challenge it is really easy to close down in terms of empathy and compassion. I hold up my hands to raising my voice in a meeting last week. I did immediately apologise, but it is really difficult with the cognitive and emotional load everyone is experiencing, coupled with me being so tired to always remember to think of others. Every little moment like that if not addressed chips away at the others in the room and adds an unnecessary additional burden. At the moment, in those moments where we may not feel like it, it is even more important enough to be kind to each other.

Whether you are in a formal or informal leadership position, it is also really important right now to acknowledge the work of those around you. It’s easy to have tunnel vision and revert to task thinking when we are all so overwhelmed but people are doing A LOT based on good will. If we want people to go above and beyond then we need to acknowledge it and respect the fact that it is not a given that it will always happen. Saying thank you is still a powerful tool.

The system isn’t set up to support us so lets change it

Two years into the pandemic the system is still not set up to support the work demands that are being placed on the workforce. I have colleagues who have not had a full day off in two years. I do weekends on-call without any acknowledgement in terms of pay or returned time. From conversations I’ve had most IPC teams do not have systems in place to support on-call working, despite the fact that we have just about all had to do it over the last 2 years. We’ve all been doing this because we focus on the needs of the patient and the service, but at some point the service and the system that it sits within needs to be fixed. Services shouldn’t constantly rely on good will and changes need to me made so the system is empowered to support those who work within it. When emergencies and major incidents first happen it takes a while for the infrastructure and the system as a whole to respond, at this point however we need to be looking to the future and working to fix the system we work within. This won’t be the last time we have to face these kind of challenges, although hopefully not over such a protracted period, lets learn the lessons and get measures in place to make it better for everyone moving forward.

The workforce issues are going to get worse before they get better

As I said, I’m not going anywhere, but it would be naïve to say that this is the wider attitude amongst healthcare workers. A number of my colleagues who could retire have done so, more have moved either into non operational roles or out of healthcare all together. I don’t feel we have reached the peak of this yet. I think a lot of people will stay until they feel this aspect is over and then make decisions about what is best for them moving forward, burn out is a real thing right now. This will place even more pressure on those of us who remain. Its takes ~11 years to train a me, there aren’t a lot of people waiting in the wings to swoop in and support. My guess is also that a fair amount of trainees will be included in the numbers who are considering alternative choices. Those of us who remain need to know what the plan is? How are the exhausted workforce who remain going to be supported so they don’t have to then do the work of the 2 people who have left as well as their own? Are we, as we all predict, going to be hit my massive catch up targets when the pandemic is finally over which means there will be no respite to support recovery. The focus of the system seems to (understandably) be on right now but to give people hope for the future we need to know that there is a plan on how we will make it through not just today, but tomorrow and next year.

This isn’t a war, no matter how much our politicians language make it sound like it is

A lot of the language people have utilised linked to the pandemic has very deliberately utilised language reflective of going to war. In some ways this creates a nice psychological short cut in terms of significance and in peoples minds. The problem with it is that most healthcare professionals didn’t enlist to be part of a war, they are not obligated to stay and fight it out. The support systems are not part of the existing infrastructure to enable them to deal with the stress and emotional load we have put upon them. Most of them have given extra hours and supported extra job roles as part of good will, a gift if you like from them to wider society. However, like all gifts these can and should not be taken for granted, they are under no obligation to just keep on giving. We have moved from an emergency situation to a state of life, as much as we don’t want to acknowledge it. It’s a state of life that will not last forever but we cannot expect people to continuously act like they are in emergency response anymore. Plans and language aimed at healthcare workers need to acknowledge this otherwise we are not recognising the reality of most of their lives.

