Professor Keith Grimwood’s career has combined academic, research and clinical roles. He is Foundation Director of the Queensland Children’s Medical Research Institute and Conjoint Professor at the University of Queensland’s School of Medicine. He works as a paediatric infectious diseases physician at the Royal Children’s Hospital in Brisbane while pursuing research in cystic fibrosis, bronchiectasis, rotavirus and respiratory viruses. He has presented at numerous conferences and has over 150 peer-reviewed research articles published.
“There were two factors in my decision to become a paediatrician. The first was that we had exceptional role models in paediatrics when I was studying medicine at the University of Otago. Professor Fred Shannon and Associate Professor George Abbott were both outstanding teachers and clinicians. They were also tough taskmasters — when you presented a case, you had to be prepared to justify your diagnosis and management decisions. This instilled a discipline of critical appraisal in the way we managed our patients.
The second factor was a 10-year-old girl with tuberculosis who I saw when I was a medical student. She gave a superb history, had great clinical signs and with relatively straightforward treatment would be expected to live a long and productive life. I realised that for many paediatric patients, prompt and appropriate management could have benefits for decades, which is very different from adult medicine.
After completing my basic training in paediatrics in New Zealand, I became a senior registrar at the Royal Children’s Hospital in Melbourne, where I later had the good fortune to do an MD on rotavirus infections with Professor Ruth Bishop, who discovered the virus, and Professor Graeme Barnes. We described the acute systemic and local immune responses in young children hospitalised with severe primary rotavirus infections. Later, we outlined the nature of protective immunity following this illness.
This work has been extended by other groups and it is wonderful to see the recent development of rotavirus vaccines and their introduction into the national immunisation programs of more than 30 countries, including Australia. In Australia, rotavirus and all-cause gastroenteritis hospital admissions in children aged under 5 years have been reduced by 60%–90% since the vaccine was introduced.
Another of my research interests is the microbiology of cystic fibrosis (CF). After completing my MD, I went to Calgary, Canada, for postdoctoral experience and to complete my infectious diseases training. I studied the impact of sub-inhibitory antibiotics on the virulence of Pseudomonas aeruginosa clinical isolates from patients with CF. Upon my return to Melbourne, this helped me establish a study at the Royal Children’s Hospital, which showed, for the first time, that bacteria such as Staphylococcus aureus occurred in the first few weeks of life in babies with CF. It could cause damaging inflammation to the lungs, without symptoms. The finding altered management of these children — we realised the importance of early, aggressive antibiotic treatment. We also showed that Pseudomonas could occur in very young CF patients where previously it was thought to be mainly a problem in older children and adults.
In Brisbane, we have been examining the nature and clinical significance of Pseudomonas transmission between CF patients where previously physicians thought most patients’ strains originated from their environment.
The thing I enjoy most about clinical paediatrics is that, unlike research, you get more or less instant results. Children can become ill quickly, but also usually recover rapidly and they’re remarkably resilient. You can see a child who has had a life-threatening infection and within the next 12–24 hours they’re sitting up and beginning to eat. An adult would take several days to show this level of recovery. Clinical medicine keeps you honest and grounded in your specialty by highlighting the many things we still don’t know.
I also enjoy working with families. It’s nice to be able to take a history from the child, if they’re old enough, but also from the family. It’s really important that the family understands the diagnosis, because when you’re treating the child you’re also treating that family unit. Sometimes the child can be a symptom-bearer for what’s happening within the family. Additionally, if a child has a chronic illness, that illness also impacts on everyone else in the family.
I would recommend paediatrics to a junior doctor without question. One of my patient’s parents recently asked me if I would do anything differently if I had my life over. I said ‘No, I don’t think so’. I’ve been very fortunate. I’ve had the best of many worlds. I’ve had the opportunity to teach students and residents and see bright young people mature clinically. They then start teaching you about the latest developments in the medical literature, which is tremendous, especially with the rapidly expanding state of knowledge. I’ve also had the the instant gratification of clinical service, and then research, which has allowed me to work with a range of very bright and stimulating people. To find answers through carefully conducted research and in turn improve clinical practice is very rewarding.”
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