{"id":106326,"date":"2025-09-01T05:51:03","date_gmt":"2025-09-01T05:51:03","guid":{"rendered":"https:\/\/www.newsbeep.com\/uk\/106326\/"},"modified":"2025-09-01T05:51:03","modified_gmt":"2025-09-01T05:51:03","slug":"youre-the-only-port-of-call-for-400-hospital-patients-which-is-absurd-matthew-hutchinson-on-the-perils-of-life-as-an-nhs-doctor-doctors","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/uk\/106326\/","title":{"rendered":"\u2018You\u2019re the only port of call for 400 hospital patients, which is absurd\u2019: Matthew Hutchinson on the perils of life as an NHS doctor | Doctors"},"content":{"rendered":"

Are You Really the Doctor?, Matthew Hutchinson\u2019s memoir of being a black doctor in the NHS, opens in A&E with a patient suffering from a thunderclap headache and taking time out from his excruciating pain to complain that Hutchinson is \u201cvery scruffy\u201d. \u201cI\u2019m wearing scrubs, the pyjama-like, hospital-issue uniform \u2013 something pretty difficult to put your own personal flair on,\u201d Hutchinson writes, concluding wearily that the guy must have been reacting to something else: \u201cSkin, hair, or general \u2026 vibe.\u201d You couldn\u2019t call it a microaggression, the patient\u2019s assumption that, being black, Hutchinson was unlikely to be an expert. But this anecdote barely registers on the Geiger counter of bigotry in healthcare that Hutchinson writes about trenchantly and acerbically, from the prejudices doctors face from patients and the gender and race blindspots in medical textbooks, to the racism that could endanger a patient\u2019s life (black women are four times more likely to die during childbirth<\/a>).<\/p>\n

Meeting Hutchinson in the Guardian\u2019s offices in London, he emanates forethought and competence. Even in shorts and a T-shirt, he seems like the kind of guy who couldn\u2019t look scruffy if he tried. He says the book he\u2019s written about race had to be done, but \u201cI\u2019ve spoken to people who are non-white and female, and without even prompting, they\u2019ve said: \u2018Actually, the thing that is held more against me is being a woman.\u2019\u201d Hutchinson\u2019s wife, Louise, is a GP. \u201cThe lack of respect that can be shown to female doctors is outrageous, sometimes by certain other healthcare professionals, not even patients. In the same way, we haven\u2019t really had a book, as far as I\u2019m aware, about being disabled as a doctor and the lack of access to medical school for someone with a disability. I\u2019ve met only one doctor with a hearing impairment in the entire time I\u2019ve been working.\u201d<\/p>\n

It\u2019s a curse, being this fair-minded, stepping back from each point to look at every perspective, but it also gives an immediate sense of the kind of doctor he is. It speaks also to the speciality he\u2019s chosen, rheumatology, which perhaps out of any field is the one that can cope with the most mystery: pain without a source. At 38, he is about to become a consultant.<\/p>\n

Hutchinson also does standup comedy, and his act and the writing ambitions that led to the book are the product of his years working as what used to be called a senior house officer in the NHS<\/a> \u2013 the period before specialising \u2013 in the mid-2010s. It\u2019s a time when \u201cyou\u2019re becoming senior enough that people expect you to know what you\u2019re doing, yet you\u2019re still getting all the rubbish work. I was just a bit disaffected with medicine, wondering what other things I could do. Eventually, I did some standup, and just really got into it.\u201d His routines started off as a softcore, leftie side-eye at the ridiculousness of politics, parenting, life and everything (Suella Braverman, \u201cthe Michael Jordan of multiculturalism\u201d, railing against multiculturalism; Formula One being so white it\u2019s amazing that Lewis Hamilton doesn\u2019t get pulled over on the race track). The skills, he says, aren\u2019t completely dissimilar to medicine: \u201cTrying to get a room full of people on side to believe that you know what you\u2019re doing.\u201d The book is often a sharp-intake-of-breath funny (one medic on a dementia ward called it \u201cveterinary medicine\u201d), but doesn\u2019t play it for laughs. He describes a situation like the grinding suffering of a lupus patient with such a close eye for detail that you feel as if you\u2019re walking alongside him.<\/p>\n

A key preoccupation at medical school? Not being sent to an area where Reform are suddenly on the rise<\/p>\n

Hutchinson\u2019s parents were both biochemists, now retired, and his younger brother is an anaesthetist. His dad arrived in Birmingham from Jamaica aged 19; his mother is Scottish. He grew up in south-east London, where he still lives, in an area that has gone from rough-with-leafy-pockets to only-just-affordable-on-two-doctors\u2019-salaries. Not far from Eltham, where Stephen Lawrence was murdered, racism was hardly unheard of, but it wasn\u2019t until Hutchinson went on a camping trip to Cornwall as a teenager that he discovered the unabashed bigotry of rural, monocultural Britain. Some local teenagers tried to pick a fight with him, uttering the bizarrely sinister line: \u201cWhat are you doing here, dark horse?\u201d<\/p>\n