Wellness programmes are not going to fix this

I’ve already come out as not being the biggest fan of wellness programmes, although I know what they are trying to achieve. I’ve talked before about the fact that I think the NHS system has to address the issues and not continuously put the responsibility on individuals to fix. That said I don’t think the system is going to ‘White Knight’ for me anytime soon. I have come up with a strategy for me that means when I reach the point that all I want to do is walk out or walk away I have a bathroom disco. For those of you who don’t know I have a converted bathroom cubicle as my office, hence bathroom disco. I frequently fail to make time for food or even a couple of tea, back in the day I used to have a walk around the block or settle down for a cup of tea, I drink my tea black it takes 20 minutes to cool, when things became too much. There’s no time for any of that right now. When it becomes overwhelming I’ve decided I will allow myself a ~3minute bathroom disco break. I lock the door, put on an energising track and dance like a loon. It not only brings me joy but stops me spiralling and wakes me up enough to re-set myself for the challenge ahead. If we have going to survive this we all need to find a bathroom disco equivalent to get us through the next 5 minutes some days, let alone the next 5 months.

So there it is. I’m going to put on my big girl pants and prepare again for my ‘extraordinary effort’. Those making these requests however should remember that I am so fortunate to know that I will eventually get back to a job I love. Others were not so fortunate prior to this and so they are right now making different choices in response to your plea. Lets follow our words with actions that also enable them to stay!

All opinions on this blog are my own

Absence Makes the Heart Grow Fonder?: My month spent with shingles and the Varicella Zoster virus

Well my friends, it’s been an age. I think I have a reasonable excuse but I am sorry to have left everyone in the lurch by not being well enough to post. I’ve been laid up with Shingles. It was the first time I’ve had it, although as many as 1/3 of us (who have previously had Chickenpox) might have it at some point in our lives. My father pointed out that this whole event might be karma (I believe he was *mostly* joking) as he had Shingles for the first time earlier this year and I responded as a typical medical child in terms of management, without really acknowledging the pain and discomfort. I’m now 4 weeks in and functioning OK most of the time on pain killers but it has certainly been much more of an experience than I had accounted for when I saw the rash appear. Working in what I do I knew a lot about the Shingles experience on paper. Having now been through it however; I thought I would share not only some Shingles facts but also about the difference between ‘knowing’ and ‘Knowing’, as there are probably lessons to be reminded of for all of us when we see all our patients (or in my case supporting my father).

Shingles, otherwise known as Zoster, is caused by the Varicella Zoster virus or VZV. VZV is also the causative agent of Chickenpox, which is also known as Varicella. VZV looks like a fried egg under electron microscopy (a high powered way of viewing virus) and is part of the human herpes virus family, related to the same viruses that cause cold sores. Chickenpox and Shingles are intrinsically linked, with Varicella being the primary infection and Zoster being the reactivation of the virus.

See the source image
Herpes viruses have a fried egg appearance under electron microscopy

What do these terms actually mean? Well, to ever get Shingles you need to have had Chickenpox at some point in your life, you can’t get Shingles without ever having the other. Once you have been infected with the virus for the first time (primary infection) and develop Chickenpox the virus then goes dormant when you recover in the nervous system (trigeminal and dorsal root ganglia). The virus is held in check (held dormant) and stopped from replicating by the immune system. It is when this immune system fails to hold the virus in check that it begins replicating again (reactivation), leading to the development of Shingles.

Most people is temperate climates i.e. non tropical, tend to get Chickenpox in childhood, but the infection is much more severe if acquired in adulthood. When you get your first infection you are infectious by the respiratory route for 48 hours before the vesicular (pus filled) lesions appear. After this the main infectious route is via contact with the rash itself, although some groups are still an airborne risk. Those exposed to the virus have an incubation period of 8 days (10 till rash appearance) – 21 days, with up to 28 days if prophylactically treated as a contact. Groups such as the immunosuppressed and pregnant woman are at increased risk of complications, such as pneumonia if infected.

See the source image

Shingles presents in a similar way to Chickenpox, but is more localised. In my case I had sore and painful area on my back, which over the course of ~ 5 days spread around to my front, all on my right side. On Friday I went shopping with my mum and when I arrived home at 5pm I was so exhausted all I could do was sleep. I wasn’t feeling great the next day and by the evening the painful area of skin began to be itchy and I noticed a small red patch. I’m super allergic to just about everything under the sun so I assumed it was a local reaction. When i woke the next morning the rash had spread and I had a characteristic set of lesions, which meant I called 111 and got a referral for treatment. The pain then increased alongside the itching and 4 weeks later I am still suffering from radiating pain down my right arm, sensitive and painful skin where the rash has just about healed and tiredness.

