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A €38m lesson with my latte

Yesterday, I stopped for a coffee in the lobby of one of Amsterdam’s more upmarket hotels. I settled into a stylish yet surprisingly comfortable armchair next to a wrought iron room divider, and cracked open Fay Weldon’s The Life and Loves of a She Devil. Before I knew it, though, I had stopped reading, and instead tuned in to the intriguing conversation on the other side of the divider.

At a coffee table was a man with a shaved head, who looked of a similar age to me, wearing a white shirt, and a somewhat over-tight unfastened blue suit jacket, pale blue denim jeans, and black suede shoes. Opposite him, with their backs to me, were a man and a woman, each in smartly conservative suits, with leather folios of notes and papers before them. All three were served cappuccinos.

My ears pricked up when the conversation revealed that the man in jeans was confirming and signing the paperwork for a €38m personal loan: that’s not a conversation one hears every day, and not one that I would have expected to hear in such a public place. It turned out that the loan was to fund the purchase of a luxury boat from the man’s father, at below market value as it was partly being offered as a gift. The man intended to use the boat for general recreation, but also had designs on renting it out commercially for cruises, as acquaintances with similar boats were reputedly wont to do.

I know very little about luxury boats. I’ve seen articles in newspapers and magazines about million-pound super-yachts, but I can’t even conceive of what sort of vessel €38m buys you – let alone the full amount including the ‘gift’. I’d believe you if you told me this was a conversation about a four-bedroom yacht that one might sail into a small harbour, and I’d also believe you if you told me this was a conversation about a mini cruise ship with tens of rooms that would require dedicated port facilities. I’ve really no idea. And I’ve also no idea on what sort of terms a €38m personal loan would typically be offered: it’s never a conversation that’s crossed my mind, let alone one that I’m ever likely to take part in (especially if I spend all my money on expensive coffees in posh hotels). And so I was intrigued. Fay Weldon was not going to receive much attention as I sipped this particular latte.

As the conversation progressed, the man in jeans explained that he was confident in the arrangement because he was near certain that his pay cheques would cover the loan repayments whether or not he got round to renting the boat out (goodness only knows what his job was), and if he should fall on hard times, he could sell the boat and easily pay off the loan given that it was for less than the market value. So to this nosey parker, listening through the divider, the deal seemed as sensible as a loan to spend €38m on a boat ever could.

Yet just as he was on the verge of signing the paperwork, the man asked a question which confounded me: “Given that there are no arrangement fees, why are you charging me such as low interest rate?”

The man went onto explain that he was concerned that he had misread the wisdom of the deal. The loan provider had sent two members of staff to meet him in Amsterdam from their offices elsewhere in Europe, at presumably high cost to their firm. The amount of money being borrowed was substantial. The low interest rate meant that the profit they would make on the deal would be small in comparison with the outlay. Why, the man wanted to know, weren’t they pushing for more? Were they expecting that he would default on the loan, and that they would recoup a greater financial prize from the fallout? Were his assumptions about the safety of the deal wrong? What did they know that he didn’t?

This question confounded me because it’s not common to hear someone clarify the reasons for suspected undercharging. I’m not sure I would have done so—not that I’m ever likely to borrow €38m—because I think I would have been concerned that the lenders would raise their price to meet my expectations.

Yet on my way to Amsterdam, I’d just finished reading Thanks for the Feedback by Douglas Stone and Sheila Heen. This book makes the case that receiving feedback is an interactive process, and we should always seek to understand the point of view of the person giving the feedback. The interest rate on this loan is clearly a type of feedback from the lender.

By discussing the rate with the lenders, the man in jeans could either avoid a huge and costly financial miscalculation on his part, or could set his mind at rest. If the lenders had jacked up the rate in response to his question, he could always have taken his business elsewhere—and, of course, the lenders were unlikely to do so for exactly that reason.

The decision by the man in jeans to have this conversation could have only positive effects: and yet, it is a conversation that I would naturally have shied away from. I suppose, given that he was taking out a €38m loan, the man was probably more used to large scale financial transactions than me. It wouldn’t be an absurd supposition that his day job may be in the financial sector. Perhaps that is why he had he confidence that I would have lacked to initiate this conversation.

But that’s a very easy get-out for myself. What other conversations do I shy away from for illegitimate reasons? Do I avoid asking things that could help prevent me from making unwise decisions because I lack the confidence to ask them? There’s some food for thought and reflection.

And the answer to the man’s question? Simple, really, according to the lenders. Pricing for loans is risk-based. The loan is secured on the boat which is worth more than the total value of the loan regardless. The terms of the loan state that appropriate insurance must be in place. Even if the man fails to make his repayments, the risk of the lenders not receiving their capital back is very low: such low risk investments for such large amount of money are rare. And besides, even at a low interest rate, the lenders stand to make hundreds of thousands of Euros in pure profit, because a small percentage of a very big number is still a big number.

Before long, the paperwork was duly signed and all three were on their way. The meeting lasted twenty, maybe thirty minutes. If I were one of the lenders, travelling internationally for such a short meting would feel like a waste of time, even though I’d just brought in a huge amount of profit for my firm. But as someone travelling solely for pleasure, I think this was possibly one of the most thought-provoking and educational coffees I’ve sipped in a very long time.


Most of the pictures in this post are not my own, though I did post a nice picture I took at the Rijksmuseum in ‘real time’. In this post, the first picture (Amsterdam) is by Boudewijn “Bo” Boer; the second (a ship’s wheel) is by Maximilian Weisbecker; the third (Amsterdam again) is by Javier M; and the fourth is my own picture of a boat’s wake, co-incidentally taken from the back of the DFDS ferry to Amsterdam (though not on this trip). All are used with grateful thanks, and under the terms of their Creative Commons licences.

