So I’m a medical doctor and I work as a consultant medical microbiologist. That means that my role is to diagnose, treat and prevent infection caused by microorganisms, those of bacteria, viruses, fungi and parasites. As a medical student, I got to have a taste of microbiology. I did a special study module so I got a feel for what the subject might be like. And then, it was really working as a junior doctor on the wards and having the opportunity to meet microbiologists actually doing their jobs that I think really inspired me to think about pursuing microbiology as a career. So I met some incredibly knowledgeable microbiologists who always took took the time to explain what was going on and took the trouble to teach me and I was always struck by how much they seemed to enjoy their roles. It’s got lots of positive cultures. They’ve repeated that, they repeated that after one dose of naproxen. Microbiology is incredibly important. We’re surrounded, we live in a microbial world. We’re covered in bugs, we have microbes inside us and the environment’s full of microorganisms, and infection affects every single one of us. If you think back a century ago, over half of all deaths were caused by infection. But that has improved and reduced to about a quarter. Principally because of vaccination, improved sanitation and of course, antibiotics. But microbes can divide very rapidly and evolve quickly and they are developing resistance to first line antibiotics and that’s a real threat to our ability to deliver modern medicine. And globally, the burden of ill health caused by infection is still really huge. So microbiology is incredibly important because of the burden of ill health, the evolving changing microbes and just the challenges for the future of new and emerging pathogens and increased resistance. So there’s plenty to do. After qualifying for medical school, I worked as a junior doctor in general medicine. And then I had an opportunity to do some research, so I did a PHD and the subject of my PHD was really interesting. It was molecular microbiology, looking specifically at how bugs use small signal molecules to communicate. So that was really interesting and a real insight into the complexities of the microbial world. After that period, I came back to clinical medicine and I undertook my specialist training in microbiology and that allowed me to qualify as a consultant microbiologist. Microbiology is really, really important for patient care. At the individual patient level, microbiologists support clinicians to decide whether a patient has an infection, and if they do what the cause of that infection is and then what we can actually use to treat that infection? So that’s for the individual patient but then of course, infection can spread. It can communicate, bugs can communicate across and spread between people. So, there is that need to try and prevent that spread within that population of patients in the hospital and also in the community. And microbiologists play an important role in preventing the spread of infection. But we also study the patterns of infection over time and also the patterns and rise of resistance. So we’re also looking to our future ability to use antibiotics and to be able to treat infections. So we have individual roles across the population but also looking to the future. I remember a case from when I was a trainee. We got a sample of puss in the laboratory that had come from someone’s kidney, so a deep sight. And we grow a bug from that puss and actually, when we identified it, it was a bug that normally lives on the surface of the skin of dogs and animals. So we couldn’t really quite work out how we’d got this bug deep inside someone’s kidney. So I went to see the patient on the ward, and found out that he had a kidney stone that was blocking his kidney. And to treat that, the doctors had inserted a plastic tube, it’s called a nephrostomy, to help drain his kidney. So he had a plastic tube coming out from his back. Then I asked him that key question, I said “Actually, do you have a pet, do you have a dog?” And he broke out into a huge grin as he whipped out his phone to show me a picture of his huge, shaggy German shepherd called Bessy, who he admitted shared the bed with him. And then it all started to make sense because Bessy, we theorised, was covered in this bug, shared the bed and the bug probably got into the nephrostomy tube and worked its way into the kidney and caused an infection. But actually we went one step further and were able to prove that. One of my colleagues was brave enough to go out and meet Bessy and swab her. And we grew the same bug from Bessy and then we did some DNA fingerprinting with our colleagues in the reference lab and showed that the two bugs from the patient and his dog were identical. So I think that just always stuck with me that case because it always shows the dynamic world we live in in and how it’s a constant interface and the environment and humans and animals. And actually microbiology helps you work out what’s going on if you understand both the patient and the bug. The patient did get better, the surgeons drained the puss. And we were able to work out, that actually, the bug coming from the dog did behave like a similar organism that you get from humans and we were able to pick the appropriate anti-biotic because they did have a course of antibiotics and did go on to have that renal stone removed so he made a good recovery. Yes, actually, microbiologists have a lot of patient contact. We see all the patients in the intensive care unit everyday so we conduct a ward round daily and we also go and review patients with difficult or complex infections at the bedside. Colleagues who are also trained in infectious diseases or those or those who deliver outpatient anti-microbial therapy services, they run weekly clinics. So we have regular patient contact and daily intensive care ward rounds. I think when you actually go to the bedside, meet the patient, it really helps put the pieces together. You actually get to understand the impact of the infection. You can try and explore how it may have arisen. Was there a travel history? Is the person’s occupation relevant or their previous medical history? What have they been up to? Have they been in water? Have they been exposed to something? You need all of that to be able to understand what you’re looking for or to make sense of what you’re growing in the laboratory. I think you also realise the very real impact of infection on people’s lives. And I think that’s very much working to our vocation where our real priority is patient care. And seeing people get better, seeing the effects of your advice, your diagnosis, your therapy, actually making things better for patients. This is one of the best bits of the job: dealing with a patient, someone who’s sick, wondering what might be wrong, starting best guess antibiotics and then coming in the next day and having a look and seeing what’s growing. I work in a large teaching hospital and actually we’re a referral centre for other teaching hospitals so we’re known as a tertiary care centre. So it’s a big centre. And our department in total is