How is it diagnosed?

The Shingles rash is fairly characteristic. It appears in a band along something called a dermatome (see image). The dermatome where the lesions are present are linked to the nerve where the virus has reactivated and is replicating, which leads to the virus travelling to the skin and forming lesions. The pictures of the rash below are some of my lesions on day 1 when I presented to the GP. Over the course of several days more lesions appeared and the rash continued to spread, in what we call cropping. It always stays on one side of the body and is highly localised.

Often, as the presentation is fairly clear, diagnosis can be made just by taking a history and examining the rash. Vesicular fluid can also be taken from the lesions themselves by removing the top of the lesion and using a swab to get at the fluid; which is then placed into viral transport medium (VTM) for further processing. Historically this was via tissue culture and visualisation of the virus, but more commonly now is by polymerase chain reaction (or PCR), so looking for the DNA of the virus itself. This is much more sensitive and rapid. These additional tests are usually only undertaken in cases where the presentation is less clear cut i.e. the immunosuppressed or to allow follow up in case of vaccine failure/response.

What is the treatment/management?

I hate going to any form of healthcare, I think I’ve mentioned this before. The fact that I called 111 was therefore a huge thing for me, so why did I? One of the biggest risks linked to Shingles is the risk of post herpetic neuralgia i.e. nerve pain. There has been data collected to show that treatment, in the form of aciclovir, can help reduce the risk of this, but only if commenced within the first 72 hours. A Cochrane Review in 2014 stated that oral aciclovir did not significantly reduce the risk of long term pain but helped in reducing it during the 1st 4 weeks. My rash was so classic that I knew either way that I needed to ensure I started treatment as soon as possible for either outcome to be impacted.

Interestingly when I said to my father that the pain could easily last 6 weeks + I didn’t know why he sounded so horrified, now I do. Although the pain hadn’t properly kicked in at the point where I got treatment, if it hadn’t started to reduce by the point I’m now writing this I wouldn’t have known what to do. One of the main delays in getting any blog out has been the significant pain when using my right arm, and I’ve only just been getting through work. This blog for instance even now has had to be written in small chunks across a day, whereas I would normally have just knocked it out. I am therefore super glad that I started treatment as soon as possible, even though the tablets were ENORMOUS!

How do I stop myself having a recurrence?

There are vaccines available to help prevent Shingles which are aimed at those aged 70 to 79. The vaccines should aid in prevention of shingles for ~5 years and there are 2 shingles vaccines used in the UK:

  • Zostavax, a live vaccine given as 1 dose (similar, but not identical to the Chickenpox vaccine)
  • Shingrix, a non-live vaccine given as 2 doses, 2 months apart (used for those people who can’t have the live vaccine)

I have spoken previously about having poor viral immunity and so it’s been recommended that I should consider having the Shingrix vaccine by my local immunologist; which may be a way forward. The main way to reduce the risk of this happening again however is to learn to take better care of myself so that I don’t get so run down. This is easier said than done, being an Infection Control Doctor during a global pandemic, but I need to make room to sleep and at least eat better when I’m not on service. I always worry that if I stop I may never get going again, but this recent experience has shown me that if I don’t make time for some rest and relaxation by body will take that choice away from me.

Top tips:

  • Beware of whom you come into contact with whilst you have Shingles, non Chickenpox immune people may be at transmission risk
  • Make sure you loosely cover the rash if you can to prevent risk of contact transmission to others
  • If you have a rash develop on your face ensure that you see medical support
  • If you suspect you have Shingles make sure you get it reviewed within 72 hours to support management
  • If eligible for the vaccine make sure you get it to reduce your risk of developing Shingles in the first place
  • The pain is substantial and if you are a daughter, probably don’t minimise it’s impact to your father 🙂

Anyway, I’m back, even if not 100% and I’m so glad to be posting again. I may just need to take it a little slower for a while. If you are on the edge of exhaustion, learn the lesson I did not and take some time for you, you owe it to yourself!

All opinions in this blog are my own.

Celebrating National Pathology Week: What is a clinical microbiologist?

