Professor Andrew Goddard, President of Royal College of Physician

AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.

Here the subject is Professor Andrew Goddard, a consultant gastroenterologist and president of the Royal College of Physicians, the youngest president in more than 400 years. Prof Goddard’s main clinical research interests are in bowel cancer screening, iron-deficiency anaemia, and inflammatory bowel disease. 

A podcast of this interview is available here: 

 

What is the journey that got to where you are today?

I was a medical student in Cambridge, did my house jobs in Cambridge and Norwich, and did my SHO jobs in Cambridge and Bury St Edmunds. It’s all sounding a bit boring so far, but then I moved to Nottingham and did research in gastroenterology for 3½ years, got onto the registrar rotation in what is now Nottingham, Derby, Lincoln, and then got a consultant post in Derby starting in 2002. 

At the same time, I was college tutor at Derby and I was on the New Consultants Committee at the college, which I then chaired. Then I became director of the Workforce Unit, then became Registrar, and then became President, as I am now.

 

What attracted you to gastroenterology?

Like many people, I suspect, who are doing internal medicine training (IMT) posts at the moment, or foundation training, and thinking about, “What specialty am I going to do?” I didn't have a Scooby what I wanted to do. I knew I wanted to do medicine and didn't want to do surgery.

In those days, you could choose what house jobs you did in surgery, and I specifically chose not to do a general surgical house job because I didn't want to have anything to do with bottoms. So, it's rather ironic that I ended up specialising in inflammatory bowel disease and other diseases of the low GI tract.

What determined it, really, was I had a lot of exposure to gastroenterology when I was doing my SHO posts. The job I did in the district hospital in Bury St Edmunds was gastroenterology, and the consultant who was supervising me there was so inspirational.

He made me realise that gastroenterology was a great specialty. Then I went into research in Nottingham. It really hit all the right spots, both from a practical point of view but also from an intellectual point of view. 

The other thing I'd say is that you often end up in specialties with people who have similar ideals and personalities. I think I'm probably quite typical of most gastroenterologists. I'm a doer. I like to try and solve problems, but also I'm reasonably comfortable working in a team and I like the intellectual challenges that medicine can create.

 

How did you get involved in research?

In those days, there was huge competition for consultant posts so, if you wanted to get a good post where you wanted to be, you had to have an MD or a PhD. So, research was something, almost, you had to do. It came at a good time. I did it between my SHO roles and my registrar posts, which was a time where I needed a break from clinical medicine, because it was one in threes and pretty full-on.

My girlfriend at the time, now my wife, said, “I’m moving back to Nottingham. Are you coming with me?” I said, “Ugh, yes, I want to do gastroenterology, so I'll just see if I can find somewhere in Nottingham to do some research.” 

It just happened that Nottingham and Bart's were the two big centres for gastro research at the time. I was lucky enough to get a research fellow post under Robin Spiller, who is an awesome gastroenterologist and academic.

He walked me through the early stages of development and the skills you need as a researcher, so I was once again in the right place at the right time – very lucky. 

I did my MD on antibiotic pharmacology in the stomach because this was the era when Helicobacter pylori had just been discovered and we were finding new ways to treat it, in the mid-90s. That then opened up doors to the local GI and academic communities, and I got to present at international meetings and so on. 

Then I developed an interest in iron-deficiency anaemia (IDA) when I was a registrar. There was no national guidance and my boss, a guy called Brian Scott, said, “I think we probably need to write some national guidance, don’t you?” So, we did all the literature reviews and evidence trawling for that, came out with the first version of the British Society of Gastroenterology (BSG) guidelines for IDA.

That was also my first foray into that aspect of research. It's partly being in the right place at the right time. It's a lot to do with having inspirational supervisors and people who will really encourage and enthuse you, but also you have to work fairly hard. Nothing comes for free in this life. It was probably a combination of those three things. 

 

Would you recommend research to medical students and doctors?

Yes, everybody should do it. Medicine, it's an academic topic, as well as an art. It's a beautiful combination of the both. Research can take so many different guises, be that patient-based behavioural stuff or epidemiology or clinical pharmacology or lab work.

The idea that medical research is just being in a lab, doing lots of molecular work, is a poor description. It’s such a broad field.

Given that I would say that every patient we see has the potential to take part in a research study if we got our acts together – and the RECOVERY trial during the pandemic has been a fantastic example of what can be achieved. In order for us to understand how best to improve patient care everybody should have an understanding of research methodology. 

The best way to do that is to get stuck in and do it for a bit. Some people get the bug and then want to be career academics. Most people end up like me: we continue to be NHS clinicians who do research alongside it. To me, that's a great blend.

