A different pathway into the profession

7 minute read

Dr Pauline Habib joined Sydney clinic BJC Health as the very first rheumatology fellow in private practice in Australia and tells Rheumatology Republic about her experiences.

Dr Pauline Habib joined Sydney clinic BJC Health as the very first rheumatology fellow in private practice in Australia.

Tell us about your experience as a private practice fellow. Why is this a unique experience?

Starting my career in rheumatology as a consultant in private practice has been a steep learning curve, but very much an enjoyable one as I had not had any experience in private practice during my training.

The spectrum of rheumatic conditions varies from that seen in public hospitals in terms of the acuity and types of conditions seen. In particular, there are relatively more musculoskeletal presentations, which are important to recognise in order to appropriately refer to our allied health colleagues. 

Seeing these kinds of presentations and working at BJC Health with so many knowledgeable and approachable allied health professionals has helped me fill a significant gap in my rheumatology knowledge as I have been able to see not only how these conditions are managed by them but also how to gauge patients’ responses to those non-pharmacologic treatment strategies.

How did COVID influence this experience?

COVID was challenging on many fronts: firstly, as a result of the initial uncertainty about the gravity of the virus, new referrals had significantly decreased and as a new consultant whose profile was not known, this was concerning as I did not have a base of long-term patients to rely on. Secondly, because of the understandable concern by many patients on various immunosuppressant medications for their rheumatic conditions, there was initially some concern regarding their risk of infection with COVID particularly early on when there was very little data from international cases. 

This made advising patients who needed to start these medications and those already on them, a challenge. Finally, like many people who have had to work from home and heavily rely on technology with telehealth, drastically altering how we conducted consultations without being able to physically examine patients was initially difficult. However, working with so many fellow rheumatologists who were in the same situation despite their years of clinical experience provided me with some comfort that we were all in this together and would be able to manage as best as possible to deliver the best care possible to our patients and maintain our own sanity.

Why did you go into rheumatology?

From my early encounter on the ward as an intern managing a patient with SLE who was quite young and facing the prospect of immunosuppression and possible renal dialysis for her severe lupus nephritis, I was captivated by the often diagnostic and management complexities inherent with rheumatic diseases. 

Having also had personal experience with my grandmother suffering from rheumatoid arthritis and having seen how she was affected by the condition while still managing like a trooper, I knew I wanted to become a rheumatologist to make a difference in the lives of people with rheumatic conditions. Luckily, none of the other specialties I had worked in during my training gave me the same satisfaction and passion as rheumatology though I certainly appreciated the experience and knowledge I gained from those specialties.

What areas do you specialise in and why?

At this early stage of my career in rheumatology, I do not have a sub-specialty as I want to get as much experience as a consultant as possible across the full rheumatology spectrum to ensure I am a competent general rheumatologist. However, I particularly enjoy the challenge and complexity of managing connective tissue diseases and inflammatory arthritides, including the spondyloarthropathies especially in those patients on biologic agents, but also crystal arthropathies (e.g. gout). 

What leadership roles have you had in the profession?

I have been very passionate about medical education since I was an intern and have been always involved in some capacity in medical teaching from tutoring and bedside teaching medical students and JMOs to assisting in the RACP clinical exams as well as being the organiser in one year, which was a mammoth task (but had an amazing team of people helping me). 

While a rheumatology advanced trainee, I have been involved in bedside medical student teaching. More recently, I was a clinical tutor for University of Sydney students during their clinical examination musculoskeletal rotation, which was again interesting as we conducted our examination tutorials via Zoom due to the COVID restrictions. I hope to continue with medical education as it not only allows me to keep up my fundamental knowledge and skills but also is a way to contribute back to the system that helped me get to where I am now.

What are some of your career highlights?

Some of my highlights to date include diagnosing a patient with Behcet’s disease and Adult Onset Still’s disease who had seen multiple other health professionals with non-specific symptoms. As very rare conditions within the rheumatology world and only read about in textbooks, it was quite exciting to see the extent to which they manifest in real life, though I am positive it was less exciting for the patients themselves (though they did not have any major complications).

What advice would you give early career rheumatologists?

That is a difficult one to answer as an early career rheumatologist myself, but the biggest advice I would give is do not be afraid to get out there and continue putting into practice the knowledge and skills you have gained as an Advanced Trainee. Although it takes many years to master rheumatology, there are always colleagues available to turn to for advice when unsure or just to get their perspective on how they would tackle a certain problem. 

By the same token, it is also very important to ask for help when one feels they are out of their depth. 

Finally, enjoy the journey of becoming the kind of physician and rheumatologist you want to be to provide the best care for your patients while balancing a healthy social and personal life.

In 50 years’ time, what improvements would you hope to see in rheumatology?

I truly hope that it does not take 50 years, but I would like to see fewer hurdles in obtaining biologics for patients who desperately need them but do not fulfil specific criteria, as rheumatic diseases do not always present as described in textbooks but still affect patients’ quality of life and general health enormously. I feel this will require a significant reduction in the cost of these drugs to make them more accessible to patients but this economic/financial issue is a separate matter in itself.

I would also hope that with more research into personalised medicine and individual rheumatic diseases, treatments may become more targeted to specific patient factors to minimise side effects and improve efficacy.

Tell us something about your personal life that your colleagues might not know about?

That is difficult as I feel I have managed to disclose many things about myself from day one, whether that information was solicited or not. But one of the things I am quite passionate about includes caring for people who are less fortunate such as those living in developing countries. As such, I had always wanted to volunteer in a developing country and had the opportunity to do so in January 2020 when I visited a small village in Limpopo, South Africa for one month to care for orphaned children varying from toddlers to teenagers in a non-medical capacity. 

It was an amazing and eye-opening experience that revealed how resilient children could be in the face of abject poverty and sickness. I also learned so much from the incredibly warm locals who taught me about the turbulent history but also beauty of their country, more so than I would have probably appreciated reading a history book. It is definitely an experience I would like to have in the future, once the world returns to order.

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