To celebrate this week being National Pathology Week , I thought I should take some time to post about what a clinical microbiologist is. I do this because, when I was at university, I really didn’t know that this career path existed. So here is a shout out to all those students who are trying to decide their next steps. You too will find your way.

When I googled microbiologist this is the first item that comes up

Microbiologists study microorganisms (microbes) in order to understand how they affect our lives and how we can exploit them

Prospects.ac.uk

This seems like a pretty good cover-all description. It goes on to discuss that there are microbiologists in many different areas:

  • medicine.
  • healthcare (I’m not sure how they differentiate this from medicine or visa versa).
  • research.
  • agriculture and food safety.
  • environment and climate change.

I must admit that when I was at university most of the options I encountered were linked to the food and drink industry or pure research. I think that their list missed things like Pharmaceuticals (although they may count that as medicine) and other forms of production, i.e. cosmetics.

At university I only did one module of microbiology (I was reading Zoology) and that module was about environmental bacteria and plating out bacteria onto agar plates to see what grew.

How did I go from Zoology to Microbiology?

I really wanted to work in an area of science where I could work to make a difference. I wanted to work somewhere that I could see that difference being made. Working in research felt too abstract to me. When I discovered, through a friend, that I could become a scientist in healthcare I knew it was what I wanted to be.

The National Careers service says you need to have two to three A-levels to become a microbiologist, plus a post-graduate degree. That is mostly true. However, in a world of apprenticeships and T-Levels, that is no longer the only route.

When I became a Healthcare Scientist I became a Clinical Microbiology trainee. So, what was the difference between that and what I’d done at University? The main difference with clinical microbiology is that I focus on organisms that cause infection: parasites, viruses, fungi and bacteria.

I also discovered that there was so much more to microbiology than agar plates. Although – don’t get me wrong – agar plates are still a mainstay of life within the bacteriology laboratory.

One of the techniques I learnt to love was polymerase chain reaction (PCR), which enables us to look for the DNA or RNA of a microorganism instead of growing it. Viruses and parasites don’t grow on agar plates and bacteria and fungi may not grow well if exposed to antibiotics or if present in low levels. PCR allows us to diagnose patients with infections that would not be diagnosed otherwise, or to speed up the process so patients get put on the right treatment faster.

Variable number tandem repeat typing of Klebsiella pneumoniae

PCR also enables us to do things that are harder to do using traditional bacterial techniques such as culture. The picture is of patterns that are like bacterial fingerprints so that they can be clustered into similar groups. This enables me, as a clinical microbiologist, to tell whether bacteria within the same species are the same or not. This is important when deciding whether a bacteria has spread from one patient to another. It helps in acting like a hospital detective, which is a lot of my work in Infection Prevention and Control.

As a trainee I spent four years rotating within laboratory settings. I spent one year in a molecular laboratory, diagnosing patients using PCR. I then spent six months rotating between benches (each sample type has its own laboratory bench) in bacteriology: wounds, respiratory samples, faecal samples, blood cultures, urines, fluids (cerebral spinal fluid etc.) and the primary bench where samples were put onto agar plates. Six months in virology, a year in research and time in food and water, parasitology and mycology (fungal) labs.

The diagnostic process is pretty similar in principle between the specialisms:

  • collect specimen from possible site of infection.
  • select the most appropriate test to detect any organisms (agar plate for bacteria, PCR primers for viruses, etc.)
  • evaluate whether the result (positive or negative) is accurate and whether there are other tests that should be done, i.e. further characterisation of positives such as antimicrobial sensitivity.
  • decide on treatment or management of the infectious cause, i.e. antimicrobials or non-antibiotic management such as surgery.
  • advise on infection control if actions are needed to investigate where the infection came from or to protect others from risk.

During my first four years I spent most of my time in the laboratory doing the first three bullet points.

Time goes on. I’ve been in the NHS for 17 years. Most of my time is spent at my desk in the on-call bathroom. Since 2010, most of my time has been spent either in Infection Prevention and Control undertaking the final bullet point or increasing my skills by gaining Fellowship of the Royal College of Pathologists to do bullet point four.

