It’s not an original observation, but I’m of the strong opinion that the role of the doctor and the role of the priest are more closely related than many people realise. I think I’d have made a great priest, though I’m probably better paid as a doctor, and my atheism might have proven a barrier to the alternative.

This is perhaps even more true in public health than other specialties: I often ask people to do things which are to their own detriment—staying of work or isolating themselves—for the benefit of the greater good. The parallels with priesthood are inviolable.

When either role is done well, a large part—perhaps the majority—is listening. The act of simply listening while someone unburdens themselves provides a therapeutic benefit in itself—perhaps most of the benefit in many cases.

But, as Richard Smith reflects, this isn’t easy.

We interrupt because we mistakenly think people want answers, solutions. I’ve been making this mistake most days for 50 years.

Keeping quiet disguises the lack of solutions—but even with that impure motivation, allowing people to express themselves by keeping quiet provides a lot of therapeutic benefit.

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

On The Imperfectionist last week, Oliver Burkeman wrote:

If there’s one error of thought that most reliably holds me back from living an absorbing and meaningfully productive life, it’s the idea that certain things really matter, when the truth is that they don’t matter at all. Or at least nowhere near as much as I seem to believe.

This feels a bit thematically connected to my post yesterday about buying a ‘good enough’ fridge-freezer, but Burkeman’s post made me reflect more on understanding what matters in a professional context.

In my professional role, as is the case for most professionals, I’m asked to make hundreds of decisions per day. Most of them, however they may seem to the person who is asking, are pretty insignificant: whatever decision is made will have little impact on the public’s health.

A few years ago, I got into the habit of occasionally saying that ‘I didn’t care’ which option was chosen, often explaining that I didn’t think it would particularly influence the ultimate outcome. A typical example that comes to mind was whether a letter, whose content had been agreed upon by a group, should have my signature or someone else’s appended to the bottom.

One day, a kind colleague gently corrected me, saying that I did care, I just didn’t mind.

It was one of those useful small correctives that revealed to me the potential impact of the casual language I had habitually employed. It forced me to reflect and change my language.

The situation also made me reflect on the skill, wisdom, and kindness of the colleague who gave me that nudge. I hope that I one day have enough of the same qualities to help others.

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

Wendy and I recently needed to replace our fridge-freezer. Usually, this would have sent me down a rabbit hole of researching, reading reviews, comparing prices, and finding the very best fridge-freezer for our specific needs.

This time, it didn’t: we picked one fairly arbitrarily. We knew the size we required, we knew the colour we wanted, we knew we wanted it to be energy efficient, and we knew we wanted it conveniently delivered. The whole exercise, from deciding we needed a new fridge-freezer to receiving an order confirmation email, took less than half an hour.

I didn’t think much of it at the time, but Callum Booth’s latest post reflecting on his similar experience of buying earplugs caused me to reflect a little further.

It often feels like life involves countless decisions, most of which count for little. I have no doubt that we could have found a slightly cheaper model, or one that was better in one way or another. But sometimes, ‘good enough’ is good enough, and indeed preferable to a better outcome that takes longer to reach.

The image at the top of this post was generated by DALL·E 3. It looks nothing like our kitchen, but then, wouldn’t it have been far more disturbing if it did?

In The Times Luxury newsletter this week, Kate Reardon wrote:

A lifetime ago, when I was editor of Tatler, I got into terrific trouble. I gave the Speech Day address at a girls’ boarding school in the Cotswolds (I did a lot of that sort of thing at the time — being editor of Tatler gives you the status of, if not a minor royal, then at least a non-royal duchess) and I said something that caused a bit of a stir.

It was along the lines of this: manners can be much more important than academic results (outside an ever-decreasing list of licensed professions). It’s a ticklish business, but bear with. Good manners will make people like you. If they like you, they will help you and, more importantly, they will want to work with you. I’m not talking about some weird etiquette like using the correct spoon for soup or eating asparagus with your left hand. I’m talking about being polite, respectful and making people feel valued.

