Get Booked – Tim Howard, Let’s Kill All The Lawyers 291121

Hello, you're listening to Get Booked with me, Hazel Butterfield, for the Women's and Men's radio station. I love doing the show, talking to authors, chatting about anything and everything books related, and all the joy, enlightenment, and escape that good books can provide. Sit back and let us entertain you with a different guest each week, sharing who they are, what they do, and what inspires them. Today on the show, we we have Tim Howard, the author of Let's Kill All the Lawyers. Tim Howard is a doctor, a fourth-generation GP. His whole life has been about caring for patients. Tim trained at one of the best London hospitals and worked in an academic department there doing clever high-tech medicine, but realized that his real calling was in the homes and lives of patients in the community, providing long-term care. It was only when he realised that some, or lots, of medicine wasn't as good as he thought it was that, uh, that he became involved in these standards and regulation, trying to improve the system. Tim spent the latter part of his career as chairman of the Tribunal Service, which judges doctors who are accused of failing, thereby setting the standards for all UK doctors. It is this that has led him to question some of the standards of present-day medicine and to explore how and why the NHS is in the state that it is now. This has been the premise for the book to discuss today. Let's Kill All of the Lawyers is about a doctor, a good doctor doing his best for a difficult patient but being sued for doing so, and a solicitor, her marriage failing, beset by personal demons, trying to defend him in court. This story explores the difference between the law, justice, and fairness, and how it affects the lives of ordinary people who are doing their best in difficult circumstances, and how the life and death events can damage individuals, drive them apart, and ultimately bring them together. Mistakes— we all make them— but this book talks about the issues the NHS face due to constraints set and responsible for by those not on, on the front line, and are subject to daily criticism. I'm sure you've come across this so much, and I must say this book was a delight to read, not just for the story but the intricate mechanisms of the world of law and medicine. Let's get stuck in. Tim, hi, how are you? Hi Hazel, thank you very much for asking me onto the show. You're very welcome. I, I must say This book has had me enthralled. I mean, I'm one of these people anyway that likes to kind of think outside the box and be very mindful of, you know, we're very easy as a, especially as a westernized society to kind of blame the first person we come across, and they're often not the ones making the decisions. And I thoroughly loved the knowledge you have of the system and how sympathetic you are to so many different sides. You must have thoroughly loved putting your knowledge and expertise out there so that people can get a better understanding of what goes on, just so we can be nicer to each other. I think that's a really good way of putting it. I mean, I had a really privileged career as an old-fashioned GP. I was one of the old— the last of the group of GPs that regarded it as a lifetime dedicated issue, you know, looking after the same patients for year after year, delivering children, seeing them grow up, delivering their children, and taking them through all life's events. So that was a hugely privileged position to be in. And then we've come up against this huge dramatic change over the last few years where not only has medicine changed, doctoring has changed out of all recognition, but the expectations of the public, of the patients, have changed as well. And it produces tension, this dynamic tension between doctors and patients, between patients and the system, that is producing all the abrasion and angst that's going on at the moment. And it's, it's very, very sad to see because both sides have got a viewpoint. The doctors are trying, on the whole, they're trying their level best to do their best for their patients, and yet the patients feel very often that they're not getting what they want to need. Well, this is a situation where people who are at their most vulnerable and they're most emotional, whether it's happening to their self or a close friend or family member, and, you know, the first person they want to attack is the first person they come across who has not actually been responsible for the constraints that they're in. There are books like Adam Kay's This Is Going to Hurt where, you know, he went through the whole situation. I mean, it's an incredibly funny book with a very sad kind of underlying theme. And I just think, especially with what's going on, as we kind of said a little bit off air, how everyone's complaining about the wait times at the NHS, but at the end of the day, this is a system that is completely overwrought. It is overprescribed. There's not enough people to go around. And unfortunately, there's not enough money to actually pay enough people to actually be there. And yet they're exhausted because they're doing 12 and 14-hour days. And that is purely because, you know, if there aren't the staff, they've got the choice of either walking out at the end of their shift and just leaving nobody there. People, you know, you hear about people being left in corridors with nobody to look after them. But yeah, it's a sort of a terrible chronic vicious circle that we've managed to get ourselves into in the NHS. My son's GP, fifth generation, and he was telling me the other day that he was on call for his practice and he had 90 requests for appointments in a day for himself. Now that is simply impractical, so somehow he has to decide who he's going to see, who really needs seeing, and who can be managed, dealt with, and their problems solved by other members of the team. So that means triaging. That means somebody at some stage asking the question, is this urgent? Where is your— is this a pain? Is it something that can be dealt with by a physiotherapist? Is this something that can be dealt with? So on. And people don't like that. They hark back to the good old days of the personal doctor, the person they knew and trusted. And I hate to say it, those days are gone. They simply cannot exist anymore with the expectations and demands of the workforce, the number of GPs are actually falling despite the, the, uh, the evidence that you had to the contrary from some sources. But