I still support the lab and, occasionally, get my lab coat on – but not as much as I’d like. It is, therefore, possible to be a clinical microbiologist and be anywhere on the spectrum. You can go as far as you’d like and do the type of work that makes you happy. It’s why being a clinical microbiologist is a great career!

Modernising Scientific Careers Framework

All opinions on this blog are my own

Laboratory Testing for SARS CoV2 (COVID-19): Is all testing the same and why should I care?

Why Am I Posting This Now?

In light of the news that came out yesterday linked to the withdrawal of the testing service in Wolverhampton, I think that this post from April still has relevance so I have decided to re-post.

Every tube is a person

This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.

BBC iPlayer – Panorama – Undercover: Inside the Covid Testing Lab

Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.

This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme

Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.

How Did We Get Here and How Does the Testing System Work?

When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).

The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.

English Government Testing

Tests in the UK are carried out through a number of different routes:

  • pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
  • pillar 2: swab testing for the wider population, as set out in government guidance.
  • pillar 3: serology testing to show if people have antibodies from having had COVID-19.
  • pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The 5 pillars of testing shown as a building

The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:

  • Accuracy and reliability of tests.
  • Getting the right supply of people, lab space, equipment and chemicals.
  • Logistics.

What Points Did the Panorama Programme Make?

The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.

The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).

The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.

Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:

Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:

  • establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
  • defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
  • specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
  • sustains high-quality employee performance.

In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.

The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?

Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?

It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.

Staffing and Training

Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.

Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.

This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.

Quality Monitoring

In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?

Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.

All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.

To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.

So Where Does that Leave Us?

Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.

These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.

As stated in the programme:
‘If we’d spent the money supporting the existing system we would have been better off’

That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!

As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.

All opinions in this blog are my own.

Embarking on My 17th Year as a Healthcare Scientist: What have I learnt?

When I applied to become a Clinical Scientist (the term Healthcare Scientist didn’t exist then) in 2004 I have to admit I didn’t even know what one was. This lack of awareness that such a wonderful position existed has been a real driver for me ad became an ongoing passion to raise the profile of this, all too often invisible work force, that impacts across patient pathways and is so key to patient outcomes. If the great future scientists out there don’t know that they can join us, they never will.

Life has changed a lot since I walked in on my first day with very little idea how to pipette, what Staphylococcus aureus was, or how to spell Erythromycin. I (mostly) know what I’m talking about now, I’ve got married, brought a house, got a PhD, passed FRCPath and been awarded a New Years Honour. Importantly for me I found my passion, I know my why and I’m privileged to work with amazing people doing the best job on the planet.

My NHS career turned 17 on the 4th October 2021 and so is old enough to learn to drive. In continuing this metaphor I thought I’d write about the journey so far and what I’ve learnt.

Things to know as you start out on your journey

Have a plan

Your plan will change and evolve over time but if you want to make the most of the opportunities presented to you it’s worth having an idea of what boxes you need to tick in order to get to various fixed points along the way. Do you ultimately want a consultant post? You’ll need FRCPath, what will you need to be able to get there? Do you want to be a lab manager? You’ll need some leadership, recruitment and management experience, what opportunities can you access to help you?

Having a plan doesn’t mean you should feel boxed in and trapped by these ideas, but you can use them to help you prioritise chances that are presented to you. Not only that but can use it to ground yourself when everything feels a little overwhelming. You can also use this awareness to find champions and coaches/mentors that will help support you along the way. Invest a little time early on to make the most of your time later.

It’s OK to re-plan your route

Opportunities will come about and open up that you can’t predict when you start out. The term Healthcare Scientist didn’t exist when I joined the NHS, therefore there certainly weren’t any lead Healthcare Scientists. Getting a PhD wasn’t part of my plan, as when I joined there wasn’t a clear route through to being a Consultant, and so I didn’t know that I needed one. The National Institute of Health Research (NIHR) has been a massive part of my scientific career, enabling me to have a role as a Clinical Academic, but they didn’t even exist until 3 years+ into my career.

So have a plan, but don’t be so tied to it and so linear that you miss out on things that will change your life and career. Having the right people as part of your networks can help you realise when you need to take a leap of faith into one of these alternate routes is key.

