How did you first get into medicine?
I can’t really remember a light bulb moment when I decided that I wanted to be a doctor – careers advice in the 1990s wasn’t as useful as perhaps it is now.
I do remember filling in a questionnaire tool that told you what you’re best suited to and mine said fishmonger. Thankfully, a good friend’s father was a surgeon and he was the first doctor I’d met who wasn’t my own GP. To me he was happy, seemed content with his life, had wonderful stories from work and that was enough for me to look beyond the potential of a life filleting salmon!
What inspired you to pursue your specialty?
Genitourinary medicine (GUM) or, as we increasingly call it, sexual health is not a subject that is usually dwelt on at undergraduate level – mainly due to the challenges in arranging the clinical placement of hundreds of students in an environment where many patients decline observers. If you’re lucky, you get a few days of lectures and the option of attending a clinic to watch a couple of patient journeys.
I really enjoyed the course at Bristol and the consultants were brilliant teachers, so after I’d completed my pre-registration house officer year (this ages me), I was keen to dip my toe in GUM waters and applied for senior house officer jobs. Guy’s and St Thomas’ in London took a chance on me and from there and I was totally hooked – I’d found my place in the NHS family. These were the patients I wanted to look after and these were the staff I wanted to spend my working life with.
The subject was broad and the work varied. These clinics were where I felt I’d be of most help as a doctor. I remember at that interview at Guy’s, they asked me who comes to GUM clinics and of course the answer is absolutely everybody – that’s why I still love it.
How does your chosen specialty differ from other medical settings?
Many people have a preconceived idea of what it’s like to work in sexual health – we’ve been called pox doctors and deemed a Cinderella specialty. We’re often in buildings removed from the rest of the hospital and some may pity our patients who have the shame of queuing to be seen.
The reality of the work is quite far removed from this and breaking down the stigma associated with sexual health and HIV is something I feel really strongly about. I want to see a cultural shift during my career. We deal with treatable, if not curable, infections acquired through engaging in a sexual relationship and any moral judgement of this is misplaced and entirely unhelpful.
Day to day work in sexual health and HIV medicine is quite different to many specialties. It straddles both community and hospital medicine and, due to the nature of our commissioning from local authorities, there is also a contracts and finance focus to the work.
Broadly, we run busy walk-in clinics increasingly integrated with reproductive health services and also lead on the management of HIV positive patients. As a specialty, we work closely with colleagues in public health, infectious diseases, gynaecology and dermatology. We work with all patients who have sexual health concerns but focus particularly on those at higher risk for infection.
Regularly, we work with young people and marginalised groups, as well as considering safeguarding issues, health inequalities and cases where there has been non-consensual sex. We also lead on the psychological aspects of sexual wellbeing and the stigma associated with sexually transmitted infections.
It has been extremely interesting this year to reflect on the parallels between the HIV pandemic and the COVID-19 pandemic, where there has been a disproportionate impact on certain groups and the differing views held around preventing transmission.
What additional skills have you learned as a result?
There is a particular skill to being a successful GUM physician where you need to balance the people focus of a GP, the inquisitive mind of a neurologist, the detail focus of a nephrologist, the time management and decisiveness of working in emergency medicine and very occasionally the conflict resolution ability of the hospital security staff.
I remember at that interview at Guy’s, they asked me who comes to GUM clinics and of course the answer is absolutely everybody – that’s why I still love it.
It goes without saying that superb communication skills are essential. You have to like people and enjoy learning about who they are, where they’re from and be able to communicate with them about some of the most private parts of their life.
What advice would you give to a student who is considering this specialty?
It really is a great specialty with fantastic opportunities to work in a whole host of settings – our past registrars are not only running UK based services or working as academics, they are working with Public Health England, have taken on global health roles, working in Zimbabwe, Malawi and Australia.
Please don’t hesitate to speak to one of us to find out more and potentially get some more clinical experience but do also think about community organisations and educational programmes and how you can be of use to them. As the formal undergraduate exposure can be limited, try to do a student-selected component (SSC) in something related to the specialty or offer to help with data collection for conference publications and presentations, email the consultants or registrars, they’ll be really grateful and you may even get your name on a publication.