As doctors, we need to know how to communicate. We may have impressive technical skills and advanced scientific knowledge, but unless we can properly listen to our patients, explain what we think, and relate to their concerns, we can never hope to do our best for them. Each one is an individual, with their own hopes and fears and their stories to tell.
The ability to communicate and inspire, to a wider audience and in creative ways, is the topic of a new series of BMA podcasts. In Inspiring Doctors, I, as president of the BMA and a professor of public health, will be joined by people whom I see as role models. They have gone beyond one-to-one communication, important though that is, and have used creative ways, including books, television, and graphic novels, to explain and entertain while conveying often complex medical issues and concepts to a wider audience.
In each episode, I allow them to tell their stories and ask what has inspired them and who they look up to as they craft their ideas, words and drawings.
We have been through three years in which everything has seemed to change. A pandemic, on a scale unseen for a century. Millions have lost their lives and many others have become bereaved or disabled, with large numbers still afflicted by long COVID or exhausted from burnout.
But, as England’s chief medical officer Professor Sir Chris Whitty has said, the response of the medical profession was ‘astonishing’, as was that of the wider scientific community. The genome of the virus was decoded, its evolution was monitored, its spread tracked, and models were developed to explain and anticipate its transmission. Systems were created to track the responses of the public in real time.
Collectively, this work generated information on an unprecedented scale. But information is only useful if it is used, and for it to be used, it must be understood and trusted. This means that it must be communicated to those who should act on it.
There is, of course, a well-established mechanism for doing this, through the medium of peer-reviewed journals, some of which may reach the wider media or politicians.
But the system is struggling. You might even say it is broken. The explosion of research means those who need to review the submitted papers can easily become overwhelmed. The process can be glacially slow. It can also fail to identify papers with problems or prevent the publication of those that are important.
Coverage of the findings can be inaccurate, especially when the paper is accompanied by a press release that is misleading, perhaps because it was drafted by someone seeking to overstate the importance of their findings. And if it does reach a politician or, more often, their advisers, it may be virtually incomprehensible.
And it rarely reaches the public, who in many cases have paid for the research through their taxes or charitable giving, and whose engagement is often essential if it is to lead to change.
It may also be the case that the research itself is badly flawed. Richard Horton, one of the podcast guests and editor-in-chief of The Lancet, has said it can be ‘afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance’.
We know that the public wants to know more about science, and especially medicine. Medical books are often among the best sellers. Television programmes attract very large audiences. The daily briefings by Sir Chris and his colleagues were viewed by millions.
Although not on the same scale, the weekly briefings that we on Independent SAGE provided, where we asked the public about their concerns and tried to respond in ways that were understandable, attracted tens of thousands of listeners every week.
But what this experience has taught us is that communication, especially when it involves complex issues, is an ability that not everyone possesses. Training, for example in media skills, can help, but it is often defensive, designed to reduce the risk of making mistakes or what some newspapers call ‘gaffes’. And the mass media are only one of many outlets that can be used to explain what is important.
Throughout history, some doctors have found other ways to communicate in ways that reach beyond medical and scientific audiences.
One was the Jewish scholar Maimonides, born in Cordoba in 1138 and who would become physician to Saladin. He offered us all some advice, which now seems more relevant than ever: ‘Do not consider it proof just because it is written in books, for a liar who will deceive with his tongue will not hesitate to do the same with his pen.’
There are many others:
Anton Chekhov turned to writing to make ends meet as he earned so little caring for the poor. He once said: ‘Medicine is my lawful wife and literature my mistress.’ His character Dr Astrov captured the loneliness of rural practice and a keen environmental concern. He chronicled death and suffering in Russia’s far east with a piercing sense of humanity.
Arthur Conan Doyle modelled his most famous character in part on his surgical teacher from Edinburgh, Joseph Bell, and Sherlock Holmes’ famous description of his method would also serve many a diagnostician well: ‘When you have eliminated all which is impossible, then whatever remains, however improbable, must be the truth.’ Holmes’ ever-reliable companion is of course John Watson, one of the most famous doctors in literature.
Jonathan Miller, a doctor who became an eminent writer and director, drew an explicit parallel between his varying careers: ‘I spend a lot of my time trying to draw the attention of actors to the minute and subtle details of human behaviour, which was the sort of thing I was looking at when I was a neurologist.’
Mikhail Bulgakov, most famous for writing The Master and Margarita, abandoned his practice after the Russian civil war, but later gave us a fascinating account of medicine in rural Russia in A Country Doctor’s Notebook.
Margaret Todd, one of the first students at the Edinburgh School of Medicine for Women, drew on her experiences to write her acclaimed novel Mona Maclean, Medical Student, which explored women’s roles in the medical profession. She also wrote a biography of Dr Sophia Jex-Blake, describing the fight of her contemporary women to enter the medical profession.
Atul Gawande, a surgeon who became a staff writer on the New Yorker, wrote a piece comparing the costs and quality of healthcare in two neighbouring towns, a critique of corporate capture of American medicine, which is credited with strengthening Barack Obama’s commitment to reform. His books, drawing on his experience as a surgeon, address topics such as the fallibility of doctors, the importance of intuition when confronted by a medical ‘mystery’, and the many ethical dilemmas that arise in clinical practice. He has said: ‘There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing.’
Oliver Sacks trained in the UK but soon moved to the United States, working with patients suffering from Encephalitis Lethargica, a condition linked to the 1918 influenza pandemic and a pertinent reminder of the long-term sequelae of viral infection. His book Awakenings, which described the remarkable effect of treatment with L-dopa, was made into a celebrated film. He once wrote: ‘If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it.’
Siddhartha Mukherjee, an oncologist, wrote The Emperor of All Maladies: A Biography of Cancer, which presents the struggle against cancer as a battle against an ‘adversary [that] is formless, timeless, and pervasive’ in which there are ‘victories and losses, campaigns upon campaigns, heroes and hubris, survival and resilience—and inevitably, the wounded, the condemned, the forgotten, the dead’.
Kate Granger, a geriatrician, was diagnosed in her late 20s with a sarcoma that would eventually kill her. She was shocked by her experience as a patient, when a doctor, whom she had not previously met, told her in an off-hand way that her cancer had spread. She then launched the #hellomynameis campaign, which spread widely on Twitter and has been adopted throughout the NHS. In her book The Bright Side she reminds us of one of the most powerful lessons of all: ‘Sometimes in medicine there are no answers.’
The list goes on, from John Locke to John Keats, from Somerset Maugham to Harry Hill, and from Alexander Borodin to Jed Mercurio, all medically qualified and highly creative people who communicated in many different ways with a wider audience. There are also many more whose names and opportunities have been lost due to bias, prejudice and discrimination. And there are a great many who are yet to get started.
In the podcasts, I am delighted that we have managed to assemble a talented group of doctors and those closely linked to medicine. They are all people who have inspired me with their ability to communicate to a wider audience. I hope that our conversations will, in turn, inspire you.
Martin McKee is president of the BMA, and professor of European public health at the London School of Hygiene and Tropical Medicine
The podcasts are available at bma.org.uk/inspiringdoctors, or wherever you listen to podcasts.
Those interviewed for the series are Rachel Clarke, Saliha Mahmood-Ahmed, Phil Hammond, Ian Williams, Jason Leitch, Richard Horton, Guddi Singh, Trish Greenhalgh, Ben Goldacre, Dom Pimenta, Alice Roberts, Nick Black, Hannah Barham-Brown, Ian Fussell, Stephen McGann, and Heidi Thomas.