Sometimes you may take a wrong turn, the extra journey will not be wasted

There will be times during your career when things don’t go to plan. Road blocks will spring up, paths that seemed clear will be obscured, and to be frank sometimes the car will just break down. The thing to bear in mind at these points is that none of this time is wasted as long as you learn from the experiences being offered to you. Sometimes these experiences are not particularly pleasant whilst you are going through them. I would be lying to you if I said there wouldn’t be challenges along the way. You will however emerge stronger and more knowledgeable from them, as long as you see them for what they are, learning opportunities. So deep breaths, make that cup of tea and know that this is still an important part of your journey.

For those of you mid-trip here are some things I learnt somewhere post registration

Remember you are part of a system at every level and take the time to understand how it works

It was only when I started on my leadership journey as part of the GOSH Gateway to Leadership programme, that I really began to appreciate the importance of systems. As a trainee I was very focussed on my department, with a few links to my professional community at a national level, via the Association of Clinical Biochemists and Laboratory Medicine. It was only when I was on this cross disciplinary programme that I met people who were outside of my silo that I began to understand what the drivers for other peoples behaviour might be.

Now I spend a lot of time in national strategic committees and working with different professional backgrounds and it has enriched not only my practice, but also enabled me to work towards impact on a level I could never achieve as an individual. If you really want to be a driver for change then understanding the landscape within which you are working and making those changes will only make you more successful.

Influence is not about seniority

For a long time when I was starting out I believed that titles and seniority were key to influencing others and therefore supporting change and improvements. It took a while for me to learn about the difference between formal authority and informal authority. Informal authority is actually really key in order to win people over and get engagement with proposals. It’s built up over time, requires work and effort to maintain and is based on your credibility. Formal authority is given to you in the form of job title and role. You can make huge impact where ever you are RIGHT NOW, you don’t need to wait to be given authority. Put in some time and develop the informal authority to enable you to make things happen.

Don’t compete with anyone but yourself, your journey is your own

The world of Healthcare Science is a small one, it can feel like everyone is trying for the same end points and therefore is competing over the same limited opportunities. In my opinion this isn’t actually the truth. It feels like it, but it isn’t. When you speak to people, very rarely do they want the exact same thing as you. This competitive drive can mean that as a community we don’t support each other enough. Once you realise that others are not really competition, it dawns on you that your only competition is actually yourself. You can tick the boxes you need to tick with principles and grace, these don’t require anyone to lose out. Also, if we do these things as a community together we also often achieve more. If we form FRCPath study groups to help us pass then we are not losing out on consultant posts, as more people have FRCPath, we are increasing our chances of succeeding together. There will be enough consultant posts as we are not all looking for the same things in a job, the ideal post for one person will not be the same for another. Don’t spend too much time focussed on what others are doing and achieving, keep an eye on your road map.

We rise by lifting others

Part of succeeding as a community is to really function as a community. Twitter and #IBMSChat are great examples of this, sharing opportunities, knowledge and experiences for the good of everyone. No matter where you are with your journey there will be people behind you who you can sign post and offer support to. This is part of the reason I believe outreach and public engagement is so important, we need to support people at all parts of their pathway.

The other thing is, that it is crucial that as your formal authority increases you consciously make the decision to send the elevator back down, or ride share where you can. As leaders we are obliged (in my opinion) to amplify the voices of those who may not otherwise be heard. If you are lucky enough to have a voice then you need to use it, not just for yourself, but for everyone that either doesn’t have one or holds one that is unheard or ignored.

You will never be liked by everyone, and that’s ok

Amplifying the voice of others or being a driver for change, frequently does not increase your popularity. I’ve always been a people pleaser, I want people to like me, I want positive feedback, I want positive reinforcement. Sadly I have discovered that not everyone is going to like me. I am not going to be everyones favourite person. Being someone who likes change and disrupts the status quo will lead to benefits, but will also make people feel uncomfortable and that will sometimes drive challenging behaviour. Sometimes clinically it’s also my job to hold the line, to deliver bad news, to not be the popular one. Not everyone is going to like me, but I’ve discovered that it is rarely personal. It’s mostly about the response to the role or the situation and some key learning for me has been learning to separate these from who I am, in order to not take it personally.

