If you were to ask haematologists why they entered the specialty, a major reason given would be the opportunities provided for both clinical management and laboratory investigation. There is great satisfaction in making a provisional diagnosis in the out-patients and then confirming it by examination of the blood film or bone marrow. Patient care has become the main focus of a haematologist's work with direct responsibility for patients suffering from a wide range of blood disorders. White cell diseases are represented by the leukaemias and lymphomas, red cell abnormalities by the anaemias including haemoglobinopathies and blood clotting imbalance by abnormalities of coagulation and thrombotic mechanisms. Since patients are often acutely ill and management requires a high level of clinical expertise, possession of the membership of the Royal College of Physicians is an important requisite before trainees enter haematology training grades.

Despite these clinical demands the haematologist must be equally expert in the laboratory as well as on the ward. This area of responsibility requires detailed knowledge of analytical procedures and as head of the department the haematologist must work closely with biomedical scientists to ensure that high quality work is performed by well qualified staff in a safe laboratory environment. Automated analysers are used for the bulk of the routine work but specialised laboratory techniques are still required in many areas including blood transfusion, coagulation and thrombotic disorders, haemoglobinopathies and white cell immunophenotyping. Molecular techniques are increasingly being utilised and have the exciting potential to improve diagnosis and to provide clearer insights into the aetiology of disease.

The medically qualified haematologist has the unique ability to assess the clinical significance and relevance of the results generated from the laboratory. This is essential both for the effective management of patients directly under his/her care and also to provide clinical advice to a wide range of medical, surgical and obstetric colleagues. Also included must be close liaison with general practitioners who increasingly rely upon a rapid diagnostic service in order to provide effective primary patient care.

In a specialty which has so many innovative clinical and laboratory developments there are many opportunities for research since haematologists are ideally placed to take full advantage of the rapid advances being made in molecular and cell biology. Trainees entering the specialty are required to have high levels of clinical acumen and the intellectual rigour to cope with rapid change and although they must be willing to work hard they can be guaranteed a stimulating and worthwhile career.

For further information on training programmes, please contact the Training & Educational Standards Department on 020 7451 6741 or email education@rcpath.org

Dr David Winfield

The Intercollegiate Committee on Haematology