Are You Really the Doctor?, Matthew Hutchinson’s 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 “very scruffy”. “I’m wearing scrubs, the pyjama-like, hospital-issue uniform – something pretty difficult to put your own personal flair on,” Hutchinson writes, concluding wearily that the guy must have been reacting to something else: “Skin, hair, or general … vibe.” You couldn’t call it a microaggression, the patient’s 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’s life (black women are four times more likely to die during childbirth).
Meeting Hutchinson in the Guardian’s offices in London, he emanates forethought and competence. Even in shorts and a T-shirt, he seems like the kind of guy who couldn’t look scruffy if he tried. He says the book he’s written about race had to be done, but “I’ve spoken to people who are non-white and female, and without even prompting, they’ve said: ‘Actually, the thing that is held more against me is being a woman.’” Hutchinson’s wife, Louise, is a GP. “The 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’t really had a book, as far as I’m aware, about being disabled as a doctor and the lack of access to medical school for someone with a disability. I’ve met only one doctor with a hearing impairment in the entire time I’ve been working.”
It’s 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’s 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.
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 – the period before specialising – in the mid-2010s. It’s a time when “you’re becoming senior enough that people expect you to know what you’re doing, yet you’re 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.” His routines started off as a softcore, leftie side-eye at the ridiculousness of politics, parenting, life and everything (Suella Braverman, “the Michael Jordan of multiculturalism”, railing against multiculturalism; Formula One being so white it’s amazing that Lewis Hamilton doesn’t get pulled over on the race track). The skills, he says, aren’t completely dissimilar to medicine: “Trying to get a room full of people on side to believe that you know what you’re doing.” The book is often a sharp-intake-of-breath funny (one medic on a dementia ward called it “veterinary medicine”), but doesn’t 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’re walking alongside him.
Hutchinson’s 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’-salaries. Not far from Eltham, where Stephen Lawrence was murdered, racism was hardly unheard of, but it wasn’t 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: “What are you doing here, dark horse?”
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. “That is one of your key preoccupations, almost from day one at medical school: how do I not get sent away? Even if it’s 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’s going to be a consideration.” There’s no easy solution – medics used to be placed according to a complex points system; now it’s done by lottery. Both methods have their critics, and “everywhere needs doctors,” Hutchinson says. He’s not trying to land an easy fix, merely noting that in the current environment, where politicians generate racial tension with their euphemistic “concerns about immigration” and endless discussions about whose anger is legitimate, you don’t often hear from the black healthcare professionals who have to go and live in that anger.
In the event, he spent his first year in 2012 “at the bottom of that pyramid” (foundation year 1), in Essex. “I don’t think I could do now, as an experienced doctor, what I was asked to do in my first placement,” he says. As the general dogsbody of doctors, FY1s are often the only doctor doing out-of-hours ward cover. “Overnight, you’re 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’s you, the most junior person, turning up. It’s improved in some places, so you’ll 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.”
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 “very mentally destabilising, I get terrified of the notion of death. I’ve had that since I was 17 or 18, but I don’t think about it unless I’m sleep-deprived.” 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, “when everyone got dragged out of elective care and out of clinic” did they suddenly have enough healthcare professionals in urgent care. “It’s probably some of the most well-staffed work I’ve ever done in my entire career,” he says. But there was a flipside, as there always seems to be. “What we’re 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’t been assessed and managed properly.”
Hutchinson has some pretty salty views about the other medical specialities, particularly cardiology, which attracts “people who can be quite blunt, aggressive, and have a high opinion of themselves”. 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: “If 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.” But no, “even now that there’s more diversity in the demographic, it’s still quite an aggressive speciality. Behaviour in the past was far worse, but those people haven’t gone away, they’ve just moderated their language. Having said that, I don’t want to give rheumatologists too much of an easy ride – there are plenty of abrupt rheumatologists.”
In between surviving till dawn in Essex in his first year, to arriving back in London for his second foundation year – at a hospital he describes as “the kind of well-resourced centre of excellence where pampered professors carve out fiefdoms”, he met his wife at a party of his brother’s. 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. “It’s such a difficult job, the idea that you can be expected to work out what’s a cold versus what’s 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’re expected to take on is ridiculous.”
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 – from kidney stones to rheumatoid arthritis – are often so heartfelt and precise that it sounds more like poetry than work. “The nature of pain is often hugely diagnostically important,” he says, “so 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… 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.”
Within medicine, rheumatologists are the people you call in when every other test has come up blank. “It’s quite closely coupled to immunology, a kind of highfalutin, investigative field of weird and wonderful diseases,” he says. But it’s also frustrating. “There 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’re my problem, or you just have chronic pain and some other non-immune-mediated thing, in which case you’re not my problem. Goodbye. I think that’s certainly what the managers probably want you to do, because it gets you through lots of patients.”
The other way is to accept that your patient “may 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: ‘I understand you’re in pain, we can’t quite get to the bottom of it and I don’t want to give you a drug that’s gonna make you worse, but I still want to engage with the problem.’” From a patient’s perspective, just to feel as if someone has heard the pain is real is better than feeling written-off because they can’t find the cause.
Yet to take that holistic view of a patient is to be constantly confronted by all the things you cannot solve. “You can give people the best kind of medical intervention they could hope for, but you’re still probably not going to be able to do everything else that’s going to be required for them to actually feel fulfilled and happy. You’re not going to fix the lift in their block, so they don’t have to walk up 20 flights of stairs with rheumatoid arthritis. That’s the other frustration.”
Medicine has to operate in the conditions of the world around it, often with very little influence on that world. Take a cancer diagnosis – which, on the surface, might seem like a leveller. But if you take “someone who’s a multi-millionaire, and someone who’s living on a council estate – fine, they both have cancer, but the environments in which they’re 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.”
Nowadays, Hutchinson spends three days a week in his clinic, and two days researching rheumatology and internal medicine at the Crick Institute in King’s Cross. If he has any nerves about the book coming out, it’s mainly whether or not cardiologists can take a joke. Being involved in the worlds of comedy and publishing “made 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.”
On the cusp of becoming a consultant, presumably braced for a new round of “are you really the consultant?”, he’s determined not to change his bedside or overall manner for the job. “A 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’s mainly cardiologists.”