A few years ago, I would have inwardly nodded while reading those paragraphs and moved on with my day. Yet in 2024, in the forty-eight hours or so since I read them, a debate has been raging between different parts of my brain.

My first reaction is strongly negative: Reardon’s is a privileged take which gives preference to people who adhere to a narrow set of cultural norms. It’s difficult to see someone with a strong regional accent and an underprivileged background being judged as polite by Reardon’s yardstick, let alone people from entirely different cultures. It reminds me of being at a House of Lords event and finding it deeply weird and confusing to be asked where I went to school, until it clicked, days later.

My second reaction is the opposite: there are many different ways to make people feel valued, and to act with politeness, respect, and consideration. Anyone can be nice—there’s really no class or cultural issue to be found.

My third reaction is disgust: this is a posh woman proudly declaring that she tells young girls that their agreeability is more important than their education. That is… problematic to say the least.

My fourth reaction is anxiety: it’s true that being nice is a useful quality in life regardless of gender. Is my disgust an inappropriate and revealingly prejudiced response to the writer’s identity rather than the content of her ideas?

I no longer know what to think.

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

On a recent walk, Wendy and I spotted a buzzard. Or rather, we were walking along deep in conversation when somebody came over and said, “excuse me, have you noticed that buzzard over there?”

We hadn’t, and frankly, I wouldn’t have recognised it even if it came and perched on my arm.

This struck me more than it would usually have done, as I’d only recently read a blog post by Richard Smith in which he called himself uneducated:

Recently a group of us walked through the Yorkshire Wolds. One friend knew the name of every bird, and he recognised their songs from just a few notes. He could see them when I couldn’t. He knows the names of flowers and trees. I can tell an oak tree from a beech tree—but not even that with confidence. I marvel at flowers but know the names of few.

My ignorance began to weigh heavily on me as we walked. What is the point of knowing the difference between a mean, median, and mode if I don’t know the names of stars, flowers, trees, and fish? If abandoned on an island like Robinson Crusoe—or even in my own garden after a pandemic had killed everybody else—could I grow anything to eat? I fear not.

I agree with Richard that we need to live as part of nature, but my complete lack of knowledge of stars, flowers, trees, and birds doesn’t weigh heavily on me: I’m perfectly content to simply enjoy them.

This occurred to me on another occasion recently, as Wendy and I were walking under some trees, and she wondered aloud what species they were. Neither of us had a clue. On almost any other topic, I’d have later found myself searching the web, my curiosity driving me to learn a little about it. I don’t have that compulsion at all when it comes to the natural world around us: it’s completely absent.

And I think that’s okay. I think it’s legitimate and healthy to have areas of life that don’t drive me in that way. I think it’s good for my mental health to have things that I see and wondrously appreciate, rather than analysing. It’s nice to have the freedom to appreciate the shade of a tree without being nagged by an awareness that I’ve no idea whether it’s an oak or a beech tree.

Sometimes, being at peace with my ignorance is preferable to forcing self-development.

Wendy took the picture of the buzzard at the top of this post.

Ordinarily, I’m a voracious reader. I typically have two books on the go at any one time. I usually get through about a hundred per year.

But occasionally, I have spells where I don’t read much at all. It’s as though I fall out of the habit, and just can’t bring myself to pick up a book. I find myself wondering how I ever found the time to read as much as I did.

These spells typically last about six weeks, and I’m about five weeks into one at the moment. I know it is starting to lift because, in the last few days, I have been reading again–albeit less frequently and for less long than usual.

I don’t understand why this happens. I haven’t spotted any great pattern to it. And it’s not something that really concerns me. But given how much I bang on in this blog about reading, and the books I’ve read, it seems reasonable to mention that it’s not always like that. Occasionally, my drive to read inexplicably evaporates.

It always comes back.

The picture at the top of this post is an AI-generated image created by OpenAI’s DALL-E 2.

Ten years ago today (eleven by the time this is published), I learned that I had passed my medical school finals and became a doctor. It doesn’t feel like it was a decade ago.