the number of whole-time equivalents are falling, and I hate to say this too, GPs are leaving in droves because they can't manage continuous intense 70-hour weeks anymore, which is the sort of standard full-time GP workload. So they're either cutting back or they're leaving early. Well, they're damned if they do and they're damned if they don't. Exactly, exactly. It's a no-win situation. I mean, I've spent a great chunk of my life— I used to be involved in managing GPs and I directed— was a director of a health authority for a while, so I've been involved in trying to analyze what the drivers are for this odd situation we've managed to get ourselves in over the last 20 or 30 years. And it's not all down to one thing. It's not down to government, it's not down to the public, it's not down to over-demanding patients. It's an accumulation of a multitude of small factors. There is absolutely no doubt that, like most nationalised industries, government with a small g does not run the health service very rationally, sensibly, and I've I've got the scars to prove that from challenging senior officials, ministers, over many years about some of the more potty decisions and requirements that are imposed on both general GPs and hospital specialists as well. But things like, for instance, the present one, the face-to-face appointments, which is the present sort of public thing— I want to see my doctor. Last year we had a minister, Hancock, who said the future of general practice is it's all going to be online. This year we've got a minister saying, I'm sorry, GPs have got to see any patient face to face when they want to be seen. Now you can't have two leaders of an organization just saying exact opposites, but that's what's happened because they are, let's face it, politicians. Neither of them knows a damn thing about general practice, and so they're just responding to the wind that's blowing. And, um, it, it, it is very frustrating for those at the coalface who get the flak, they get aggression, they get real, real anger, um, forced on them. People are deeply offended when they ask to see their doctors and they are told, 'I'm terribly sorry, the doctor is saturated, he's completely overwhelmed with a a tsunami of work and he can't see you for 3 days or 5 days or a week, so you have to tell us whether it's urgent. So inevitably they then go to A&E, and A&E is what it says it is, it's accidents and emergencies. It's not there for long-standing problems, it's not there to manage chronic backache, it's not there to deal with the normal headaches that we all get. They're seeing relatively new junior doctors who are trained in accident and emergency work, not in a separate specialty, general practice, for which you need training. I think you, you wrote about this so sympathetically, because you read a lot of books where neurologists hate psychologists, and surgeons hate this, and GPs hate A&E, and A&E blame the GP, Exactly. And at no point do you actually do that. You explain the nuance of the difference. Now, you hear so many people say, can't get an appointment with my doctor, so you're best just going to A&E because somebody will be able to see you, albeit you'll have to wait. However, GPs actually have separate training to learn to be a GP, whereas accident and emergency, they're nurses and doctors who have trained to be in that particular scenario. They're not incompetent, they are just trying to deal with different elements of health, and it's— and then that's where everything falls down. Exactly true, exactly true. People tended to think, and I suspect a lot of people still think, that GPs are merely doctors who can't hack it in hospital. In fact, the exact opposite is true. It's a specialism a specialist training, just in the same way as becoming surgeons, especially say training as a psychiatrist or whatever. You, you have very intense one-to-one training for a long time after you've qualified and done your basic hospital training work as a junior doctor in order to become a qualified GP. And you have to pass an exit exam that proves that you're competent, and it's actually a very challenging exam. I'm not sure I could pass it now, but it's, it's The idea that the GP is just somebody who deals with things that the hospital can't deal with is long gone now, and I'm not sure that the general public is very much aware of that. To give a very simple example, I mean, a GP really is about managing— I've used the word in the book, I've used the word risk. Risk is a bad word because it implies You should never take a risk with anybody. I'll give you an example of it. Every single one of us gets a headache. Every single person in the country gets a headache a few times a year. I don't know anybody who doesn't get the odd headache. If every headache was fully investigated by— to hospital standards, we'd all be having brain scans 2 or 3 times a year. So the job of the GP is to manage the risk that the 1 in 10,000 headaches that is actually a symptom of major underlying disease that needs treating isn't missed. So he's managing, he's acting as a sieve, he or she is acting as a sieve. They're trying to make a judgment about what they see in front of them, and they can't do all the clever tests, but the patient they see in front of them with the headache or the mild chest pain or the tummy pain or the back pain or whatever it happens to be is actually presenting with something that is just part of being human, the normal aches and pains we all get, or whether it's a symptom of severe significant underlying disease. And that is a judgment, and there's no such thing as a human who makes perfect judgments. So sometimes, occasionally judgments turn out to be wrong with hindsight. And the current tenor of our society has been in blame people. I say, if he'd realized that my child who had a cold was going to go on to get meningitis, and so I'm going to take him to the cleaners and blame him and make sure he never damages another child. And I've heard that said in court, you know, and it's a very difficult to get over this idea that actually the GPs are presented with a huge range of, of unwell children, but only 1 in 10,000 of them will go on to have the significant disease such as meningitis. Interestingly, I, I managed to catch meningitis myself when I was 50, and I didn't recognize it in myself. So it shows to show it's not that easy to know how things are going to develop. Are doctors the worst patients though? Oh, we're a complete nightmare, absolute nightmare. Yeah, I know. I've had two quite long sessions in hospital myself, both when I was working as a GP. Once was an injury and once was with the meningitis, and I was— they must have cursed the day that they admitted me, I think. I probably made a hell of a fuss. Well, I think also you have to remember that people are overworked. Nurses can do 14-hour days, and yet then you can't. If I worked a 14-hour day, I would be tired, grumpy, making mistakes. I'd be walking around like an absolute zombie, and yet they have no other choice, and it puts them in a situation where they can make mistakes. And exactly, interestingly, it's not so much the length of time, it's the intensity of work. Oh yes, the constant decision-making and this constant sort of black crow on your shoulder. Am I making a mistake? Is somebody going to suffer as a result of a wrong judgment I'm making? I've got to look at, what should we say, 100 blood results in an evening after I get home. 