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An Interview with Dr Nick Scriven (NHS Acute Med Consultant)

• December 23, 2020

BDI Resourcing had the pleasure of interviewing Acute Medicine Consultant and the past President of the Society of Acute Medicine, Doctor Nick Scriven.

In this Interview, Doctor Nick Scriven explains how Acute Medicine differs from General Medicine or ED. He also covers what a typical working day looks like for an Acute Medicine Physician, his own training journey and the different associated subspecialties.
 

What is Acute Medicine?

So in Acute Medicine we look after patients when they come into hospital, acutely, from either A&E or their GP. We tend to look after them for up to the first 48 hours. So we will assess them, stabilize them, then either discharge them or move them onto an appropriate specialist. That's usually any adult who comes in that doesn't need a surgical operation. 

Acute Medicine can be as urgent as A&E. Normally around 2 thirds of our patients have been to A&E first and then have moved to us. A third of them will have come from their GP to us. So, we work alongside A&E for anything that's not Trauma, Paediatrics or Surgery. 

We also do these extra bits like Ambulatory Care - that's another big part of our work.
 

At what point in your own career did you decide that you wanted to specialise in Acute Medicine?

Well when I was training, Acute Medicine wasn't even a specialty yet! It's only actually been a training specialty for about 10 years. So, when I got my CCT, I did it in General Medicine and Respiratory but I had always enjoyed the Acute take, on-call work. The actual Acute Medicine specialty seemed to be invented in around 2001 - I remember one of the first posts coming out and I immediately thought 'that's interesting!'. It's exactly what I liked - a bit of everything for various amounts of times. It's fast and every day or patient is different. Whilst this may sound fast like A&E, I was always a Medicine Doctor. I chose Acute Medicine as a specialty over working in Emergency Medicine because I'm not the sort of Doctor that wants to fix broken bones or be in Surgeries for long periods of the working day or deal with really big trauma cases.
 

What sort of patients do you deal with?

We see people with pneumonia, chest pains, overdoses, liver disease and all sorts of medical problems from the age of about 16 upwards. We're an important department that links everything together, sitting between A&E and General Medicine. 
 

How did you get where you are today?

Firstly, I did my undergraduate training and then did my medical rotations. Following that, I did my MRCP and then applied for a Registrar training program which at the time was Respiratory and and General Medicine. So I did my 5-6 years of that training and then began applying for jobs.
The main thing to remember is, you have to have your MRCP to become a Registrar these days. 

How difficult did you find the MRCP exams?

I actually found the writing bit quite tricky. I failed the first one the first time and then passed the second. The clinical I found a little bit easier.
 

If an international Doctor doesn't have specific experience in Acute Medicine but has been working in another specialty such as General Medicine or Respiratory, can they enter into the NHS within Acute?

Yes of course! The most important thing is to show enthusiasm and the fact that you've looked into the specialty a bit. Most people that have done General Medical training can do Acute Medicine, they just need to have the drive to do it and the want to work in that busy setting.
 

What does a typical day look like for an Acute Medicine Doctor?

Every day is different. It depends on what rota you're on. My typical day, if I'm on the ward would be to come in and initially do a walk round, seeing all the patients on our ward including new patients that have come in during the night and those that were there the day before. That usually takes most of the morning. 

Then in the afternoon, a Consultant will usually be there seeing new patients, with the Junior Doctors, as they come in and often you'll be working into the evening quite a lot. You'll often be doing routine shifts up until 7pm / 8pm at night.

Other days you may be rota'd to do an Ambulatory Care Session where you'll go to the Ambulatory Care Unit and work in there. Some other days, you may be working general outpatient clinics, follow ups or maybe even another specialty interest. For example, I still do a Respiratory Clinic. 
 

Can you subspecialise?
Now a days, more and more people train specifically in Acute Medicine. There are areas within Acute Medicine that people do subspecialise in. Some Doctors will subspecialise in the more invasive Intensive Care side of it, whilst others may specialise more in the Ambulatory Care end of it. Some may subspecialise in Respiratory Support.
 

What is the Society for Acute Medicine (SAM)?

It's been around since 2001 and is a Multidisciplinary society; in that any healthcare professional working within Acute Medicine can join it. We're about 75% Doctors and 25% non-Doctors. The latter includes Nurses, Physios, Pharmacists and Advanced Care Practitioners. We represent all those people that work in Acute Medical Units. We've currently got around 1000 members and are a growing influence in that we are regularly asked by the NHS for our views on certain things. 

In general, SAM's goal is to promote best practice within our specialty in terms of patient care and things like career development for our specialists. We also provide advice on how to best train within Acute Medicine. 

In a normal year we hold 2 conferences. One of them will be a very clinical based conferences whereby we discuss clinical advances and the other one will have a more political base. 

We also have our own journal and magazine, which is recommended as reading material for any Doctor looking to sit the MRCP SCE Acute Examination.
 

Do you have any advice for international Doctors looking to work within Acute Medicine within the NHS?

I suppose, you don't really know what it's like until you've experienced it. Come and observe, come and see what's going on! Especially with Acute Medicine as it may not exist in many Doctors home countries. There's only so much reading and research you can do.