What to do when you hit your original destination

Know your why, why are you doing this? What are you passionate about? Where are you going?

When you reach your planned destination, there’s only one thing to do and that’s plan for the next stop along the way. It’s really important therefore to check in with yourself and know your why? Why did you pick this original target and how are you now going to build upon all of the hard work that has got you to this point? What is your driving purpose and how are you going to stay true to that in the next phase of your career?

It’s worth doing some of this thinking as you approach your destination so that you can be ready once you’ve re-stocked on drinks, snacks and mix tapes/downloaded Spotify playlists to hit the road again.

Sit back, smell the roses and take time to celebrate

Finally, to complete the metaphor. It’s important to look in the back mirror every now and again to assess just how far you’ve come. Celebrating can feel indulgent and like boasting, in fact it’s the opposite. It’s inspiring to those that are following behind you and is important to show to others that they to can achieve. People can’t be what they can’t see and so by talking about the journey you will enable others to make informed choices about their own. On long journeys it can feel like you still have miles to go but by looking back you can see how far you’ve come and put it into some kind of context.

I’ve been listening to Hamilton a lot lately and these words have a particular resonance for me. Whatever your journey, it is yours and no one elses, therefore it will come together at the time that is right for you. So celebrate the moments, large and small, after all the journey is most of the fun.

I am the one thing in life I can control
(Wait for it, wait for it, wait for it, wait for it)
I am inimitable
I am an original

I’m not falling behind or running late
(Wait for it, wait for it, wait for it, wait for it)
I’m not standing still
I am lying in wait (Wait, wait, wait)

Wait For It – Hamilton

All opinions on this blog are my own

Keeping Things in Perspective: My attempt at seeing the glass as half full with a list of pandemic positives

It’s been a long 18+ months in the world of Healthcare Science and Infection Prevention and Control. I’ve posted quite a lot about the pandemic here and how hard it’s been, especially coming into winter and the challenges that will bring. Challenges now acknowledged, it’s a Friday night, I have music playing and so I also wanted to reflect on what the pandemic has brought us that isn’t all negative.

Raised the profile of my profession

For many years I have had to try to explain what my job involved to the public, explain what polymerase chain reaction (PCR), and I’ve frequently been met with slightly glazed expressions. This is no ones fault, it’s just that those terms haven’t really meant anything for most peoples day to day life until the last couple of years. Suddenly public interest and awareness in not only testing and infection control, but also in the science behind these processes, has really been increased. Now I can hardly ever get a cab without being asked about how things work and what the current clinical situation is. If we engage well with this interest and awareness we will be able to have conversations about science and its impact on individuals and society for years to come, in a way we haven’t been able to before.

We’ve been invited into the room

Despite my love for my subject, microbiology has never been a sexy discipline. It’s never a topic that gets you into many strategic meetings where key decisions are being made, pathology as a whole is often left out in the cold when big decisions happen. Suddenly pathology, and microbiology in particular, have become a focus for decision makers. Healthcare Scientists as a professional group have often struggled to be invited to meetings, or even know that they were occurring. There has been a definite pivot over the last 18 months, with consideration of the importance of diagnostics in patient management. 80% of patient pathways rely on diagnostic impact at some point, it’s logical therefore that pathways can’t truly be optimised without considering diagnostics. So I for one am happy about the fact that by having a seat at the table we can work together to make this better, not just for SARS CoV2 but across all patient pathways.

The scientific and infrastructure legacy

Implementation of research techniques into clinical settings is always challenging, it requires access to space, finances and expert knowledge. We’ve always been very fortunate in the NHS, in that we have a lot of wonderful scientists who are really well placed to respond to scientific and clinical challenges by not just improving what they have, but by bringing in the latest research approaches. The things we have always struggled with are access to financial support to develop services and space in which to locate the new platforms required. One thing that has really struck me over the last 18 months is that the conversations in this regard have changed. Instead of flat out no, the discussion is about which is the best way forward and how can we make it work. This doesn’t mean that the answer is always yes, but it means that many of us have access to the infrastructure we need to really maximise patient care. The big question for us all now is how we maximise the legacy of that infrastructure to improve across challenges when this particular one is less enormous. This is a great problem to have and we need to ensure we actually spend some time thinking about the answer, rather than drifting into a solution.