'And, you know, gosh, is that one that's just marginally outside normal— could that be an indication that something's going wrong? Should I repeat it? Should I not repeat it? Was it something that the hospital did and the hospital should be checking up on?' And so on and so on and so on. And so there's this sort of black crow of anxiety on people's shoulders now because of the concept of blame. And blame is awful. I think it's partly because Doctors as a group are brought up to care for people and to put their emotional arms around people and be nice to people on the whole, and therefore they take terrible offense and get terribly upset when the person turns around and bites them. Interesting, I've watched this in lawyers as well, having worked with a lot of lawyers, and they didn't seem to worry nearly as much when they're sued or could be sued because their job is— of course That's part of their everyday life. But doctors seem to take it terribly badly. And I mean, I've had experience of being sued, and it nearly broke me. It really— I found it just beyond words awful because I thought I'd failed. In fact, you know, it was— it all came out in the wash in the end, and, and it was just a patient taking out their angst and distress and anger at what life had thrown at them. And I happen to be the nearest person in the firing line. But interestingly, actually, what is quite interesting though is that we are all human, we do make mistakes, and there are ambulance chasers out there, but there are some people who are genuinely feeling like that they have been wronged. And in any single profession, as we've actually seen in the police force as well, where, you know, the majority of of the police force are out there to really do as much good as possible, but there are bad eggs in every profession, and when they have been negligent, they should be made accountable and hopefully not being able to make the same mistakes with somebody else. Exactly. And sometimes the process needs to happen just to ascertain actually if that is the situation, and so there is an element of some of it needs to happen, but it happens way too but it is a situation where people are hugely emotional and at their most vulnerable. And also some people are just trying to make a quick buck because you have the no-win, no-fee basis, which has completely destroyed humanity, which is basically what Let's Kill All the Lawyers is about. And I must say, as I was reading this book, I kind of had a little bit of a glint in my eye thinking that this felt like a little bit of a love letter to your career? That's a deeply observant thing to say. Yes, I think you're probably right. I mean, basically I wrote it as a— it is a love story tied around two people who've been emotionally battered by what's happened to them. And it happened to be one was a lawyer and one was a doctor. But I think that's amazingly observant of you to say it's a love letter to my career. It is, because although it's a— I mean, it is a wonderful career to have, being a doctor, and in my case a GP. It's got its ups and downs, but it's still an extraordinarily privileged career to be let into people's lives in the way that we are as doctors. And leaving it, going on to something else as I did, I found almost a bereavement. I really, really missed my patients. I was sad for them. And I'm one of the old-fashioned doctors that lives on the patch and have always done so. And still now, 20 years on since I went on to do another career, I see my old patients when I go to the co-op to buy some milk, and they still say, 'Hello, Doctor, nice to see you. By the way, I've had this rash. What do you think it is?' And, you know, I, I, I, you know, it sounds arrogant to say this, but it actually warms the cockles of my heart to get included in their lives still. Yes, because you have been there for some of the great times and the worst times. Sometimes you get to give incredible— you get to give beautiful and incredible news and good news, and you also get to give bad news, but you also get to be a part of delivering that bad news in the best way possible to ensure their well-being. It's a skill, it's a great skill, delivering bad news. I used to give a lecture to it on it to junior doctors, and it is a— it's an art, you know, how to let people down charmingly and gently, how to be honest without being pessimistic, and it is a skill. And, you know, as you will have probably noticed, quite a bit of Let's Kill All the Lawyers is about death and dying and the descriptions of death and dying and coming to terms with it. The book. And I'm involved with wearing another hat in, in the whole process of how people should be allowed to die and whether medicine goes on treating people too vigorously when the real benefits of treatment are less than the public expects. And, and so I think that trying to find a balance between what is good for patients and them coming to terms with the fact that they're nearing the end of their life is a— is what— it's an impossible thing to do perfectly, but at least we should all be trying to do it. And of course, that gets lost in the chaos and rush of an accident emergency department or a busy acute ward or a GP overwhelmed with dozens and dozens of patients a day. And that's one of the great sadnesses of the present situation. There simply isn't time to do the very best for the individual patient. See, well, I've got this fantastic story to tell you about. I'm part of a dog walking group. We all go out, there's a bunch of mums, and one of them is