A Day in the Life: Professor Adam Fox, Professor of Paediatric Allergy, reflects on his career and his approach to his work

Tell us about your job and how you juggle so many roles? 

I’ve always been a big believer in a portfolio career – having a few different roles rather than just one suits my personality (or, more likely, my short attention span!) Whilst I have always loved clinical work, I have seen many colleagues burn out from doing nothing but this all week, every week. As a career, medicine has always been very well suited to portfolio working and I was able to develop an interest in research and education alongside my clinical training. Once I was established in a senior medical role, I was able to develop a team to support this work which effectively transitioned me into clinical leadership.  

In more recent years, I have stepped away (though not completely) from my NHS practice to develop my own practice – this was mainly driven by a need for autonomy as frustratingly, amazing as the NHS is, it can be slow to support rapid changes in clinical medicine especially in areas not considered a priority. This has, again, inevitably meant having to develop more commercial and business skills, which felt the right way to build on the experience I had gained as Commercial Medical Director for my hospital trust.   

I now spend my time between my private paediatric allergy clinics (I do 3 to 4 a week), setting up and now running our new Allergy Centre of Excellence in London’s Harley Street medical district and leading the National Allergy Strategy Group together with an ongoing NHS commitment. 

Walk us through a typical consultation 

I have always liked the ‘one stop shop’ approach, trying to get as much done as possible in a single clinic visit. This helps us get as close to the answers that patients need as quickly as possible and is more convenient, especially if people have travelled a long way.  

I have come to learn that the best approach is to start by carefully listening to what the patient and their family has to say first – it’s time very well invested and not only does it usually give away the diagnosis, it also reveals a patient’s own priorities, experiences and values which inevitably will impact how we progress with investigations and treatment. This means I will start by asking patients to “tell me their story” and, wherever possible, for this to come from the child as well as the parent. For some, this can be brief and I will follow up with open and then increasingly more specific questions. Other families may not even need this and simply tell you everything you need to know!  

Once I have taken a history and examined the patient, we have on-site diagnostics – skin prick and lung function tests which yield immediate results.  This means we can discuss these and what they need and together come up with a treatment plan. If necessary, we can also then do blood tests. Clinics are well supported by specialist nurses who can go through training with adrenaline devices, inhalers or nasal sprays as well as discuss eczema or asthma plans in detail. Increasingly, as treatment options have grown but are not yet available on the NHS, families will come with a very clear existing diagnosis and just want to discuss treatment options. 

For some patients, a visit can feel a little overwhelming – they get a lot of information, so I always share written information, written with patients in mind, as well as contact details so it’s easy for them to ask follow-up questions. I also ask my team to follow up asking for feedback – it’s a really good way to make sure we are always listening and improving. 

What are some common concerns or misconceptions patients have about allergies?  

There are so many! I would like to think that these are improving, but I suspect this may just be that many of my patients follow my Instagram and have seen me talk about these things. Common misconceptions are people interpreting allergy tests as a measure of “severity”, ie a high test means a bad allergy or thinking that each time they react, it will get worse. These are unhelpful myths that create an awful lot of unnecessary anxiety. I also find it fascinating how differently different families will manage a very similar problem due to their approach to risk. 

It’s lunchtime – how do you take a break and return refreshed? 

 I do always try to ensure I have a break for lunch. I am a big fan of Asian food so if there is anything Japanese close by, that’s usually my first choice. 

How do you stay updated on new treatments or research in eczema and allergies?  Are you involved in research projects?  

I am still involved in a number of different research groups, in different ways and this helps but in reality, it’s geography that helps – working in a clinical setting with lots of colleagues, all with different interests, many of whom are very involved in research, means that we are always talking about papers we have read or conferences we have attended but typically and helpfully, in the context of the patients we discuss. Having such a strong multi-disciplinary team around me has always been my best asset. 

What has been a highlight of your career to date?  

I am lucky enough to have had a few – getting the Cambridge University prize for the best doctoral thesis, especially as it isn’t awarded every year if the standard isn’t met, was big for me as I probably wasn’t the most conscientious undergraduate when I was there! Receiving the William Frankland Award and later becoming a fellow of the British Society of Allergy & Clinical Immunology (BSACI) was special as it is recognition from colleagues and, likewise, becoming the first Paediatrician to be elected as President of the BSACI felt like it was part of something historic as our speciality of Paediatric Allergy came out of the shadow of Adult Allergy as a speciality in its own right.  

More important though are the very many patient outcomes – when a peanut allergic child completes immunotherapy and eats 25 peanuts at a food challenge – that never gets old! 

You are often asked to speak to the media about allergies – what are the benefits of this and how do you prepare for interviews?  

This has always been something I have done due to the remarkably small size of the speciality – there are only so many people the media can ask when they want an allergist. Being based in central London means TV channels can get you into the studio at short notice. To be honest, I don’t really prepare, beyond maybe checking a few key stats although often media interviews are arranged at very short notice – I find I come across best just chatting as though I would to anyone else and I suspect this is more engaging for the audience too. I am lucky that I have never really felt nervous in front of a camera.  

Outside of work, what are your interests or hobbies?  

I have recently taken up Padel, which I am terrible at but thoroughly enjoy. I also enjoy travel and am looking forward to visiting Vietnam in March.