2019 Jan Welcome Speech of new CMS President Dr Max Hickman

Welcome everybody to the 2019 presidential year. I am very honoured to have been asked to be this year’s president. First of all I would like to thank our outgoing President for such an excellent year in 2018 and in particular for his work in involving the society in trying to improve the morale of our colleagues particularly our younger colleagues. At this point I would also like to welcome Laurel Spooner and her husband Dick. I know that this issue is particularly close to their hearts.
I would also like to thank Dr Melanie Carter for her excellent work in supporting the committee, James and myself and all her hard work in putting on such a splendid evening.
When I was asked to be President, apart from being very honoured one of my first thoughts was what am I going to talk about at the presidential dinner? I really had no idea..!!
In order to try to decide i did investigate what previous presidents had done. I am not sure how helpful this was though! One President who is sitting on my table decided to describe his family history of Doctors. Well I am the first Doctor in my family so that wasn’t going to work for me. Another spoke entirely in verse! Well I am no poet. Another donned a flat cap and talked about her Yorkshire roots. And at our presidential dinner last year I was sitting at the back so couldn’t quite hear what was being said but from the screen it looked like some aquatic adventure à la Jacques Cousteau! Well I do a bit of sailing but that is nothing unusual in medical circles.
My conclusion from this is basically I have free license to say what I want so I have decided to speak from the heart (sic) about what I think is important about and what it means to me to be a Doctor. There will inevitably be a bias towards medical politics given my background in NHS organisations. I have titled it ‘Anniversaries and the future of Doctoring’. (Next slide).
My next thought was how long should this speech be? Again there do not seem to be any firm rules. Now I am conscious that I am interrupting some very convivial conversations going on in the room so I am going to try take some advice from a Doctor who was a previous mayor of Colchester but was in fact never President of the Medical society (and I don’t mean you Chris Hall). Dr John Sanderson was a GP-Obstetrician in Rowhedge (where I now live) for many years and I am sure that there are people here in the room who remember him. His daughter, Lucy is in fact here with me tonight. According to Lucy his advice was ‘a speech should be like a woman’s skirt (or in these more politically correct #metoo days perhaps like a man’s kilt.) It should be short enough to be interesting but long enough to cover the bare essentials. Let’s hope, for your sake, that I follow that advice.
Now I know that to many of you, in doctoring terms I am a mere baby or whipper snapper but it is now 30 years since I started as a Doctor. The NHS itself is only 70 years old and we have just celebrated its anniversary so it is young too. But it is under threat, as is the medical profession so we should do all we can to make sure that they both thrive in the future.
At this point in a departure from usual protocol I would like to do something different and introduce a commercial break.
(Next slide). This year there is another anniversary and it is of an organisation that
you may not have heard about but which many in this room were responsible for forming.. 30 years ago the Doctors of Colchester decided to do something truly momentous for the residents of North East Essex. Colchester Catalyst Charity started its work and here is a picture of the first board of directors (Next slide). On the left there is someone you may recognise, Dr Ron Griffin.(Next slide)
Well the charity was set up following the sale the old Oaks hospital. (Next slide) The original private hospital was founded in 1949 following the advent of the NHS under the leadership of Ronald Reid an eminent physician. (Next slide) A new hospital was subsequently built and then sold when it moved to its present site near Colchester General. I am sure our resident medical historian, Fab Casale, will remember this. From the proceeds of the sale it was decided that the money would be used to set up a charity that would provide relief for the sick and suffering of North East Essex (Next slide). As a result the charity has managed to fund transformational projects for organisations such as the hospice, Headway, the hospital and various small charities. It has also given individual grants for things like specialist equipment for people with a variety of medical problems and for respite care and counselling. Incredibly that money has been invested so well that, despite the fact that the charity has just reached the £10 million mark in it’s grant giving it still retains its original investment including inflation.
So thank you to those of you that were involved in that original decision to use the proceeds in this way. We are holding a gala event here at the town hall on 29th April and you would be welcome to attend. (Next slide) And if not if you have a project that you would like us to fund then please contact us via our manager Rodney Appleyard on rodney.appleyard@colchestercatalyst.co.uk.
Ok commercial break over! ⏱
Sailing has been a recently acquired interest of mine and whilst doing my dayskipper course in rather cramped conditions on the river Orwell (which incidentally will be the location of our summer event this year as we will be hiring an old Thames sailing barge from Ipswich marina (new slide).
(New slide) Any way a young companion of mine said to me ‘well I think in the future, with all the advances in technology and medical science we won’t need Doctors’ (new slide).
