Professor Phil Routledge, clinical professor and consultant clinical pharmacologist, Cardiff University
What do you do? and what is a typical week for you?
I have recently retired from clinical pharmacology teaching at Cardiff University. But I still have clinics looking after patients as their physician – usually in general medicine but also dealing with hypertension, the adverse drug reactions and drug allergies clinics and advising other health care professionals in the UK and Ireland on managing patients who have been poisoned via the National Poisons Information Service.
There’s never a typical day and you’re always faced with a challenge, whether it’s dealing with an emergency with your patients or advising on a controversial medicine, there’s always something to get stuck in with.
The most common day for me for most of my career would feature a ward round and clinic, teaching at the bedside or giving a lecture and maybe some of my research work (possibly in the lab). Clinical pharmacology research is really satisfying because your research can make an impact on clinical practice in a relatively short amount of time.
What qualifications and experience do you have?
I completed a Medical Degree and Foundation training. I chose Clinical Pharmacology and Therapeutics as the speciality for me because of two people! The first was the late Professor Dai (DM) Davies – he was a superb clinician who always provided the highest standard of clinical care. He had an interest in medicines safety and adverse drug reactions which got me interested. The second person was Professor Mike Rawlins who arrived in Newcastle when I was finishing off my general medicine training. I got a Fellowship with Mike and after working for him, I definitely wanted to be a clinical pharmacologist and nothing else!
What’s the most interesting aspect of your job?
My favourite bit has always been looking after patients, especially in general medicine because it’s really rewarding. I also have really enjoyed contributing to policy development to make sure medicines are used safely and effectively in lots of hospitals. In Wales we have a single national drug chart in all hospitals which means that all doctors are trained on and use one chart so it reduces the risk of errors. Being involved in helping that happen was challenging because systems take time to change, but it was really worth it. The way to improve safety for lots of patients is to be involved with policies and systems, and that’s one of the best things about being a clinical pharmacologist, being in a position to use your expertise to have that wider impact.
What are your research interests?
For my research I started working on anticoagulants in 1975 when one of my consultants noticed that older people needed a smaller dose of warfarin. This got us thinking about what dose of warfarin you need to give patients because too much causes bleeding and too little leads to thrombosis which can result in strokes.
The effect of warfarin is measured by the International Normalised Ratio (INR, how long it takes your blood to clot) and there is an optimal INR. Patients vary hugely in their response to warfarin so it was difficult to get the right dose to reach that optimal INR.
We developed an algorithm to adjust the initial dose of warfarin according to the INR to reduce the risk of bleeding and also to predict the future warfarin dose a patient would need. This algorithm is still printed on the drug charts in Wales and elsewhere so a doctor can look at the daily INR and adjust the induction dose their patient needs.
All of that came just out of one observation from a colleague who asked a question about it.
What one piece of advice would you give to someone seeking a career in clinical pharmacology?
Try to get experience in different aspects of clinical pharmacology (there are lots of specialist interests, such as toxicology or hypertension) and consider working in another region or even country to find out how other people do things. Build all that learning into your practice as a consultant and when you are undertaking research.
Obviously, last but not least, join the British Pharmacological Society! I have learned a lot of skills for my career at the Society, such as presenting my data as a new researcher. This experience teaches you to communicate more succinctly and clearly. I presented my first research findings at a Society meeting in Dundee 40 years ago and it really opened my eyes to the excitement of science and research, and I’ve never regretted my subsequent career choice of clinical pharmacology.