At work, I recently happened to have a meeting with someone I worked with as an F1 doctor but haven’t seen since. It felt like we worked together a month ago rather than a decade. I still occasionally say “hi” in the street to the porter who used to comment on my “Bird’s Custard” colour tie as an F1. And yes, somehow my F1 year was long enough ago that ties weren’t yet banned in hospitals.

I think the Simon of ten years ago would be amazed to find that I’m now working in public health. I didn’t enjoy the occasional public health bits at medical school, and I wasn’t even really aware that it was it’s own specialty until I came to pick a career path. Public health always struck me as worthy, dull, and far removed from anything that actually had any measurable impact on patients.

It was only after a serendipitous run of F1 hospital rotations that I started to see the point. My first job was in upper gastrointestinal surgery, a subspecialty involving seriously brutal surgical interventions to treat cancers with very poor prognoses. My second job was in stroke medicine. My third was in gastrointestinal medicine, a speciality in which a large proportion of the patients had end-stage liver disease as a result of alcoholism.

I think it’s impossible to go through that sequence and not feel slightly despairing: hospital medicine comes too late for most of these patients. Their lives very often cannot be pieced back together: as one particularly insensitive consultant used to regularly say, for those patients “the party’s over”.

The most effective treatment for these patients would be to rewind time and tackle their problems before they were ill. This initially pushed me towards General Practice, until I realised (late) that this was the point of Public Health. My realisation of this came so late that I didn’t really know what public health doctors did all day, but stuck in an application to the specialty anyway… as well as general practice.

After long essay-style application forms, written exams and half-day intensive interviews known as “selection centres”, it somehow came to pass that I was offered places on both the GP and public health training schemes. I had 48 hours to decide between a familiar career path and one which sounded fascinating but that I barely understood. In truth, I hedged: I went with public health because general practice always under-recruits, and I was pretty confident that a re-application to GP would be successful in 12 month’s time if public health turned out to be awful.

I was also put off by the obsession with portfolios in General Practice. My experience of clinical portfolios was that doctors were judged too much on their ability to write and present evidence rather than on their practice of medicine. I was, even if I say so myself, great at presenting portfolios of glowing assessments as a Foundation Doctor, but this felt a bit flat. It seemed to me that people in public health were known by results and reputation, and I liked that idea. I’m not so sure that was an accurate assessment of either speciality, but it certainly played a part in my decision-making at the time.

Leaping into public health felt brave at the time, even if it seems like hedging in retrospect: no end of people were telling me that I’d be “wasted” in public health and that my skills with patients meant that I’d be a fantastic GP. Some of this was subfusc whispers in my ear, some was formal written feedback, some was mildly paternalistic advice. Only a minority were enthusiastic. Luckily, once I set my mind on something, I’m pretty strong-willed.

Public health wasn’t awful. I mean, it had its moments: within weeks of me accepting a place, the coalition Government announced an intention to move public health outside of the NHS. This may have been the right decision, but it was terrifying for me as an NHS doctor to know that my NHS career path had been cut off just as it was beginning.

As I progressed through my training, I came to really enjoy health protection, the part of public health which deals with outbreaks and other biological, chemical and radiological threats to the population. I liked the combination of clinical-style short-term pressure, thoughtful balancing of risks, and the close association with clinical colleagues (and occasionally patients). I wrangled the system to spend almost half of my training in health protection placements, and since 2016 I’ve been a consultant in health protection. It is—by far—the most enjoyable and rewarding job I’ve ever done, in which I’m surrounded by a brilliant team who never give anything less than their best.

So, in career terms, I could not be further from where I thought I’d be ten years ago. But I also couldn’t be happier with the choices I’ve made. I don’t really know that there’s a lesson in that.

Someone once told me that the most important thing in career planning is to do what you enjoy and collect certificates along the way. Delayed gratification is rarely worth it in career terms: the gratification might never come. But its hard to ever regret doing something you enjoy, and collecting certificates provides tools to make a “leap” to something else when the first thing stops being fun.

I don’t know whether that’s good advice or not, but it roughly correlates with my experience over the last ten years. Let’s hope that I’m still enjoying things as much ten years hence – whatever I’m doing then!