Well that got me thinking. Is he right? After all my own son William (who I am pleased to have here tonight, with my other son James) is training to be an ophthalmic surgeon and his bread and butter are cataracts yet I am told that in the future cataract surgery will be largely robotic and can be performed by a non- medically qualified operator. Well this must apply to lots of fields of medicine. And I am not just talking about robotics. What about Dr Google or some advanced version of this. Essentially Artificial Intelligence. I have always wondered a bit about whether the role of a GP can really be sustained in the future (new slide). Will it be eventually reduced to some health app such as Babylon?
Well to try to answer this question I thought it might be helpful to reflect on what it means to be a Doctor and whether there are any arguments for saying that it will be a sustainable career in the future. Perhaps bizarrely I intend to take you back in history to search for the answer but also to introduce you to a modern debate on the subject. I want to describe to you what I think is truly unique about the profession of medicine.
(New slide) When I was at university I was privileged to be offered two courses whilst I was doing my medical degree.
The first course I did was on the history of medicine:
We live in a time of great innovation. But what drives that innovation? I believe it was, is and always will be Doctors and medical researchers interested in how they can improve their field of medicine.
We know that, in effect, all medical advances are built on the work of our predecessors but with occasional eureka moments.
Take for example William Harvey.(New slide) He worked around the turn of the 17th century and as I am sure you will know he discovered circulation. He was a physician who studied in the most preeminent medical institution at that time, the university of Padua in Italy. It had the only working anatomy theatre and regularly performed human dissection, a discipline that had not been done since Ancient Greek times. Theories about anatomy and circulation were postulated by Aristotle and reached its pinnacle with the Greek physician Galen in the 2nd century AD. Now William it is said loved his colleagues....(I agree! We should all love our colleagues!). When he died he left the RCP money for an annual feast as he believed it would promote cohesion amongst Doctors (well that’s why this society is so important isn’t it?). Anyway the point is he wasn’t in to upsetting anyone and the accepted doctrine about circulation before his time did not involve the heart! In fact the famous anatomical drawings of Vesalius (New slide) in his book ‘De humani corporis fabrica’ (I am sure I do not need to translate this for you from Latin but in English is ‘on the human fabric of the body’) there is literally no heart!
It took a lot of reflection and thought on the subject and a series of experiments firstly on his discovery that veins contain one-way valves or ostia (new slide) and his incredibly simple demonstration that in fact blood can only flow in one direction through veins (new slide). Not as was thought at the time in both directions. Now he was very upset about this discovery as it went against all respected teaching but he had to accept his findings and published them in ‘De Motu
Cordis’ (anatomical account of the motion of the heart and blood). As a result of this he lost a lot of his medical practice as he was seen as an unconventional Doctor and patients preferred to attend more traditional physicians but eventually his findings were accepted most notably by the Royal College.
So here was a physician who studied anatomy and eventually made a revolutionary discovery that changed the face of medicine. I would argue that it was his intellect, his enquiring mind that led to this advance. Now we can’t all be like William Harvey but I am sure all of you have during your medical careers have reflected on what is accepted practice and wondered whether it should be questioned. That IS the enquiring human mind. Can that be replaced by artificial intelligence?
My second argument also takes in some university studies. (New slide). Again I
was lucky enough to be able to study in another subject in the archaeology and anthropology department, medical anthropology. I was fascinated to learn that no matter what culture or society you studied and how basic it is there is always the role of the healer or shaman. The medicine itself may be entirely (but actually often not) ineffective but there is always a fundamental need in all humans to attend a physician-healer. That interaction is often transactional in that the patient hands over their illness, metaphorically, to the healer and the doctor patient relationship involves a process of trying to solve the problem and eventually handing back that problem (hopefully in a better state!) to the patient. So you see human attitude to illness depends on human interaction. Each society has invented the healer role. There is a basic human need to interact with the healer. So my GP friends as described in Cecil Helman’s excellent book (new slide) see yourselves as the suburban shaman!
My 3rd argument (New slide) is actually for me the most interesting. This is perhaps more of an opinion than argument but I think that physicians are in fact the artists of the scientific world. And like artists we depend on two very vital skills. To illustrate this I am again going to take you back in time. In fact to the time of Leonardo da Vinci. Well before Harvey was doing his thing on human anatomy and circulation Da Vinci was producing artistic masterpieces. He is commonly acknowledged to be a genius not just because of his art but also because of his visionary thinking. (Scroll through slides up to drawing of wings) He was ahead of his time in terms of inventions such as the helicopter and principles of physics and studies of human form and anatomy. He was so diverse in his talents that only less than 20 paintings of his are known to exist. A lot of his work was actually neglected and had to be reinvented decades or centuries later.
If you study what made him great I think it depended on 2 qualities which are also essential qualities of a good Doctor.
Firstly observation. Da Vinci’s art was revolutionary as it was entirely based on observation. Vitruvian man, techniques of sfuma. From his observation came inspiration.