This 2,467th post was filed under: Miscellaneous, Posts delayed by 12 months, Travel, , , , .

Reflecting on my first ten years as a doctor

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.

This 2,450th post was filed under: Health, Posts delayed by 12 months, , , , .

Californian taxis, gun ownership and democracy

A couple of days ago, Wendy and I took a taxi from our hotel in San Diego to the airport, very kindly paid for by our hotel. The taxi driver was a chatty fellow and struck up the traditional “going to the airport” conversation beloved of taxi driver across the world.

Wendy mentioned that she was from Northern Ireland, which led to all the usual questions: Is that part of the UK? Is all of Ireland in the UK? Don’t the Northern Irish fight with the UK? Is Northern Ireland part of Brexit?


But then: What do people in the UK make of Trump?

Now, I thought we were on safe territory here. We were in California. Even I, as an uninformed Brit, knew California to be a true blue Democratic state. No Republican presidential candidate has won California this century.

Nevertheless, I played it safe with a politely non-committal response, suggesting that while Trump wasn’t personally very popular in the UK, Brits respected the outcome of the election, and the country is so interested in his impact that he’s rarely out of the British newspapers.

The taxi driver’s equal non-committal, “he’s surely shaking things up,” didn’t give any immediate indication of the transgression I’d made.


It was harder to remain neutral on his follow-up: “So what have you thought about guns while you’ve been here?”

Wendy’s eyes widened slightly as I admitted that I’d been slightly uncomfortable to see so many people with guns, from policemen on the streets to the border control officer who’d stamped our passport. This, I explained, was very different to the situation in the UK.

“But police are armed in the UK, right?”

I explained that a small number of officers carry weapons, and that there are armed rapid response units, but that the average police officer on the street carries nothing more threatening than a truncheon.


I’m afraid, dear reader, that this provoked a rant from our driver.

Firstly: “So that’s why you have so many terrorist attacks!”

Secondly, he asked whether I have heard of the campaigns in the UK for wider gun ownership. When I admitted ignorance, he blamed “the liberals that control your media”.

Thirdly, returning to California, he described his incredulity at the fact that he, both in his capacity as a private citizen and as a professional taxi driver, was not permitted to carry a concealed weapon. He told us how he was once, some years ago, robbed when getting out of his taxi. This would not, he suggested, have happened had he been carrying a concealed weapon.

Fourthly, he told us how Trump wants to allow anyone to carry a concealed weapon, and that this made him a great President. Our driver wasn’t sure that unrestricted concealed carrying of weapons would be allowed any time soon in California, because that state had “crazy laws” and a “corrupt Democratic governor”. He claimed that the Governor “hates guns and doesn’t want anyone to have them”.

Fifthly, he asks if we in the UK had ever heard of Crooked Hillary? “They call her that for a reason,” and one of the reasons is that she wanted to take away all the guns. Which would only lead to endless terrorist shootings like in the UK. He didn’t say that she should be locked up, but he might as well have done.

When I could get a word in edgeways, I pointed out that we had had no recent terrorist shootings in the UK. The driver said I was lying, that there was that arena attack in Manchester when all the kids were shot. I had no chance to point out that guns weren’t involved.

Sixthly, our driver told us that the many school shootings “around the world” were only being effectively tackled in the US, where upstanding citizens with guns shoot dead the shooters.

At this point, we pulled up outside Terminal 2 of Lindbergh Field and Wendy and I barrelled out of the taxi while thanking the driver excessively in a very British manner.

As he drove away, Wendy and I looked at one another and breathed. I think we were both in a sort of mild shock. The conversation made us reflect on how one can’t really have a sensible political conversation with someone whose factual frame of reference is so divorced from reality.

It made me reflect on the threat of “fake news” – a problem long before social media came along, but perhaps amplified by it. Continual exposure to counterfactual stories shifts one’s frame of reference, and make seemingly illogical conclusions entirely rational.

It made me reflect on how much more difficult political life must be these days: how can a politician ever thrive if their views are misrepresented even by their supporters and to their supporters? A politician cannot deliver on a promise they have never made, and cannot defend themselves against false accusations when every correction is percieved as a “cover-up”.

This conversation was something of an epiphany for me, helping me to see how broken this part of our society has become. In decades past, we lived in a world where the means of publication were (to all intents and purposes) controlled, and we could (by and large) distinguish fact from fiction. Today, anyone can publish anything, and few people have the will or means to verify any of it. We’ve moved from a world of limited reliable information to a world where every scrap of information is at our fingertips, but we can’t tell which morsels are fact and which are fiction. And yet, in a democracy, we rely on the population making that distinction accurately in order to make the right decisions for society.

I have no solutions to offer for any of this. In his book, Ryan Holiday suggests that subscription-based news is the answer, as it places value on truth over page views. The BBC likes to present itself as part of the answer. Tech companies sometimes suggest that the algorithmic triangulation of stories can play a role. People with minds more radical than mine might suggest that this is the time to find some other form of democracy than directly voting for a legislative representative.

I’ve no idea who is right. But in the course of one taxi journey, I’ve been convinced more than ever that an answer is urgently needed.


The taxi image at the top of this post is by Ad Meskens. It gives the slightly misleading impression that Wendy and I were travelling in a yellow cab, when in fact we were in more of van. The gun hoslter image in the middle of the post is by Takeshi Mano. Both images are used here under their Creative Commons licences.

This 2,448th post was filed under: News and Comment, Politics, Posts delayed by 12 months, Travel, , , , , .




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