Consultant physicians working with patients - Royal College of ...

2 Specialties HaematologyHaematologyDr Mike Galloway Consultant haematologist1 Description of the specialty Haematologists provide an interpretative andadvisory service based on laboratory results andHaematologists are both clinicians and laboratorydirect the appropriate referral of patients withspecialists who engage in the following activities:abnormal laboratory results within an acceptabletimeframe. This may involve providing support and working within a specialty clinical team, taking full written advice to the GP to allow care to be managedclinical responsibility for patients with a wide range in the primary-care setting.of haematological disorders (see Table 1) providing interpretation of laboratory results and Clinical serviceadvising other hospital clinicians and GPs on Clinical referrals come from primary, secondary orappropriate clinical managementtertiary care. The level of subspecialisation varies, and providing professional direction and having clinical many haematologists have a subspecialty interest inresponsibility for the haematology and transfusion addition to their commitment to laboratory and generallaboratoryhaematology. providing a laboratory, clinical and consultativeservice 24 hours a day.Haematological malignancyThe British Committee for Standards in HaematologyHaematologists undergo general professional training (BCSH) has defined three major levels of care for patientsin medicine followed by specialist training in all aspects with haematological malignancies (see Table 2). 2of clinical and laboratory haematology. Many undertake The National Institute for Health and Care Excellencea period in research. Most develop further expertise in (NICE) Guidance on cancer services recommendsone or more subspecialties.that patients with haematological cancers are managedby multidisciplinary haemato-oncology teams servingMain disease patternsa population of more than 500,000, with link networksTable 1 summarises main haematological disease between hospitals and that the treatment of acutepatterns and numbers of patients seen annually. leukaemia be limited to hospitals that treat at least fivepatients annually. 3 As a result, the number of units thatcan deliver the level 2b chemotherapy that is required for2 Organisation of the service and patterns patients with acute leukaemia has been reduced.of referralAll units that undertake stem cell transplantationA typical service(SCT), both autologous and allogeneic, are accreditedby JACIE, which is the Joint Accreditation Committee ofLaboratory service the International Society for Cellular Therapy (ISCT)The haematology laboratory provides a diagnosticand the European Group for Blood and Marrowand blood bank service to its host institution, whichTransplantation (EBMT).may include highly specialised investigations tosupport specialist clinical services. It also provides aHaemoglobinopathiesrange of tests for primary care, which may allowSickle cell disease and thalassaemia represent adiagnosis of a spectrum of haematological disease insignificant part of the haematologist’s workload in areasthe community. The source of specimen referralof the UK where the prevalence is high. In London,varies across hospitals, with the proportion ofsickle cell disease is now one of the most commonrequests from primary care ranging from 30% toreasons for admission to hospital and has the highest50%. 1 rate of multiple admissions for individual patients. 4,5C○ Royal College of Physicians 2013 127