a GP. We take our dog and we basically shoot the breeze for an hour or two and then go off back to our lives, kind of feel like we've been cleansed a little bit. And I remember speaking to my friend Anita, who's a GP, And she explained that, you know, sometimes you have to try and find ways around the system that is unfortunately having so many different waiting lists for things like psychology as well, where people need immediate care, but there's just, you know, there are too many constraints. And she turned around to me and she said that there was a lady that was very, very panicked. She was feeling very isolated and she she kind of felt like she was getting very agoraphobic and she needed to get on the list as soon as possible. And it was going to be a couple of months before she could be seen. And so she turned around to us and said, listen, I think this is terrible for you, but what I want you to do is to just treat yourself and give yourself something to look forward to every single day. I want you to go down to the local shop, just say hello to somebody and get yourself a chocolate bar. And each day treat yourself to something. And she completely wrapped it up when all it was, she was trying to make sure that this woman had a reason to leave the house every single day. Mm. And it's just something so simple, but GPs need to have a level of autonomy over what they're doing, not doing things letter of the law. You know, she can't— it's not something she prescribed. It was a bit of advice and it was completely wrapped up in a different motive. And I just think it's beautiful. It, it, I think that's the right word for it. It's a classic example of what a competent, sensible, lateral thinking doctor could and should be doing, and, and what a competent, caring GP would love to be able to do if he or she had the time in their normal practice. Interestingly, um, you know that the whole principle of a primary care team is now taking over from the idea of a personalized doctor, because the doctors simply haven't got time to see everybody and do everything, and they're not very good at it anyway because you can't, you can't know everything about everything. And many GPs, certainly in larger practices now, are setting up wellness processes whereby the GP manages a whole team of which is a physiotherapist, occupational therapist, psychologists, counselors, and so on and so on. And patients find or directed to the most appropriate place to help them. And my experience was that when I set this up donkeys years ago, we had in-house psychologist who had a single quick appointment with somebody who is distressed or lost or anxiety-driven or agoraphobic. And if they had a single, quite often quite short, 15-20 minute appointment with a psychologist within a week of being presenting to the GP, that our number of referrals to psychiatry, to specialist care, reduced by about 60 to 70%. In other words, catching the problem early and providing the right technical skills in a gently directive fashion can stop the problem becoming established. Well, it's worry, isn't it? Worry playing on the mind, it messes with your mindset. And we're all worried, we're all worried at the moment. We've got all these things going on, we've been through a huge episode, COVID, which is, whatever we say, is frightening and it's still going on. We've got this great big black angry cloud hanging over all of us of global warming, sort of muttering away in the distance. So it produces a chronic intractable sense of mild distressed anxiety in all of us. We all worry about this, you know, are we doing the right thing? Are we doing enough? What's going to happen if— can we pay back the national debt? Am I going to lose my job? All these things stress Everybody, to a greater or lesser degree. Um, will I be able to get into hospital when I really need it? You know, a big stressor for the elderly especially. Um, and these all combine to produce this tension in our lives which drives people to seek help. Their first port of call is usually the general practice, but the general practice is now saturated by it. I mean, Demand for appointments in general practice has gone up by a third in the last 18 months, 2 years. Now, people aren't a third iller, they're just a third more concerned about things than they're ill. Sure, there's a backlog and the rest of it, but GPs are having to— they're having to do the vaccinations. You know, my son's practice has given 50,000 injections. That takes a bit of organizing. They're having to manage the patients who are on the secondary care waiting list. You know, we're talking about 5.5 million people waiting for operations. Those have got to be managed by somebody, so they're managed by GPs. They're managing still people with COVID They're managing the chronic anxiety, and they're managing their ordinary routine day-to-day work of supervising long-term conditions. And so this has all produced a, you know, corny phrase, a perfect storm of pressure on primary care, which is now risking breaking it. And I don't think any of us know how to solve that. It's going to be solved by a multitude of small actions, but it's not helped when you've got ministers making threatening noises saying, you know, we're going to name and shame GPs because, you know, I think that was a completely outrageous thing to do. Well, it's passing the buck, isn't it? It's just blaming some— blaming GPs for being busy, you know, and it's almost— it's the Captain Blythe school of management, isn't it? The beatings will continue until morale improves. Have you heard that phrase before? Yes, yes. Isn't that counterproductive? And in Interestingly as well, and ironically, medical advancements and quality of care have now meant that people are living a good 15, 20 years longer. So people are— that increases demand as well because people are here for longer. And yet as they age, in the latter ages, that is when things start to— Absolutely. Go a little bit— which is, again, this is something that's brought up in Let's 'Kill All the Lawyers.' And we must, we must move on to the book, which I just think I thoroughly— I enjoyed it. There were so many elements to this book, and you did take on different stances all the way through, but predominantly it's told from the side of the female lawyer. Yes, I find I always tend to write stories through the eyes of ladies. I don't know why, you know, there's nothing in there, I just find it easier to write that way, maybe because I spent the first 10 