(New slide) Take for example this painting which is actually attributed to Verocchio with whom he studied as a painter. Da Vinci contributed to this painting. Now I am going to take a vote and test your artistic appreciation skills! I am going to highlight 3 areas of the painting and I want you to tell me whether you think Da Vinci painted it.
(Next slide, next slide, next slide).
Before I give you the answer I want to say why observation is so important to Doctors. Think of what we have to do every day and think about whether that could truly be replaced by technology. Commonly in General Practice we are presented by various conundrums. My GP colleagues you all know them. The patient that presents with tiredness, dizziness, funny turns or worse of all a fuzzy head. Now you try googling that and see what you come up with. Thousands of possible diagnoses with brain cancer somewhere near the top of the first page! So in 10 minutes we have to use our observational skills and come up with some sort of strategy (or if it’s late on a Friday afternoon refer the patient!.. only joking!). Out of observation comes inspiration. I am sure that applies equally to our consultant colleagues except that the potential for observation is that much richer in general practice. Knowledge of their previous illnesses, their family dynamics, their interaction with you as a human or their accompanying relative or my favourite actually seeing the patient in their own home and observing their surroundings and even their family photographs. In my experience they can all help in reaching a diagnosis or at least a direction of travel.
Now back to the painting (next slide). Da Vinci in fact painted the angel on the left
and the body of Christ (Next) Notice how there is a 3-dimensional aspect to his painting created with his technique of sfuma and no sharp margins. The angel is half turned and dynamic as if it is about to do something and Christ’s body with the feet represented through the transparency of the water. A genius! It is said that Verocchio was so impressed he never painted again!
His second quality is showmanship. I think we are all showmen as Doctors. Leonardo was a showman. He put on pageants and processions and even designed theatre sets. In fact this was his main source of income and also helps to explain why his art output was rather modest. By all accounts they were pretty spectacular. Now I believe a Doctor is also a showman. We have to project ourselves as reassuring, empathetic professionals.
(Next slide) I would recommend a podcast produced by the BMJ entitled ‘Hal will see you now’. It involves a debate between an academic interested in health technology, a philosopher and an expert patient. Apparently a recent study showed that AI could diagnose eye conditions better than eye specialists and in 2017 a robot passed China’s state medical exams. The academic asked ‘what is better the smiling pleasant Dr who makes the wrong diagnosis or the machine who makes the right diagnosis? If we are so interested in human interaction why could we not just have a machine and a psychologist working together particularly if we have problems relating purely to a machine.’ The philosopher replied ‘well, can the communication of aspects of illness really be delegated away from humans. Physicians are able to integrate human, social and other aspects of illness in a way that is truly unique. It is difficult to imagine how that can really be replaced by artificial intelligence. There is also something that is important about the shared vulnerability that humans have that makes a patient, uniquely, trust a Doctor rather than a machine. The patient said ‘ I’ve got nothing against technology but I have had illness all my life. I had a kidney transplant before I reached adulthood. We are moving away from the age of paternalism where the Doctor always knows best towards the expert patient and the use of technology but it is still very important to be able to interact with a human being for me personally rather than a machine. I am also concerned as a patient about how information about me is used. With AI we are actually talking about industry inventing a technology that will be able to assimilate all the information about you, say including social media, to achieve a better diagnosis and a treatment plan. I am concerned as a patient about my privacy. The unique part of the Doctor-patient relationship includes confidentiality. How can I trust a computer to treat the data they have about me impartially without trying to exploit me’.
Here we get in to another aspect of the discussion. The mediator asked should we fear artificial intelligence. The patient replied ‘I will never trust it’.
I think we have to be aware of the profit motive around technology companies. We are all familiar with the issues around companies such as Cambridge Analytica and how things such as the Brexit vote can be manipulated. As I was listening to it became clear that yes technology is vitally important and no one can deny this but even the academic agreed that there needed to be clear boundary conditions in terms of how it should be used
So in summary. Ok the world is changing rapidly and we are living in a time of new invention, new thought. Actually not unlike the period of the renaissance in the 15th and 16th centuries. And we have to be prepared to reinvent ourselves as artists of the scientific world. But we should always remember the time constant skills of Doctors like the great artists of the renaissance period and apply them to our profession as we move forward.
Thank you. You have been very patient listening to me and I realise that this has not been a talk full of jokes so just to bring things a little down to earth let me finish with a few of the thoughts of our younger generation. And by that I mean our schoolchildren! I don’t know if any of you watch the secret lives of 5 year olds but as my children have now grown up I do still yearn for the gems that they used to come out with and the direct, often embarrassing questions they used to ask.
Here are a few true examples of some answers to a children’s science exam that you might find amusing..
(Next slide)
Thank the caterers, past president, secretary etc.

His presentation can also be viewed on Youtube:-
​ https://youtu.be/zrjnjIO6nDA