about 100 members of staff. We process about one million specimens a year, so it’s really busy, there’s plenty to do. And of that, the consultant body is about 13 colleagues. And that includes consultant virologists and consultant clinical scientists. So we’re a very multi-professional department. We all deliver clinical care and have responsibility for directing patient care but also we have other roles. For example, they’ll be a head of service, an infection control doctor, and community lead. I’m actually a governance lead and the neurosurgical infections lead but I also within the hospital lead with how we try and improve how we use antibiotics across the hospital. And that’s known as antimicrobial stewardship. So that’s my role. So, every day we work with other professions, so we work with clinicians on the ward, we may speak to GP’s in the community, mid-wives, we work closely with nurses, for example in infection control. And also pharmacists, and we work with doctors from all grades so it’s really rich with lots of clinical and professional concepts from people with all disciplines. So I’ll say that no two days are ever the same because actually you never quite know what’s going to grow. You never quite know to what you’ll come in to find growing on the plate. So there’s always that element, you’re interested and surprised or it may be “Ah, that’s what I was looking for.” So there’s always that element But a typical day will be 9-5:30. We start the day with a handover from colleagues who have been over the weekend or overnight and then we’ll usually have a clinical or educational meeting in the morning. Then the rest of the morning is spent undertaking laboratory liaison where we find out what’s growing and whether we need to do any further work to identify bacteria of what’s growing in the lab. We’ll then go and see patients at the bedside and do the intensive care ward round as well as phone out or authorise those important results to the teams who are waiting for those results. In the afternoon we may have a team meeting, for example, infection control, or I would, for example, have the anti-microbial stewardship meeting. We also take the time to do teaching sessions so that might be lectures to undergraduate medical students. We’ll also look out for those late results that are coming through and make sure that patients have plans for overnight so that they’re safe and that junior doctors working overnight know what they should be doing. If we’re on call, that’s generally from home from 5:30 and that’s overnight. I’ll admit I love the subject. It endlessly interests me and I never get bored with dealing with infections and bugs so the subject I really enjoy. But, I think really the best part for me is working with colleagues, that’s both inside the department and across the hospital. I find it really stimulating, I learn such a lot from dealing with my colleagues and speaking to them and working with them, it’s very rewarding. And, of course, I feel in my job I can really fulfil my vocation. I really do think we’re making a difference and that gives me great job satisfaction as well, so I really do enjoy what I do. We do do a lot of teaching. Teaching is incredibly important to us within the department here in Nottingham, and some of that is very informal. It might be an impromptu session at the bench with a bug or by the bedside. But we also do deliver more formal teaching sessions and that will range from undergraduates in medical school to junior doctors and doctors across the trust. But also we teach other health professions such as nurses and pharmacists because our real aim is to make sure that everyone feels that they have a part to play in infection, regardless of their professional role. And we really try and emphasise the core principles of approaching infection and how to diagnose and treat that. But we’re also conscious that it’s constantly changing as the bugs evolve and adapt and change so we also update people regularly through our teaching sessions. Microbiology offers many, many opportunities for research. That could be from the laboratory doing basic science, bench work, for example doing clinical trials or behavioural studies. And so there’s many opportunities and I had the chance to do a PHD in molecular microbiology looking at something called quorum signalling. So this is where we studied small single molecules that bacteria can make that allow them to sense the presence of other bacteria and communicate when their population size grew big enough to allow them then to switch on their mechanisms, that allow them to make their weapons to cause disease, to switch on their toxins and disease causing abilities. That was only really valuable when they reached a sufficient number or they were quorate. So that was incredibly interesting as it gave us insight into how these bugs can grow as populations and live in complex microbial communities called biofilms and this is a strategy that bacteria use to survive and to persist and to go on to cause disease. So we were trying to study that and how that causes disease in the cystic fibrosis lung. So I really, really enjoyed that period of my career and my training. I think it really does. When I’m at work, I’m really busy, I never notice the time. There’s plenty to do, a lot to do, I do keep very active. But then I think there is that lovely chance to step away, because you know you’ve done a good job, you’ve had a lot of job satisfaction when you’re there, and you can step away and switch off as a microbiologist. You’re on call, but that’s often from home so it’s very manageable with a family life as well. And I find personally that I can really enjoy the time I’m at work but also unwind and switch off, enjoy my family and friends when I’m away from work. I actually work less than full time as do some other colleagues in my department and that’s very achievable and really works particularly well for microbiology because we don’t have our own inpatients, because we serve all patients, we can work out rotas that work out for people and also fitting their other interests to make sure that division of care is very equal. I think I would encourage anybody who’s interested or who has wondered about a career in microbiology to get in touch with a local microbiologists, to get in touch with their local department, to spend some time, to come and have a taster day, come and shadow a doctor or one of the scientists or one of the laboratory colleagues to see what their role involves because I think that until you come and try it, it may always remain a little bit of an unknown. And I think if you’ve got a love for science but also you’ve got a love for that patient clinical interaction, it’s a fantastic mix of those two. It will definitely appeal to people who are curious, who love learning new things but are also flexible to be able to adapt and accommodate the changes that bugs pose. They are a constantly changing, evolving threat. It’s very, very sociable, great colleagues, much support there for you. So if you’re interested, please do get in touch. We really do need capable, committed and innovative microbiologists for the future.