Dr Jan Welch – Consultant in HIV Medicine and Sexual Health at King’s College Hospital London, Director of the South Thames Foundation School and Clinical Director Haven Camberwell

My career owes more to serendipity rather than planning, and I am grateful that medicine has supplied me with so many diverse opportunities.

I qualified from medical school in 1980.  I don’t recall any careers input and I had little idea what to do next, except knowing that I was quite interested in infections.  After house jobs I did six months of microbiology but realized that more clinical experience would be useful, and obtained posts in medicine and infectious diseases.  In 1982 I attended a journal club at which some case reports of homosexual men dying of strange diseases were discussed, and I became fascinated.  I looked after my first patient with HIV in 1983, and after MRCP took a senior registrar post in virology to learn more about this strange infection.

Virology was interesting but for me there was something lacking.  It took a while to realize that I missed patient contact – or rather, having responsibility for patients rather than just providing advice on treatment.  I was fortunate in that, in those days, it was possible to step sideways and I moved to genitourinary medicine at senior registrar level. My laboratory background was – and continues to be – very useful in this field as it enables me to understand investigations and their strengths and limitations.

I was appointed as a consultant 3 years later, after a lengthy locum in which I felt too insecure to take any maternity leave when my daughter was born (I needed to stay in London because of my husband’s legal career, and I wanted to be in the best position for the substantive appointment).  There were few women consultants in those days, and work-life balance less developed, but I did feel able to take eight weeks off for my son’s birth three years later.  There are no easy answers for working mothers, and my choice was always to work-full time (although with very little on-call) with the support of one wonderful nanny who stayed for 13 years.  I now think that my teenagers greatly prefer me to be busy at work rather than focusing too much on them . . .

Soon after my consultant appointment a colleague and I were approached by the police to ask if we could provide forensic examinations for women who had been raped.  The women preferred to see female doctors but there were few available, and so women were waiting up to 30 hours, unwashed, before an examination.  I became involved in this work but was appalled at the lack of proper integrated NHS services to provide emergency contraception and other aftercare as well as just forensic examinations.  I probably moaned at the police rather a lot, as seven years later they called my bluff and we were invited to tender to provide the pilot sexual assault referral centre for London.  I led the development of the first Haven in 2000 and the implementation of two more; the Havens now employ about 130 staff to provide 24/7 services to any adult or child sexually assaulted in Greater London. 

In the 1990s I also – as one does as a new consultant– became involved in various committees.  Chairing the hospital’s audit committee made me realize the importance of education and training, as one can’t audit properly without understanding current good practice, and I asked if I could organize some sessions on ‘Best Clinical Practice’.  These were popular and I was encouraged to apply to become director of postgraduate medical education, a post I thoroughly enjoyed for eight years while continuing with clinical work and developing the Havens.

I then felt ready for a new challenge, and was appointed as director of a foundation school which subsequently merged with its neighbour.  I am now director of the South Thames Foundation School, which oversees the training of 1700 newly qualified doctors in 19 NHS trusts.

My attention span is limited and I really enjoy having different things to do, and working in various places with different teams for my HIV and foundation school appointments, and all over London for Haven commitments. Fortunately I have terrific colleagues in each service who provide continuity and much more. Learning from each area contributes to others: Haven staff need training and qualifications and I have been involved in developing courses and a new diploma in forensic examination and aftercare.  When a Home Secretary came to open a Haven extension he agreed funding to develop a training website; experience gained from doing this has enabled me to facilitate similar developments in other areas.

Most of all I still like seeing patients.  The Havens attract national approbation and considerable media exposure, but patients ensure that I have to focus on the reality of their lives, and ground me. I now mainly look after women with HIV, including doing HIV antenatal clinics.  Modern treatments enable the risk of mother to child transmission of HIV to be almost eliminated, and our team has now looked after nearly 600 pregnancies.  I am happy to have had the opportunities to be involved in developing successful services, but my greatest pleasure comes from seeing the joy in a mother’s face when she knows that her baby is well.

Advice?  Think about what you like doing and how to engineer change.  If you consider that something could be done better, make constructive suggestions and ask for support to improve it.  Be aware, though, that you will probably end up running it and more . . .