The experience stayed with him when he decided to become a doctor, because in your first year of working, the NHS can send you anywhere. \u201cThat is one of your key preoccupations, almost from day one at medical school: how do I not get sent away? Even if it\u2019s not being sent very far across the country, even just having to spend a year out of London in a place where suddenly Reform are on the rise, and there are St George crosses appearing everywhere and migrant hotels being burned down, that\u2019s going to be a consideration.\u201d There\u2019s no easy solution \u2013 medics used to be placed according to a complex points system; now it\u2019s done by lottery. Both methods have their critics, and \u201ceverywhere needs doctors,\u201d Hutchinson says. He\u2019s not trying to land an easy fix, merely noting that in the current environment, where politicians generate racial tension with their euphemistic \u201cconcerns about immigration\u201d and endless discussions about whose anger is legitimate, you don\u2019t often hear from the black healthcare professionals who have to go and live in that anger.<\/p>\n

Hutchinson performing at the Backyard Comedy Club, 2018. Photograph: Steve Cross<\/p>\n

In the event, he spent his first year in 2012 \u201cat the bottom of that pyramid\u201d (foundation year 1), in Essex. \u201cI don\u2019t think I could do now, as an experienced doctor, what I was asked to do in my first placement,\u201d he says. As the general dogsbody of doctors, FY1s are often the only doctor doing out-of-hours ward cover. \u201cOvernight, you\u2019re the only port of call for about 400 medical beds which, given how sick these people are, is absurd. As a sort of crude estimate, 40 patients might need urgent care. And it\u2019s you, the most junior person, turning up. It\u2019s improved in some places, so you\u2019ll have two registrars on overnight. I would still say the night shift is just doing as little as possible to the people who are already in hospital, to survive until the morning.\u201d<\/p>\n

Things have changed since more than two decades ago, when junior doctors were famous for the inhuman length of the shifts they had to work; but every solution seems to create a new problem. Shorter shifts with longer rest breaks were phased into the 2016 junior doctors contract in England to accommodate the fact that even medics cannot survive on no sleep. Hutchinson found successive night shifts \u201cvery mentally destabilising, I get terrified of the notion of death. I\u2019ve had that since I was 17 or 18, but I don\u2019t think about it unless I\u2019m sleep-deprived.\u201d But despite junior doctors working shorter shifts, no extra staff were magicked up to fill the gap, so the result has been pervasive understaffing. Only during the pandemic, \u201cwhen everyone got dragged out of elective care and out of clinic\u201d did they suddenly have enough healthcare professionals in urgent care. \u201cIt\u2019s probably some of the most well-staffed work I\u2019ve ever done in my entire career,\u201d he says. But there was a flipside, as there always seems to be. \u201cWhat we\u2019re seeing now is that it was a complete disaster for secondary care. It was then as if no other disease existed. So you found all these people 18 months later in a heap because their rheumatoid arthritis hadn\u2019t been assessed and managed properly.\u201d<\/p>\n

Cardiology attracts people who can be quite blunt, aggressive and have a high opinion of themselves<\/p>\n

Hutchinson has some pretty salty views about the other medical specialities, particularly cardiology, which attracts \u201cpeople who can be quite blunt, aggressive, and have a high opinion of themselves\u201d. His early years, first in Essex, later back in London, are peppered with incidents with cardiologists. Is it a class thing, I ask, considering the conveyor belt he describes: \u201cIf you pick your 18-year-old who wants to go to Imperial or Cambridge, most of them want to be brain surgeons, or want to be cardiac surgeons.\u201d But no, \u201ceven now that there\u2019s more diversity in the demographic, it\u2019s still quite an aggressive speciality. Behaviour in the past was far worse, but those people haven\u2019t gone away, they\u2019ve just moderated their language. Having said that, I don\u2019t want to give rheumatologists too much of an easy ride \u2013 there are plenty of abrupt rheumatologists.\u201d<\/p>\n

In between surviving till dawn in Essex in his first year, to arriving back in London for his second foundation year \u2013 at a hospital he describes as \u201cthe kind of well-resourced centre of excellence where pampered professors carve out fiefdoms\u201d, he met his wife at a party of his brother\u2019s. They now have two children, one about to start pre-school, the other four months old. He has enormous respect for the work of GPs like his wife. \u201cIt\u2019s such a difficult job, the idea that you can be expected to work out what\u2019s a cold versus what\u2019s the first signs of lung cancer in 10 minutes. The diversity of the work and the brevity of the appointments and the level of risk they\u2019re expected to take on is ridiculous.\u201d<\/p>\n

