This Every article by Dan Shipper, in which he talks about admitting to himself that he is a writer, struck a chord.

When I first decided to specialise in public health a decade ago, I remember having a deeply reflective discussion with a colleague who was an academic. She had chosen to become a researcher immediately after finishing medical school, having never entered clinical practice. After many years, she finally reconciled herself with the view that she wasn’t a ‘proper’ doctor, as she didn’t treat patients.

I don’t treat patients either: my job is to protect the population’s health from infectious, biological and chemical threats. This does involve individuals sometimes, but rarely actively unwell people: I mainly advise people who are ‘well’ but who are at a high risk of becoming unwell unless they take some specific action.

Despite this, I still very much consider myself to be a ‘proper’ doctor. Living through the singular challenge of the COVID pandemic underlined this for me. The most important core skill in my job—risk assessment—is precisely the same as in clinical practice, even if clinicians don’t always realise it. Moreover, the guiding principles of my profession are my ‘North Star’, helping me navigate through situations that can become enormously complicated and political.

Before COVID, I might have been more reserved about discussing my background, perhaps feeling that mentioning it could exclude others. However, given the colossal challenges of dealing with competing ethical, practical, and organisational issues at an intense pace, having a clear and familiar identity and set of principles was invaluable. In other words, my perception of my professional identity was beneficial in practical ways.

Others might reasonably perceive my identity differently. Some individuals in roles equivalent to mine have different professional backgrounds, leading them to associate with varied identities. I’m secure enough in my stance not to feel challenged or offended by differing views but to keep drawing strength and guidance from my identity.

The image at the top of this post was generated by DALL·E 3.

Yesterday, as a result of the end of British Summer Time, I manually changed the time on five clocks:

• a wall clock
• a decorative clock
• an oven clock
• an alarm clock
• a car clock
  

This may only have taken a few minutes, but I was slightly surprised to notice the number of clocks involved. None of these clocks is new. I must have changed every one of them multiple times over the years, yet if you’d asked me how many clocks I change each autumn, I’d probably have said, ‘Maybe two?’

This is a wholly insignificant example of an interesting phenomenon: I underestimate the effort I put into things when viewing them retrospectively. I think many people are the same, almost dismissive of their own efforts.

It wasn’t until yesterday morning that I made the obvious connection between this behaviour and imposter syndrome. I suffer from imposter syndrome from time to time, which is unsurprising given its reported frequency among medics.¹ I’ve always associated it with feelings of inadequacy related to the current situation: ‘I’m not qualified to chair this meeting,’ or ‘Most of what I have to contribute here is common sense,’ for example. These are both phrases I occasionally find myself uttering. Intellectually, I know that feeling as though ‘I’ve not earned my place here’ is part of the syndrome. However, I’ve never made the connection between that facet and mentally discounting the effort put into prior achievements.

This is a significant insight. Strategies like systematic, structured reflection could help to increase my recognition of my prior efforts. This could improve my medical practice by giving me greater confidence in my abilities and effectively addressing imposter syndrome.

I would never have guessed that the moment of changing the clocks would provide a moment of insight like this. They pop out of the strangest places sometimes.

1. I have a particular bugbear about imposter syndrome being something that’s typically discussed as affecting women more than men despite clear evidence that the issue affects both sexes equally. But that’s for another day. ↩

The image at the top of this post was generated by DALL·E 3.

The latest issue of The New European includes ‘the shit list 2023,’ described as ‘fifty people the UK could definitely do without.’

I read this on publication a week or so ago, and I’ve felt a little discomforted by it ever since. It hasn’t been easy to figure out exactly why I dislike it so much: after all, it’s surely just a bit of fun.

Yet, the more I think about it, the more it feels like there’s a streak of nastiness. Saying that the UK could ‘do without’ someone doesn’t feel a million miles from saying that people should ‘fuck off back to France.’

It also doesn’t help that in a listicle of this type, the justifications for inclusion are necessarily brief. One inclusion is justified with these two sentences:

Embodies pretty much everything that’s wrong with modern Britain. If anyone knows of a good reason for this 30-year-old to be in the Lords on £342 a day for life, please email us.

I’m confident it isn’t the intention, but this reads as awfully ageist.

I recognise the irony of raising this in an essentially critical blog post, but it would be lovely to see less of this sort of thing across the board. We should engage with issues, not people, and find things to celebrate rather than making criticism the focus. A little positivity goes a long way, especially when it comes to changing people’s minds.

On Search Engine recently, Ezra Klein told PJ Vogt:

This is an argument I’m always having inside my own industry. I’m someone who’s done a lot of hiring in my industry, so I think I have some credibility on it. People’s social media accounts are typically a reason why they don’t get hired, not a reason they do, in my experience.

