In this interview, we spoke to Dr. Julian Barwell, a clinical geneticist, about his day-to-day roles and responsibilities as well as his career highlights.
What inspired your career into clinical genetics?
I was always mindful of the impact of cancer on families from the age of six, as this affected my best friend's father. This helped inspire me to study genetics as part of an intercalated BSc during medical school and then study for a Ph.D. in cancer genetics during my registrar years.
What are your role/main responsibilities in your current job?
I feel so lucky to dedicate my professional life to reducing the burden of inherited disease and also help introduce new genomic technologies that can improve and personalize healthcare and teaching in the 21st century.
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Image Credit: vchal/Shutterstock.com
What does a typical day look like for you?
I like to start the day by taking the dog out and checking my emails and planning my day ahead. I have a nice mix of clinical, teaching, and research commitments and so no two days are the same. I say hi to everyone at home and then head off to meet the admin team who are always in super-early and pre-armed with any queries that have come in overnight.
Apart from seeing patients with or at risk of inherited cancer and discussing the role of genetic testing, I also help look after patients with rare syndromes that mean they are at higher risk of disease in the future. So much more can now be done to identify and support these families that have often been through such heartbreakingly difficult times. Although often desperately sad, I aim to provide hope that things will be better for future generations through an improved understanding of their familial condition. This involves the use of family history taking, computer modeling, and genetic testing with the support of my clinical and admin colleagues.
In the afternoons I write letters, answer queries and help drive new personalized medicine initiatives as we aim to treat disease for what it is: not what it looks like, give the right drug at the right dose and offer screening based on risk, not age. These include molecular testing in prostate tumors, developing shared decision aids to assist in the management of inherited tumors & arterial dissections, and improved understanding of how patients access information about inherited cancer prevention online.
In the future genomic medicine will include the linking of different data sets with healthcare outcomes so that we can make better healthcare predictions and decisions and develop an 'equation for life'. This will require a very robust ethical review as we all have understandable concerns about data, rationing of resources, and equity of access to improved technologies and care.
There are incredible opportunities to learn more from the data we collect to help future patients and so I am bringing together a cohort of support groups (including those from black and minority ethnic groups) and my students so that we can develop a think tank around the way we wish to respond to the opportunities and threats that these technologies can bring.
I love to teach in lecture theatres and I have missed this so much during the pandemic. I worry about the missed mentorship opportunities this brings when someone lingers at the end of a talk when something has clicked with them and they want to talk about careers and how to get involved in genomic medicine. Nothing is more rewarding than inspiring and then enabling the next generation.
We are only what our students leave behind them and it is good to be getting back to some face-to-face teaching. I still speak regularly to my mentor who works in our department and I have known for 25 years. It is so important to have someone whom you trust and knows you to sound out ideas with and discuss problems.
During the pandemic, I spent time working on an oncology ward for the first time in nineteen years and in the third wave helped out in intensive care talking to family members about their sick loved ones as they couldn't visit. It was a harrowing and humbling experience to see another side to the NHS and reminded me of all of the great work that colleagues do and what an incredible institution it is.
I think it is healthy to be never fully happy with the work that you do and I am always striving to do the right thing more often or find a better right thing to do. Assessing and analyzing the quality of care we deliver and enabling research are equally crucial and I love working for the East Midlands Clinical Research Network a day a week to help attract and deliver high-quality studies in Genetics, Paediatrics, Reproductive Health, and Non-Malignant Haematology across the region.
On the weekends I usually try to find some time for speaking to my mentorees on the phone, writing academic papers, or preparing grant submissions so we can fund future projects to improve the care we deliver to patients. I did not join clinical genetics as a specialty just to tell people if they carry a gene change but to try and do something to help!
My motto is to make every day count for something special for my family, patients, friends, or our community. I am chairman of a Greek language school, a secondary school governor, review grants for Breast Cancer Now, help run a national helpline for hereditary breast cancer and sit on a committee for a special needs family support center in Rutland. Society is judged by how it helps its most vulnerable members and I always try to balance my scientific and medical expertise with humility, humanity, and humor.
What is the most rewarding part about your job?
The nice balance of clinical work, teaching, academia, and driving service development. Although I work hard, a great deal of the work is flexible and so I don’t have to miss family events, parent's evenings, or musical theatre rehearsals.