Rheumatology has totally different challenges, in particular, getting patients to describe the exact kind of pain they are in. In the book, his own descriptions of pain \u2013 from kidney stones to rheumatoid arthritis \u2013 are often so heartfelt and precise that it sounds more like poetry than work. \u201cThe nature of pain is often hugely diagnostically important,\u201d he says, \u201cso you do spend quite a lot of time ruminating on the specific nature of it. A thunderclap headache is literally like being hit in the head with the back of a hammer\u2026 cardiac chest pain is more like pressure or crushing. Sharp, stabbing pain may be more associated with a blood clot in the lungs. And words are obviously modulated by culture, language and background.\u201d<\/p>\n

\u2018The nature of pain is often hugely diagnostically important\u2019 \u2026 Hutchinson. Photograph: David Levene\/The Guardian<\/p>\n

Within medicine, rheumatologists are the people you call in when every other test has come up blank. \u201cIt\u2019s quite closely coupled to immunology, a kind of highfalutin, investigative field of weird and wonderful diseases,\u201d he says. But it\u2019s also frustrating. \u201cThere are two ways you can do it. So you can say: my job is to make a binary decision. I either think you do have an immune-mediated inflammatory disease, in which case you\u2019re my problem, or you just have chronic pain and some other non-immune-mediated thing, in which case you\u2019re not my problem. Goodbye. I think that\u2019s certainly what the managers probably want you to do, because it gets you through lots of patients.\u201d<\/p>\n

The other way is to accept that your patient \u201cmay not have a disease that fits neatly into your of set of immune-mediated diseases. If you have the time to have a chat with them, maybe run 20 minutes late as a result, and say: \u2018I understand you\u2019re in pain, we can\u2019t quite get to the bottom of it and I don\u2019t want to give you a drug that\u2019s gonna make you worse, but I still want to engage with the problem.\u2019\u201d From a patient\u2019s perspective, just to feel as if someone has heard the pain is real is better than feeling written-off because they can\u2019t find the cause.<\/p>\n

Yet to take that holistic view of a patient is to be constantly confronted by all the things you cannot solve. \u201cYou can give people the best kind of medical intervention they could hope for, but you\u2019re still probably not going to be able to do everything else that\u2019s going to be required for them to actually feel fulfilled and happy. You\u2019re not going to fix the lift in their block, so they don\u2019t have to walk up 20 flights of stairs with rheumatoid arthritis. That\u2019s the other frustration.\u201d<\/p>\n

Medicine has to operate in the conditions of the world around it, often with very little influence on that world. Take a cancer diagnosis \u2013 which, on the surface, might seem like a leveller. But if you take \u201csomeone who\u2019s a multi-millionaire, and someone who\u2019s living on a council estate \u2013 fine, they both have cancer, but the environments in which they\u2019re having cancer are vastly different. The worries that they have for their children, their ability to attend appointments, these little things can change how you engage with your treatment.\u201d<\/p>\n

Nowadays, Hutchinson spends three days a week in his clinic, and two days researching rheumatology and internal medicine at the Crick Institute in King\u2019s Cross. If he has any nerves about the book coming out, it\u2019s mainly whether or not cardiologists can take a joke. Being involved in the worlds of comedy and publishing \u201cmade me see that, actually, there are some really good things about medicine. When I see what other people are having to go through with their jobs, the certainty and the progression of the NHS looks great.\u201d<\/p>\n

On the cusp of becoming a consultant, presumably braced for a new round of \u201care you really the consultant?\u201d, he\u2019s determined not to change his bedside or overall manner for the job. \u201cA lot of people, when they become consultants, completely change the way they dress, come in suddenly wearing a brand new suit. I would imagine that\u2019s mainly cardiologists.\u201d<\/p>\n

Are You Really the Doctor? My Life as a Black Doctor in the NHS by Matthew Hutchinson, is published 4 September (\u00a322, Blink Publishing). To support the Guardian, order your copy at guardianbookshop.com<\/a>. Delivery charges may apply.<\/p>\n","protected":false},"excerpt":{"rendered":"Are You Really the Doctor?, Matthew Hutchinson\u2019s memoir of being a black doctor in the NHS, opens in…\n","protected":false},"author":2,"featured_media":106327,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[102,2960,56,54,55],"class_list":{"0":"post-106326","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-uk","11":"tag-united-kingdom","12":"tag-unitedkingdom"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/106326","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=106326"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/106326\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/106327"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=106326"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=106326"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=106326"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}