The reason is that if they’re doing really well on social media, it’s for that exact reason they’re not doing as much of the actual work people are looking for.

I’ve been involved in many hiring decisions in my line of work, and I’ve never checked candidates’ social media profiles… but my job is in the Civil Service rather than the real world.

However, Klein’s observation chimed with my perspective on the experiences of a couple of colleagues during the pandemic. They both used different forms of social media to ‘subvert’ the usual routes of communication processes of their organisation. They both became ‘known’ (at least within the public health world) as ‘personalities’ who communicated clearly—that is, they were both successful at social media.

Both inevitably ended up in hot water for giving messages which did not align with the organisational view. The problem was that they had become ‘big name’ representatives of their organisation but were operating entirely outside the normal processes. Crucially, they both also mistook their success in the game of social media as expertise in public communications.

In other words, they did well on social media by demonstrating a dismissiveness towards due process and the expertise of others. The errors that undid them would not have been made by people with expertise (but may have been made by—say—me, in other circumstances). They became popular, but possibly undermined their professional reputations more than they bolstered them.

In contrast, while I know many people who have fostered professional connections via social media, I can’t think of anyone I know in my field for whom success on social media has led to genuine professional progression.

But, in fairness, this is only my personal experience: while it aligns with Klein’s view, others think differently. According to Alex Heath in Command Line,

Musk thinks X can build a viable LinkedIn competitor. “Historically, I’ve done a lot of recruiting on Twitter,” he said, adding that he sees someone’s posts on the platform as the “single biggest indicator for whether they are excellent or someone you would want to hire.”

Your mileage, as they say, may vary.

The image at the top of this post was generated by DALL·E 3.

James O’Malley recently wrote about status in a way that reminded me of Will Storr’s brilliant book The Status Game.¹ It made me reflect on some disparate thoughts I’ve been having recently about the role of ‘status’ in the medical profession, and especially within public health.

A little while ago, I talked with a colleague who had moved to a new role. Their former role had been equivalent to mine: actively managing local outbreaks and situations involving risks to a geographically defined population. The formal ‘status’ of the new position was no different—the pay was the same and so forth—but the day-to-day was different. The role was part of a national team broadly concerned with developing guidelines rather than having direct input into managing ongoing situations.

I knew that, like me, this person enjoyed the messily complex, ethically challenging, adrenaline-pumping world of managing ‘live’ situations, so this seemed a slightly surprising career move for them. Luckily, I knew them well enough to ask what had possessed them to take on such a different role.

My colleague told me—not quite in these terms—that they felt that the new role had a higher ‘status’: that, in their opinion, developing policy and guidance was a more ‘senior’ responsibility than managing incidents.

I know I sound desperately naive in saying this, but that floored me. I’ve been involved in developing more than my fair share of national guidance and have always seen it as a bolt-on to my ‘core’ job. I felt able to contribute to the development of this sort of thing because of my ongoing practice and experience; it wasn’t a ‘higher status’ bit of my job than, for example, chairing multiagency outbreak control teams.

I suppose I saw writing guidance as a little comparable to teaching. It is an important and worthwhile activity, but pivoting to doing it full-time seems like a career ‘jump’ into a different field, not a ‘status upgrade’ deal.

The idea that some colleagues saw this differently was quite a revelation. I think this is perhaps unique to the public health speciality: I struggle to think of anyone I know in clinical practice who has seen the leap to a job in guideline development rather than clinical practice as a ‘status increase’ in quite this way.

Status can be a funny thing: for it to hold any meaning, there has to be a socially agreed ‘ranking’ of sorts. James talks about the boost he feels when a journalist he respects engages with his work, but part of that ‘respect’ no doubt comes from a social consensus that the journalist is ‘high status’. We might be friends, but I don’t think he’d feel quite the same status boost from me blogging about his post. At the same time, as James points out, different groups have different consensuses: I strongly suspect James wouldn’t be as excited to see a complimentary post on his work from Suella Braverman as from Barack Obama, but they’re similarly statuesque figures to their particular crowds.

Even in a small field like mine, people can see status in different places. I suspect that within individuals, people recognise different things as holding status at different times in their lives and careers. At this point in my career, I would actively decline a ‘promotion’ to a management position, for example, because I value my clinical work too highly. Perhaps later in my career, I’ll value the broader influence that management positions can have.

I guess my reflection is that our own conceptions of status are even slipperier than I’d considered. I think James and Will are right to suggest that status is underestimated as a driver of behaviour, but applying that insight to understand individuals’ behaviour is more complicated than it might initially seem.

