I’ve had a portfolio career since 1990, and do different jobs every day. I currently work as an associate specialist in an NHS paediatric chronic fatigue service, a broadcaster for BBC Radio Bristol, an investigative journalist for Private Eye, a health writer for Reveal, The Times and Telegraph Men and an author, lecturer, campaigner and comedian. I manage it by compartmentalising my life, and winging it a lot (or as comedians call it, improvising). It’s not as hard as it sounds because all the jobs are health-related, so there’s a lot of crossover. The material is similar but the timing and tone varies.
Comedy
Comedy is probably a less honourable profession than medicine. A lot of it involves lying for laughs, whilst giving your stories a semblance of truth so they ring bells with the audience. But comedy is strangely more accountable than doctoring. I could be a terrible doctor and still have a waiting room full of patients, but the outcome in comedy is much easier to measure. If you don't make people laugh, you don't get bums on seats. I often wonder if I've done more good for people's health as a comedian than as a doctor. Laughter is the best medicine, unless you have syphilis, in which case its penicillin. In truth, we need both. And doctors need to work in a climate where they are free from fear and free to laugh.
Investigative journalism
Investigative journalism has a lot in common with medicine. Although doctors are the most trusted profession, and journalists the least trusted, both jobs rely on observation, evidence and accurate documentation of that evidence. In my 23 years as medical correspondent for Private Eye magazine, I’ve specialised in advocating for and supporting NHS whistleblowers. I broke the story of the Bristol heart scandal in 1992, thanks to the astounding bravery of anaesthetist Dr Steve Bolsin. I spend a day or two a week investigating the facts to get them right. In nearly a quarter of a century, I've never once been sued for getting a whistleblower's story wrong, but I've never once been able to get a whistleblower back his or her job. It remains one of the most honourable and career limiting choices you can make in your career. And it's incredibly stressful for you and those around you. There has to be a better, kinder, fairer way that protects patients and those brave enough to speak up on their behalf.
Paediatric chronic fatigue service
I spend Fridays working in a specialist clinic for young people with chronic fatigue syndrome/ME. Prior to that I was a part-time GP for more than 20 years, but I found the job had become unsafe. My brain may be going soft, but I found I simply wasn’t able to accurately assess and support those with messy lives and complex chronic diseases on multiple medications in ten minutes. You can't practise whole person care and you can't allow patients to make informed decisions under such time pressure. In my new job, I have 90-minute consultations and it's completely transformed the way I practise medicine, and my beliefs about health and healthcare.
Chronic fatigue syndrome is a truly unpleasant illness still plagued with stigma and misunderstanding. There's a lot we still don't know, but if you listen, support, interpret and then hand over control of any chronic disease to patients, a surprising number develop the courage and confidence to live as well as they can with their illness. We use graded activity programmes where we try to stabilise sleep patterns, cut high energy activities back to a baseline for two weeks and then gradually increase these activities by 10% a week. It's a lot harder than it sounds, but the majority of those with mild to moderate chronic fatigue syndrome get significantly better in time.
Health writing
For the last two years I’ve been writing a book about how patients can get the right self-care and NHS care. Well, actually patients and carers wrote half of it. I know a bit about mental health and resilience (my Dad suffered from depression and took his life when I was seven) but I’ve never been poor or seriously ill, and I’m in no position to tell people how to live their lives and how to behave when they become patients. So I spent a lot of time listening to people who have survived and even thrived as patients, in and out of the NHS, and combined their tips and tactics with my insider knowledge. I also listened to those whose NHS care had gone terribly wrong, and the advice they gave to stop it happening to others.
To deliver patient-centred care, patients need to reveal themselves as people – what matters most to them, what their hopes and fears are – and we have to have the time to listen. As the poet Mary Oliver put it: “Tell me, what is it you plan to do with your one wild and precious life?” Most lives need a living and loving, not medicalising. I hope this book will be useful for those who use and work in the NHS, as well as those who want to get by without it. Let me know what you think.
Dr Phil Hammond (@drphilhammond) is an NHS doctor, journalist, broadcaster and comedian. 'Staying alive – how to get the best from the NHS' is published by Quercus. MPS members can get a discounted copy for just £10. Simply call BookPoints on 01235 827702 and quote BOOKPOINT. P&P is free of charge.