I am always trying to improve the service I deliver, the way I work with colleagues, and the academic environment. It has been immensely difficult at times and I have had plenty of setbacks but I am proud of the journey we have been on and what I have learned along the way.
What do you find most challenging about working in clinical genetics?
The most challenging part about working in clinical genetics is not having enough hours in the day to do everything I want to. The hospital and university have other competing and understandable pressures and challenges. It is important to take a long-term view on progress and realize a career is full of ups and downs.
If it was easy to introduce a change, somebody would have done it already and so never underestimate what it will take to improve clinical practice beyond the care you personally deliver. We never truly value what comes easy in life!
Throughout your career, what has been your proudest achievement?
My proudest achievement is representing my specialty and supporting my patients on the BBC Breakfast Sofa.
What has been the most exciting project that you have worked on?
The most exciting project is always the next one.
What advice would you give to people who want to pursue a career in clinical genetics?
Seek out a mentor and get involved in some projects so you truly understand what the Speciality involves on a day-to-day basis beyond the clinic. If you enjoy genetics, also look at academic jobs in other specialties with a genomic medicine component. We are supporting academic fellows and lecturers in thoracic medicine, endocrinology, and ophthalmology. It would be fantastic to broaden this into other areas as the influence of genomic medicine broadens. Family and friends are a huge part of my life. Genetics provides the opportunity to follow my school’s motto: Love and Work.
Genetics has been an absolute joy for me since the moment I first understood the role of DNA replication underpinning the biological history of the planet. I never forget that sense of awe when first reading about cell biology and how this links human variation to evolution and carcinogenesis. If you share this passion and want to know more, please get in touch!
Is there anything else about your career that you would like to share with our readers?
I try to treat my patients like my best friend’s mother, brother, or son. Improving the NHS as a whole though is tough and you have to take it one patient, one written sentence, and one day at a time. Failure is the hardest and the best teacher and I feel I still have so much to learn. A career in genomic medicine and genetics requires team passion, compassion, co-creation, and resilience.
Their disease, my job but both our lives.
Where can readers find more information?
About Dr. Julian Barwell
- Consultant Clinical Geneticist and familial cancer Lead for the University Hospitals of Leicester, running specialist clinics in NF2, NASH, and VHL
- Honorary Professor of Genomic Medicine and genetics academic champion at the University of Leicester. Operational clinical lead of the 100,000 Genome project at University Hospitals of Leicester and public engagement genomics clinical lead for the East and East Midlands. Launched the cancer genomic branch of this project on the BBC Breakfast Sofa
- Clinical Lead for Clinical Research Network for Paediatrics, Genetics, Reproductive Health and non-malignant hematology in the East Midlands. Joint clinical lead of Leicester Paediatric and Genomic medicine Research Space with the mentorship of two academic clinical fellows and one academic clinical lecturer in thoracic surgery, endocrine tumors, and ophthalmology. Helping to develop AI capacity for UHL.
- Breast Cancer Now grant committee reviewer, Ph.D. examiner, and Public Policy Projects contributor to debates on big data, disparities in social and health/genomic care, and the use of electronic patient records
- Clinical advisor to National Hereditary Breast Cancer Helpline, Prostaid, and B'ME Cancer, recently finished six-year term on Cancer Genetics Group Board, international speaker for the Teenage Cancer Trust, and conference chair for the Indian Board of Genetic Counsellors
- National pilot lead in prostate cancer tumor testing and tackling disparities in access to genomic testing for NHS England. Local principal investigator for studies involving gene mapping, biobanking, chemoprevention, Prostate screening, and BRCA mutation carrier risk factor modification.
- Sociology grant holder for cancer previvorship in the digital platform era, designer of a Lynch Syndrome App, and designer of 'A Smarter You' project.
- Leicester Greek School chairman and secondary school governor of an Outstanding Ofsted rated school
- Committee member for Rutland Rotoract Family Support Centre (2021 Queen's Award winner)
- One of the writers of Clinical Genetics at a Glance (commissioned and at drafting phase), the covid diaries on Dr. Julian Barwell Facebook that explains the science and emotions behind the pandemic,
- Rutland Musical Theatre Member and writer of comedy sketches and drama
The relationship between calcium consumption at various times of the day and cardiovascular disease