1. He also said that Succession is better than The West Wing, and without even having seen a single episode of Succession, I’m pretty sure I disagree. ↩

The image at the top of this post was generated by DALL·E 3.

Yesterday, I wrote about the Rishiversary. On Monday, I wrote about newspaper letters. Last week, I wrote about effective and concise writing… twice.

Readers of The Guardian might have spotted yesterday that I captured all three themes in a brief (and perhaps mildly snarky) letter to the editor.

I used to write letters to newspapers reasonably frequently. These days I do so very rarely, though find it’s a better way of composing my thoughts than ranting into the void of a comment box. I think this might be my first in The Guardian since this, eighteen years ago.

I think the last published under my own name was probably this in The Times seven years ago, though I regret to say that I might have had one or two pseudonymous letters in one or two newspapers since then.

A year ago today, Rishi Sunak stood outside the front door of 10 Downing Street and gave a speech. The opening lines were:

Good morning,

I have just been to Buckingham Palace and accepted His Majesty The King’s invitation to form a government in his name.

It is only right to explain why I am standing here as your new Prime Minister.

He never did get around to covering the topic he set himself and explaining why he is the new Prime Minister. It’s a peculiar omission which struck Wendy and me at the time. It comes across almost as though he’s not quite sure how he ended up there.

That’s not an impression that has faded with time.

There’s this odd section, where I can only assume he unintentionally skipped a line or a page from his script:

After the billions of pounds it cost us to combat Covid, after all the dislocation that caused in the midst of a terrible war that must be seen successfully to its conclusions I fully appreciate how hard things are.

There’s no pause nor flicker of recognition of stringing together 39 words into a single sentence that is devoid of meaning. It sounds though he’s slightly robotic, as though he’s converting text to speech in a manner that bypasses higher executive function.

That, too, turned out not to be a passing vibe.

I’m rubbish at political predictions, but—despite what the commentators might say about an election that’s as late as possible—I just can’t see this charade lasting another year.

The image at the top of this post was generated by DALL·E 3.

Google’s parent company, Alphabet, will publish its financial results for the third quarter today.

A couple of weeks ago, I was on a course for work about something utterly unrelated to technology.¹ During one presentation, one of the tutors said something along the lines of:

The report of that public inquiry is really easy to find on G—

I mean, it’s easy to find if you search online. I was going to say ‘on Google’, but that feels a bit creepy nowadays, doesn’t it?

It’s the first time I’ve heard someone express that idea in real life, which felt like a significant moment to me. I’m not suggesting that a perception of creepiness is about to make a huge dent in Alphabet’s profits, but it feels like a far cry from the social cachet that a brand like Google once held. It doesn’t feel like that’s a positive place for a consumer-facing brand to find itself, and certainly not for the long term.

1. It was about commanding the response to major incidents, which is the sort of course which is both incredibly useful and a bit frightening. ↩

The image at the top of this post was generated by DALL·E 3.

Twenty years ago, Tony Blair—then Prime Minster—was ‘rushed’ to hospital with a ‘heart scare’ resulting in a cardioversion.

A couple of days later, when it was clear that all was well, a single-word letter appeared in The Guardian. It was written by Percival Turnbull, and it was so perfectly pitched that I still often think about it:

I wonder whether this gently cutting humour still has a place in politics twenty years on. It often feels like public discourse has been overtaken by such violent polarisation that this kind of pointed lightheartedness has lost its place.

I hope there is still room for it. I think that interventions which gently and humorously needle in a way that makes people consider an underlying message can be remarkably effective.

There’s been a lot written about the death of the small smartphone, including two Verge articles that resonated with me: this from Allison Johnson back in April and this from Sean Hollister yesterday.

A lot of the coverage of small phones is imbued with an underlying assumption that it is people with small hands or pockets that particularly lament them: it’s often presented as an example of how the views of women are under-considered in the tech world.

I’m neither a woman nor a person with especially small hands¹ or pockets, but I am the owner of an iPhone 12 Mini. I mourn the passing of the iPhone Mini series. If there were an iPhone 14 or 15 Mini, there’s a good chance that I’d have bought one. Instead, all I’ve done is replaced the 12 Mini’s battery: far better for the environment, but less positive for Apple’s profits.

I prefer a phone with a smaller screen because it feels ‘handier’ than a larger phone and because it feels less immersive. It feels like using a tool, not like being sucked into a portal to a world of internet nonsense.

1. While writing this, I realise that I’ve finally forgotten my glove size. In surgery, sterile gloves are sized by number, much like shoes, and knowing which size gloves to pull off the shelf was an everyday essential. I reckon it’s fifteen years since I was last in an operating theatre, so perhaps it’s no surprise that I can remember that detail any more. ↩