years of my life actually being a ladies' doctor doing obstetrics and gynaecology. It was a great interest early in my career. You really did get the point of view quite bang on actually, because it was not, it's not just necessarily from the viewpoint of a lawyer, which I'm sure as you've said you've unfortunately been at the unfortunate end of the whole legal system, but also a working mum who's trying to balance everything. And I've been in that situation before as well, and you have that situation of, do you be that female person in the office who lets people down because your kids are ill? Exactly. It's, it's, it's the whole impossible tension that ladies have, isn't it? This, this dual role of achieving professionally and at work and still being the prime mover at home in terms of childcare and childhood. And however good husbands are— and I speak as a completely useless husband— I hardly met my kids until they were about 10 because I was just working continuously. And I'm deeply saddened and ashamed by that. And interesting, my father was GP, it was just the same. I know I simply never ever saw him when I was a child, and I'm afraid I fell into the same trap. I've watched with great, um, relief the way my son has managed to avoid that. He is a brilliant father, and even though he's a desperately busy GP, he is there for his kids. So he was much better at it, he is much better than I ever was, but, but still the main onus falls on on ladies for mothering and childcare. And then on top of that, they have to confront the glass, the professional glass ceiling, the, the arrogant male-dominated professions and all those things. Now I've watched and counseled and supported professional ladies confronting those issues throughout my career, and it's still going on. It's— do you know what happened? I used to work for a company, a quite high-end net wealth company who— it was run by very Eton-based men and one of my— That's a cynical statement. Well, let me tell you something. I went to one of the other big public schools so I'm not qualified to ask. It was interesting because my work colleague who was one of the pension advisors, he got the call from his wife who was a GP, quite a high-end, a high-up GP who was actually dealing with somebody very high up in the government, not allowed to say who, and she turned around and said, 'Our daughter's nursery has called, can you go and collect her because I've got back-to-back appointments today.' And he said, "Yes, not a problem," because he, to be fair, he was just in the office all day, didn't actually have appointments, but he turned around to his boss, a very kind of, as I say, it was the whole Eton kind of ethos. And he said, "I've got to go home and pick up my daughter." He turned around and said, "Surely that's your wife's job. And if she didn't want to have, if she didn't have the time to have children, maybe she shouldn't have had them." Oh God, it makes you cringe, doesn't it? Oh, I mean, I know we shouldn't put an onus on who's more important, especially when it comes to who takes the roles in terms of parenting, but he turned around and said, I don't have appointments today, and even if he did, they were only to discuss someone's pension that could easily be put off, you know, up until months, and he took that decision. Yeah, good for him, but I suspect he's in a minority. Wasn't it? Yes, but he was ridiculed for months afterwards. Really? It was appalling, so yeah. I'm sorry, but this does happen and it's getting so much better. And the concept of paternity leave, the more progressive companies encourage it because the nicer you treat your employees, the more they'll stay, which ultimately means that your company will be more profitable. But this does still happen. And I know I have 100% responsibility for my children. I am divorced, but even when before I was divorced, it was 100% my issue. And, you know, if I couldn't leave work to go and pick up my children, I would have to find a friend that could do it, which is exactly what she did in this book. Yeah, so I thought it was very astute of you the way that you actually portrayed her. Well, it's something I've come across. I mean, as you probably know, the majority of people entering general practice now are ladies, not men. It is well over 50%, a female profession now, and increasing. And that inevitably is going to lead to all these things like portfolio working, part-time working, childcare allowance, and all these kind of things are going to have to come into play. People say, 'My GP is never there.' They don't think that maybe she's looking after her children, who's got a child who's got flu. It's a balancing act, it's a balancing act, isn't it? It is a balancing act, you know, and if you do look after your children and then you're going to get what they've got and then you can't go in. You've got to— the thing is, it's books like this, and yes, we must point out it is— Let's Kill All the Lawyers is fiction. I'm sure it's based on a lot of truth here and there kind of weaved into it. I couldn't possibly comment. I'm sure. But the thing is, it's books like this that help us to kind of not only entertain us but help us to understand the intricacies of the system, the law system, the NHS, the constraints people have. And the more we read books like this that are entertaining, the more we can understand about other people and the constraints they have and just have a little bit more compassion and kindness towards each other. People, you know, doctors are not seeing you because they can't be bothered. It's because they are overrun and they've got the choice of, you know, there's this whole 7-minute issue where they're only allowed 7 minutes, but they're supposed— they're in trouble if they go over, they're in trouble if they don't find out what's exactly wrong in 7 minutes. I mean, we've been chatting for nearly 40 minutes and have barely even talked about the book, and this is a book show, you know. Yes, it's— well, it's— it— you're completely and totally right. Yeah, you feel as— I know the GPs and them all feel they're damned if they do and they're damned if they don't, and, and they just get beaten up by all sides and then blamed by the government. And yet it, it doesn't— it doesn't help anybody to behave as so many employers and organizations and government departments are at the moment. It's not achieving anything, it's merely destructive. And reacting to headlines, you know, the reactive dog bark to headlines. And until we can