The picture at the top is obviously my own. It was from my graduation which was, of course, a little later than the day I found out I’d passed.

I wanted to reflect my nine years of blogging in today’s photo-a-day, so had the idea of nine fairy cakes assembled in the shape of a 9… I’m not entirely sure I pulled it off to the extent that you’d realise it was a 9 without being told…

I wrote a bit more about my nine years of blogging earlier today, if you’re interested!

Today marks nine years since I started blogging. Nine years. Increasingly, people are becoming concerned about the permanence of stuff posted the internet. Rick Santorum’s presidential campaign was hampered by the web, and the fact that for almost everything he said, he’d previously given an equal and opposite quote to some other source at some point in the past. And, of course, there’s many other less prominent examples of people’s online history coming back to haunt them.

Anyone with a blog, like me, can essentially make a choice. I could delete a load of old stuff. It wouldn’t make it completely unavailable online, as content from this site is cached all over the place; I guess it might make it slightly more difficult to find. But I’ve chosen not to do that. I’ve chosen to keep the complete sjhoward.co.uk blog intact. And I’m sure many people wonder why.

Firstly, let me say that it’s not because I think everything on here is great. It’s not. There’s some terrible stuff. There’s stuff that’s just plain dross. I’ve written things that I’m a ashamed of, like using “gay” almost as a punchline, or referring to the entire French population as “crazy frogs”. There’s positions I’ve asserted that, at best, are altogether blunter than I’d ever express now, like saying “I’m very anti-smoking”. And that’s before we even open the can of worms labelled “unnecessarily base humour”.

So why, you might ask, do I keep this stuff online, with my name written at the top of the page in a massive font size?

This is something I’ve thought a lot about. In the end, my reasoning was fairly simple. What I wrote in 2003 might have been unprofessional, but I wasn’t a professional then. It might have been immature, but so was I. The date is clearly and prominently shown on all the posts I’ve written. Of course I don’t hold all the same opinions I did when I was 18 – does anybody? We grow, we develop, our viewpoints and opinions change.

One of the more remarkable things about this little site is that you can how it happened. You can see the softening of my opinion on Tony Blair, from barely concealed hatred, to grudging admiration, to actual respect. My changing interests are reflected, from the 2005 election, during which I published daily “swing updates” based on a complex formula weighting different polls, to the 2012 local elections which were only mentioned in passing beneath a pretty picture of a bus stop.

All of this history, and all of these changing opinions, set out the path to where my politics and opinions lie today. And, of course, both will continue to shift over time.

In the end, I guess I came to the conclusion that if someone chooses to judge me on a personal opinion I held a decade ago, then so be it. Though I’d suggest that a far more interesting and intelligent approach is to ask questions: “You once said you thought x: do you still believe that?” or “Your position used to be y, now it’s z. What changed your mind?”

I don’t know exactly when the meaning of the term “flip-flopping” in political discourse changed from being about presenting different views to suit different audiences to being about actually changing your mind on a given issue, but I don’t think it’s a helpful change. I’m vaguely suspicious of people who claim to have “always believed” something – it has a slight whiff of valuing dogma above thoughtful and reiterative consideration of the issues. I can only speculate that the increasingly tribal nature of politics has led to increasing institutional derision of free thought: we must all toe the party line.

If you ask me, the sooner we lose the vogue notion that a change of opinion or reconsideration of position represents a weakness, the better off we all will be.

I’ve finally completed my Mencap Spellathon challenge, which was to learn to spell 2,500 words. It’s taken me quite a few weeks, but I’ve made it, and want to thank everyone who has sponsored me over the last little while. At the time of writing, I’ve raised £50, which is beyond both my own expectations and Mencap’s target.

But let’s raise even more! Mencap is a great cause, supporting 1.5 million people in the UK with learning disabilities. If you gave me a penny for every ten words – that’s just £2.50 – Mencap could make that go a long way. So get over to the JustGiving page Mencap have created for me, and give them some cash.

Thank you.