Developed networks across boundaries and silos

It’s too easy in times of challenge and stress to react by becoming insular and regressing into known comfortable places, reinforcing silos and boundary based working. One of the things I’m proudest of for my profession and clinical colleagues is that instead of regressing into the known during the pandemic, they have instead reached across divides in order to form networks and learn from each other. This can’t have been easy to manage and yet the impact this has made has been really clear to me. At no time before as a scientist have I have been at a table with so many different professions, all with their own expertise, discussing, listening and learning from each other. I really hope that those networks and relationships that have been forged under such pressure will continue when we move back to a more standard healthcare model, as being part of those discussions has given me real pleasure.

I’ve got to know my colleagues much better

I am fortunate enough to be part of some exceptional teams (research, HCS education, IPC and microbiology). I’m not saying that the pandemic hasn’t on occasions challenged us and relationships within those teams, how can it not. The gift of those challenges has been however that we have come to know and understand each other in a way that would never have occured in a more standard situation. I spend more time with my teams than my family, I’ve known many of them for over 10 years, in many ways they are parts of my family. I’m super grateful therefore for the way we have bonded and deepened those relationships over the last 18 months, and it will only make us stronger to face whatever challenge happens next.

I’ve learnt so much about myself and my preferences/drives

Not only have I learnt more about my colleagues, but I feel I’ve learnt an awful lot about myself. The things that really matter to me, the things that drive me, the things that energise me and the things that drain me. For instance I have learnt that for me planning for the future is energising, whilst existing in constant responsive mode is draining. I miss sitting and planning research events, outreach events, teaching and developing the service. All of those things fuel my need for creativity and change. Living every working day in responsive mode where non of those things can happen I find incredibly draining, which is why my battery feels constantly empty. It’s why this blog has been a lifeline, even though it time consuming and yet another thing on my to do list.

The other thing I’ve learnt about myself is that despite appearances I’m more of an introvert than I knew. I’ve loved just spending time at home with my husband and not having the demands of a social life. I always knew that I could turn on ‘extrovert me’ for a given number of hours but then would reach a point where I needed to stop. Now I’ve discovered how happy and comfortable I am without the need to deal with those social demands in my world. I think I may try to keep my limited social circle up for some time to come as I feel happier and less anxious in small groups.

I’ve learnt so much and upskilled in so many areas

I didn’t realise until I came to sit down and write this blog how many new experiences I’ve had as a result of the pandemic that I would never have experienced otherwise. I’ve been involved with a life drawing class posing (fully clothed) as part of their pandemic professionals series. I’ve has my COVID-19 dreams painted as part of the Dream Appreciation process by DreamsID, the product of which I not only have for my office as an amazing piece of art, but has also been exhibited at the Freud Museum in London as well as other places. I’ve even been persuaded to take part in a stand up comedy show after training for National Pathology Week. These experiences have all developed skills and left me with memories that will last far longer than the pandemic. Many of them would never have happened if it wasn’t for the pandemic pushing creativity and causing people to work and develop projects in new ways. Even this blog was started as a way of being able to still channel creativity and sharing in the pandemic. So I guess I’ve learnt a lot, and not just about viruses.

Enjoying the genius of responses from companies and professional bodies

This may be a weird one but I have rather enjoyed seeing companies and other professional groups trying to come to terms with the pandemic. It’s been really interesting and enjoyable for me to see people tackle difficult and sometimes repetitive messaging in a way that brings humour or innovation into the mix. I’ve also found it pleasing when big business or big names have channelled some of their resources into learning and other messaging to support the pandemic approach. It has often renewed my faith in mankind when other sections of the population have been busy destroying it.

Leicester General Hospital Genius Signage

If we can survive this we can deal with anything that’s thrown at us

Finally, I think it’s easy to forget how much we’ve achieved and how far we’ve come. No matter what your job, or the reason you’ve spent a few moments of your valuable time reading this blog – know that you have come far, that you have achieved much and that you are making a difference and having an impact. Sometimes you just need to step far enough back that you can see it. So thank you, all of you.

All opinions on this blog are my own