somehow sit down and make some objective decision about sharing the responsibility for running our lives, the way that GPs have now taken on the pastoral care that 50, 70 years ago vicars used to have, they're the sort of repository of all society's ills and angst. And if society wants that, fine, I've got no problem with that, but they've got to realize that you're going to need an awful lot more people, and those people take 10 years to train. This is so incredibly overwhelming, isn't it? It's a big, biggest, big problem, and there's not going to be a simple answer. One of the great problems, I think, is we look for simple answers, and certainly government looks for simple shit. Term answers. I mean, there isn't a simple answer though, because it's not— it's, as you said, it's a multitude, a vast multitude of different issues. Because some patients are ridiculous, some are annoying, some are just wanting to make money, some doctors aren't the best, some nurses are exhausted, or they've gone into it for the wrong reason, or people are just having issues at home. And I must say, the way that you kind of— there were so many different elements, even the judges as well, the way you talked about the perspective of the different judges that were evident in this book, Let's Kill All the Lawyers. And also the way that the main character, the lawyer that's representing the doctor that's come under scrutiny, the way that the constant guilt and actually It is normal to kind of let your kids down a bit when you're, you're being pulled in so many different directions, and then you're constantly trying to deal with an ex that really isn't making your life easy, and you're, you're constantly thinking that people are seeing more of your failures. We all do that. I mean, I think it's more a female trait where we think people I think you're right. These things sticking out of our heads, you know, I forgot to give my kids a nutritious breakfast this morning. Yes, I think you're right. I sent them in with the wrong pot. I mean, do you know what? I once sent my kid in with— I'd made this beautiful pasta the night before for the, you know, he needed to be nutritious for his packed lunch. He never had school dinners. And I felt so good about myself. And then I got called by them to say that I'd sent them in with the full margarine pot rather than actually— Oh my God! And I was like, I'm such a failure! But you know, the intentions were there. Did they have to— did they have diarrhea that evening? He didn't eat it. Actually, it was butter, not margarine. No, he didn't eat it because he wouldn't. But I was just like, oh, it sounds— it reminds me of the situation that happened to us. We've got a Lurcher, and as you probably know, Lurcher dogs are complete seeds. And we left a dozen eggs and a pound of butter out to make an omelette one evening, and the leprechaun jumped up on the work surface and ate the lot in a single thing, and he pooed omelettes for 3 days. Oh no! In the house or out the house? Outside, luckily, mostly. Oh well, the foxes would have loved that, but I should possibly not digress too much. Oh, that's so scary! But again, it's just sometimes we're just human, we make mistakes, we leave things out, and in retrospect, yeah, the lurcher can easily reach the side and it's going to be able to get those. Yeah, yeah. I have a beagle, I mean. Oh gosh, yeah, brilliant. Well, the beagle is actually— I must point out to our listeners that I might sound a little bit different to how I usually sound on Get Booked because I do have the Lurgi, and so my voice is sounding kind of a little bit dodgy, and my son is currently off school because I very kindly and generously gave him the Lurgi, and the beagle is now looking after him. She's playing nurse. Oh really? Well, my Lurch is sitting on my feet. Oh, how very good of it! I bet your Lurch has absolutely loved lockdown. Oh, grotesquely spoiled, much more than the children ever were. My dog looks at me now and says, "I don't understand, you keep on going out of the house and not 'What's going on?' They have no idea. Now, something that I like to ask all of my guests that come on to Get Booked, there's two questions. The first one is, and I'm sure as a doctor you have some quite, quite an interesting answer to this, is your three top tips on just good mental health and mental well-being. Oh, interesting. Well, I think that, gosh, off the top of my head, the first most important one is don't punish yourself. We've all got that little chattering voice in our minds that leads you off into the blind alleys to which there aren't solutions, you know, the 'if only I'd done that' kind of thoughts. Don't beat yourself up, don't punish yourself, don't let your little chattering voice upset you in a way that is self-destructive. And especially the other side of the same coin is don't beat yourself up about things you can't control. Don't get angry at the government or your boss or the shouty people on social media or in the press. Leave them to it, that's their problem. Walk by on the other side, don't let them get to you because otherwise you join in the shouting and it hurts and it damages your peace of mind. And I suppose then the last thing is, and I've said this to any number of patients, you can't do better than your best. If you've tried your hardest, what more can you do? You cannot be perfect, none of us are perfect, and so it's just about doing the best you feel you can, whatever your circumstances and whatever your skills and so on. And then it all comes down to the, you know, I happen to love poetry, it all comes down to that lovely poem that Philip Larkin wrote, in which the last line, I think it's called, what's it called, Arundel Tomb, He says in the last line, "All that will survive of us is love." I love that. Yeah, it's beautiful, isn't it? So I'm really— I feel the message I would say to people in answer to your question is be kind to yourself as well as to other people. Do you know what? And it's the intentions in the kindness as well. But I've said to people so often, if you're just honest and genuine with how much you're trying, that means so much more. Even if you can't achieve whatever it is that you really want to, the fact that you're trying is worth so much more. Do you know, you, you've actually said something very important, I think. I used to say to— I never had any anxiety about saying to my patients, I don't know what this is, as long as I then said, well, I know a way of finding out, I