Dr Natasha Ratnaraja; Consultant Microbiologist

Being a microbiologist involves being a detective; you take the clues given by the clinician speaking to you, or by examining the patient yourself and formulate a diagnosis and management plan. Quite often you are lucky and obtain the “evidence” for your diagnosis by way of laboratory results. 

Can you tell us what medical microbiology is?  

Medical microbiology is a speciality that involves the prevention, diagnosis, management and treatment of infections due to microorganisms. These microorganisms can be bacteria, viruses, parasites, mycobacteria or fungi.  

What kind of work does your job involve? 

Medical microbiologists offer advice on microorganisms according to how they are causing colonisation (living in the human host without causing infection) or infection in a patient. 

Medical Microbiologists are also involved in the investigation and management of outbreaks of infection, infection prevention and control and laboratory diagnostics. They participate in multidisciplinary team meetings (MDTs) and ward rounds, and may have clinics, especially OPAT (outpatient antimicrobial therapy) clinics. Medical microbiologists are usually the main speciality involved with infection prevention and control as well as antimicrobial stewardship.  It is a busy but rewarding job that involves a lot of communication with other specialities and organisations, from ward clinicians to GPs, UKHSA and integrated care board clinicians.  

Why did you choose this specialty? 

As a child I was interested in infections and how the body worked. I once gave my doll “worms around the heart” (rubber bands laid on top of her chest) which I treated with “antibiotics” made from my mum’s Elisabeth Arden perfume! studied Medicine at Manchester University, where we received one afternoon on Microbiology! I remember the consultant who was teaching Microbiology saying “this is a great job, you always get to finish at 5.” How wrong she was…

As part of my course I spent time at Monsall hospital, the Infectious Diseases hospital in Manchester. I was fascinated by all the different types of infections I encountered, especially Tropical Diseases and TB. In my fifth year, as part of my summer studentship, I chose an attachment on the newly opened Infectious Diseases ward at Manchester General Hospital. This was at a time when HIV was still causing a lot of morbidity and mortality, and it was a sobering but extremely educational experience. 

Four days after completing my house jobs I went to New Zealand for a year. I ended up staying for eight years, undertaking post graduate Physician training. I saw a lot of infections like TB, rheumatic fever and meningococcal disease serogroup B (there was an epidemic of this at the time). My interest in Infectious Diseases grew, but at the same time I became aware of the importance of the laboratory in diagnosing infections. I was lucky enough to be the first Infectious Diseases/Microbiology trainee at Wellington Hospital. It was incredibly busy but I saw firsthand how important it is to diagnose infections promptly and accurately and as a trainee was privileged to be part of a team that brought CSF PCR in house. I used my laboratory learning to develop a “CSF trolley” that was a one stop shop in ED, with a flowchart of what specimens to take and how to optimise sampling. 

I came back to the UK in 2005 to complete my microbiology training, first at Addenbrookes and then in the West Midlands. I became a consultant Microbiologist at Sandwell and West Birmingham Hospitals in 2008, where I was able to be very visible on the wards as well as have the opportunity to develop the laboratory service. I moved to University Hospitals Coventry & Warwickshire in 2018. 

What do you enjoy most about your chosen specialty?  

I love that two days are never the same; I get bored easily! One day I could be dealing with outbreaks and the next be very clinically based, out on the wards seeing patients and discussing cases with clinicians. I love being able to see patients and then find the organism causing the infection in a sample in the lab. Being a microbiologist involves being a detective; you take the clues given by the clinician speaking to you, or by examining the patient yourself and formulate a diagnosis and management plan. Quite often you are lucky and obtain the “evidence” for your diagnosis by way of laboratory results. 

I enjoy the two halves of my speciality; I love seeing patients and advising on infections, but I also love and respect the laboratory diagnostic side of things. Being able to see organisms on plates and understand just how they can cause infection is still something that amazes me. Bringing in new laboratory diagnostics to bring more accurate and faster tests involves a lot of discipline, to ensure that all the required processes have been carried out correctly and that the results obtained from validation tests are accurate. 

Most of all I enjoy working with other people, in my own teams, as well as with teams in the community and ward clinicians. You get to understand the other person and learn every day about other specialities. You get to develop good working relationships with teams and develop a mutual understanding about how their patients can be susceptible to certain infections. 

What do you find most rewarding about the role? 

We can make patients better! After nearly 29 years as a doctor, I still get excited when I see or hear about a patient who I have advised on get better, especially those who have been gravely ill. It is humbling to be part of a patient’s journey and contribute to their recovery, even if only in a small way. 

What advice would you give to students looking to enter your field? 

Microbiology and infection in general is an every evolving speciality but it is a job for life; there will always be infections! If you have a curious nature and are keen to learn more, please contact your local microbiology department and ask if you can have a taster week or shadowing experience. There might be opportunities to join ward rounds or clinics or spend time with infection prevention and control. RCPath host many infection webinars and you can attend these. Please also feel free to contact me.