know a man who can. And patients seem to respect that, didn't seem to worry them if I said, I don't know what this pain is, or I haven't a clue what that rash is, let's find out together, I'll ring a specialist or I'll whatever. And that seemed to reassure them. So it's about honesty, isn't it? Yeah, because I mean, first of all, that's human and we can relate to people who are being human It's those that kind of fob us off with bluster. I suppose that's possibly the element of the lawyers and the silks in the book. Well, yes, it's the medical and legal art of bullshit, isn't it? Yeah, yeah, completely. Yeah, but I mean, it's one of the things I've tried to— wanted to try and get over in Let's Kill All the Liars, which is the difference between the touchy-feely caring bit of medicine and the very cut-and-dried competitive confrontational bit of the law. And that one is, as I say, touchy-feely, the other is about winning and losing. And the winning and losing is a very blunt way of deciding whether somebody did their best, whether they did something right, whether they made an honest mistake, or whether they were just being judgmental and beating them up. Because somebody has suffered somewhere down the line. And so I think this confrontation, this dynamic tension between medicine and the law, is something that needs exploring and, I think, developing in a constructive rather than a destructive way, which is what the law tends to do at the moment. But that's a big subject and I could bore you for hours on it. Well, I do like how you— the section in the book where the doctor is actually speaking to the lawyer on Box Hill where I like the way that the conversation was brought neatly round to how you would change things if you could, and I was like, this is the love letter element as well, isn't it? Yes, yes, yes. Well, there you see, I'm doing— I'm disobeying one of the things I've just told you you shouldn't do, which is challenging something I can't change, so I'm tilting at windmills myself. But unfortunately, this is the thing, this is the downside of human nature as well. We are all different and not one answer would suit all, in the same way that how the pandemic was dealt with, it's not going— one answer is not going to suit everybody. Exactly. And there's, you know, it's such a tricky subject and as Brits do like to basically put a spanner in the works for absolutely anything. And now another question that I like to ask all my guests here at Get Booked is, um, who do you admire in the public eye? And the reason why I ask this is that there's definitely, with the prominence of social media, people seem to follow people that make them feel bad about themselves for whatever reason. You know, why, why keep on looking at this person who's just had 72 children, is a size 6, and just seems to eat mung beans looks fantastic. It's unrealistic and it's going to make us feel bad about ourselves, but yet we can't stop looking. Whereas there are people out there that are funny, self-deprecating, or they're just inspiring. And I want to encourage my listeners to try and veer off in that direction. So I love what quite often my guests come out with, some of the fantastic ideas of who they've seen in the public eye that that are just adding to their world, and who would that be for you? Well, thank you for talking for 2 minutes to give me time to think. You are welcome. Says he, panicking gently. I— it's 2 people spring to my mind, again just off the top of my head. The first is somebody I've admired for a long time because I think she epitomises common sense She talks more political and practical sense than any other politician I've heard in the last 20, 30 years, and that's Ruth Davidson, who has just become Baroness Davidson. She was, I think, when she was leader of the Conservatives in Scotland, the Scottish Parliament, for a while, and she's just been made a Baroness, and she's an absolutely brilliant lady. She's tragically— she's given up frontline politics because she's made the very wise decision to become a parent herself and has got a new child. And I think she's the most brilliant woman, and as I say, I think she'd be a brilliant leader of the country and quite exceptional. The other woman that springs to mind is the woman who has actually saved all our lives, who is The lady who produced the Oxford-Zeneca vaccine, who's just got a knighthood, a damehood, isn't she? Her name is— is it Sarah Gilbert? I can't think of— I can't remember off the top of my head, but she is a classic example of somebody who has a skill acquired backroom, not publicized skill. It's not being shouted from the rooftops on social media, it's not being screamed out from the television, but when COVID hit, she sat down and created a team and worked for hundreds of hours, hundreds and hundreds and hundreds of hours, 7 days a week for 6 months, and she produced a vaccine in 6 months that would normally take 7 years to produce, and I think that's the most extraordinary achievement. It's incredible, isn't it? It's quite amazing. I mean, it is, it is the very best of science, and she's achieved things, and she's saved tens of thousands of lives by so doing. Interesting that both of these are ladies. Well, yeah, I have noticed that. And just to confirm, it is definitely Sarah Catherine Gill but I just had a quick— Yes, thank you. Sorry, my memory is going. I'm aged, my memory is cracking up. Oh, you can't use age as an excuse. My memory's going as well, but I just think that's because my brain is constantly going off in so many different directions. You must be incredibly busy. I mean, your book got released on the 28th of October. You must be busy promoting it and chatting to people. Yeah. And whatnot. How's that actually been for you? Well, it's been very exciting actually. I mean, I, I produced it, um, really for myself. I, you know, I was amazed when it sold a few copies, and I'd be absolutely thrilled if it sold a few more, um, because I wrote it very specifically to try and give messages, um, as well as to, to, to tell a story and work out my own personal angst over what had what had hurt me during my career. So it was a therapeutic thing but also about sending messages. And yeah, it's been— I've been amazed at the way people have been interested in it and have followed it up and have wanted to actually talk about it and interview me about it. And that's been very exciting. It's opened a whole new world for me. And it keeps you out of trouble as well, doesn't it? Yeah, it keeps me out of the kitchen, that's the main thing. I do, I think Let's Kill All the Lawyers, it's hugely clever and very multi-layered, and I know I said this earlier in the show, but I think it's so important for people to, even though it's really entertaining, you see on these underlying themes of it that I just think we have a responsibility to understand a little bit more about what's going on. We're always so quick to judge or go for the jugular when we just need to understand. And, and you know what, it is so, it's so easy to just go for the, the person that's, you know, front-facing, when in fact, yes, you know, yes, just as annoyed, just as upset. I remember actually interviewing somebody once, um, she was in an A&E doctor, and she said she's gone to university, you know, done training for about 7 years, and she's on less than most people who are working at McDonald's because of how the hours work out and what she actually gets paid. And yet there's this whole idea that GPs are on ridiculously high salaries, sitting in there, you know, whichever house they choose to sit in that evening, and going going around in their Range Rovers, when actually, do you know what, those that are lucky enough to be in that position have normally had to really go through the mill beforehand. I can't say that— I agree absolutely. I mean, there is this sort of silly image of this, isn't there? I mean, I can't think of any GPs who live in luxurious houses and drive Range Rovers. If they are, they've got it probably because their wives work too hard as well. And, and, uh, it's, you know, it's a, it's a good career and it's reasonably well paid. Nothing like as well paid as in Australia or Canada or the rest of it, but that's neither here nor there. You know, you choose to go into profession and you take the pay with everything else, the ups and downs. And it, it's, it's a privileged job to do and it's secure. You GPs don't get made redundant unless I happen to strike them off wearing my other hat for making a cock-up. But the, the, it, to me, it's about the huge privilege and the, the fascination of dealing with humankind in its most needy situations and complex situations. But sadly, that is being interrupted, and the ability to deal with it in the best possible way is being interrupted by— I hate to say this— pretty stupid governance from government and pretty overwhelming demand. And so we've gone, we've talked about that, but we've not, so we've gone full circle. We have indeed, and we're actually running out of time. We've just got a couple of minutes left, and what I would like to talk to you about, because I know there's quite a few of our listeners, they have a book in them as well, and they're quite intrigued about the whole process Could you tell us a little bit about how you wrote this book? It's got 350-odd pages, it's full of so much information that I don't know whether this came straight off the top of your head or whether you had to go back and do a bit more research, but I'd love to know a little bit about the process. Well, I mean, I think it sort of, to me, it festered away or mulled away in the back of my mind. For some time, you know, I thought that there was a story in there which arose from multiple events during my career, and I felt it gradually coalesced. And then when I actually finally finished work about 2, 2 and a half years ago, I actually sort of said, right, okay, I need to sit down and write it. I just sat down at the computer for 3 hours every morning and wrote. And then spent a long time editing out the complete crap that was— that I'd written in there. Huge, huge rants about this and that and hobbyhorses I got on. And, you know, whole sections and chapters I had to throw away because they were just awful. And so editing it was harder work than writing it. The writing bit was relatively easy once one had got some vague story. I didn't write careful notes about plots or anything like that. I just let it just pour out and see what happened and then fiddle with it when it, when, when it did come out. And research, you know, it's very— it is, we're lucky, it's very easy to do research now. We've got this thing called Wikipedia, and you can search pretty easily about the process that, in my case, I wanted the process of the way the court system works. Although I knew some of it already from my work, the way that solicitors work and so on. You can easily check up on those or just ask people. People don't mind, they love being asked. People like telling you about their knowledge in the same way as people like telling you about their illnesses. They like to share things. And if you ask gently and politely, you often get a huge amount of information without too much pushing. Wow. And yes, did it feel quite cathartic as well to get that out onto the page? Yeah. Put that opinion out there? Yes, it was. Yes, it was. Yes, I enjoyed doing it. Yes. Well, I must say, I thoroughly loved it. Just a quick reminder to all of our listeners, it's Let 'Let's Kill All the Lawyers' by Tim Howard. This is— you can actually find a link on my website on one of the latest blog posts with a little bit of a review there, but you can find it on Amazon quite easily, and I think it's £8.99 at the moment, published by Brown Dog Books, and you can even get it on ebook as well depending on how they want to consume it. Do you think you're going to be going down the audiobook route? I hadn't thought about it really, what do you think? Do you think people use audiobooks in that way? Yes, completely. I mean, I do all three because I like, I think they've all got their benefits. Can I commission you to read it then? Yes, can we wait until I've lost my lurgy so that my voice is okay? You're on, definitely. There we go, we've sorted all that out. Thank you so much, Tim, I And it's available in all good bookshops. It is indeed, yeah. Thank you so much for coming on to Get Booked for Women's and Men's Radio Station and giving us your time and having a good old chinwag with me. I thoroughly enjoyed it. Thank you very much, Hazel. It's been a pleasure and a privilege talking to you. Thanks. You're welcome. I'm Hazel Butterfield and you've been listening to Get Booked for Women's and Men's Radio Station. If you want to catch up on previous shows, you can do at womensradiostation.com/shows/get-booked, or you can check us out on SoundCloud. Alternatively, pop onto hazelbutterfield.com, and there's all the links up on there to make it nice and easy for you.