 

The Royal College of Physicians (RCP) is so well known worldwide. Why is that?

The RCP has been around since 1518, so 503 years. It was originally set up by Henry VIII and his physician at the time, a person called Thomas Linacre, because there was a huge problem with quackery and dodgy dealings with medicines in the City of London.

It was felt that what was needed was a body to establish some standards, to assess against those standards, and to improve public health. 

Effectively, that's what we still do. It's a membership body and a charity, but we set standards. We measure against those standards, by our exams but also through guidelines and audits. We, hopefully, then also influence the politics of the time to deliver stuff.

The work done on smoking and health was spearheaded by the RCP 50 years ago. I think that shows that a big organisation like that can make a major difference to public health. 

It is quite a complex organisation. Trying to describe it is tricky. We've got over 40,000 members, who range from physician associates through medical students, through all grades of physician, up to retired fellows. We’re represented in more than 110 different countries. About 23% of our membership is international, so most is within the UK.

We have a really strong standing in England, Wales, and Northern Ireland. There are two physician colleges in Scotland. There's the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow. So, we don't tend to do much north of the border. 

The things that I've been working on recently have been around workforce, new NHS structures, research, and health inequality. Those are the things that really make us tick. Yes, we run exams. Yes, we run all sorts of teaching and education. That’s the college bit, if you like. If we didn't do that well, we wouldn't then be able to influence all those policy bits, but they all fit together. 

We're in the process of writing our strategy for the next three years. That was based on what our members said that we should do. They would say that, basically, our role is educating, improving, and influencing. Those three words, I think, say what the college does, but if you then take that back to Henry VIII’s day, that's why the college was set up originally.

Our raison d'être is the same as it has always been. Our way of doing it is on a much bigger, much more public scale. The public have heard of the RCP, and that's really helpful for getting stuff done. That allows us to have a loud voice, but you do have to be quite careful that you then use that voice wisely. That’s one of the big challenges of my job.

 

What made you run for president?

After five years chairing the New Consultants Committee I felt I wanted to do a bit more. I really enjoyed working with the college. I felt it was an organisation that made a difference, and I really agreed with the values, so I then took up the post of Director of the Medical Workforce Unit. 

Now, at the time, I wasn't sure whether to go for it. It sounded a bit of a dull job but the person who was standing down was another gastroenterologist who I knew and I had a long chat with him. He said, “Actually, if you want to know more about the college, it's a good way to do it,” so I went for it and got it.

I will never forget, the president at the time, Ian Gilmore, telling me, “We've given you the job, but more in hope than expectation,” which was not a ringing endorsement, but I found I quite enjoyed it. I didn't realise I love playing with data and graphs. It allowed me to work with all the different medical specialties.

The college looks after 34 different medical specialties, would you believe? So, I got to work with the workforce leads of all of them, so you get a really good understanding of the broadness of medicine. 

Then along came the European Working Time Directive. Suddenly, we wentfrom having, probably, too many doctors in some specialties to having nowhere near enough doctors in any specialty. Everybody suddenly got interested in workforce and “I was the one-eyed man in the kingdom of the blind”. I happened to be at the right place, at the right time. 

That allowed me to build links with the different specialties. Then, when the Registrar job came up, which is effectively second in command to the President, I was in. I had the right skills. I did that for almost five years. Going for president was the next natural step.

It's important to say that I ran with nine other people. So, it's one of those jobs that you are in no way guaranteed to get, but I went for it, and here I am.

 

Your priorities when you became president were the three Ws. What you have managed to achieve?

My three ‘W’s were workforce, well-being and worldwide. I see workforce as the biggest rate-limiting step when it comes to both health and social care. We’ve seen that with the pandemic. I was asked when I was running for president what I wanted to achieve and I said I wanted to achieve a doubling of medical school places.

The reason for saying that is that we need more consultants, more GPs. More people are going to be retiring. More people are going to be working less than full-time. The demand is going to continue to increase, but the only way that we'll have those people available in 10 to 15 years’ time is if we increase the number of medical school places now.

So, it's very much investment for the future, but at the same time we’ve got this challenge that we haven't got enough doctors at the moment. 

The well-being bit was everybody was aware there was a challenge with how healthcare workers were feeling in the workplace. That was, perhaps, best shown by the Bawa-Garba disaster and how Hadiza was treated when something went wrong. What makes us happy, as trainees but also as consultants, is pretty clear.

The GMC came out with a document called ‘Caring for Doctors, Caring for Patients’, which was written by Michael West and Denise Coia a couple of years ago, but all of that stuff has been well known in the psychological literature for 20 years.

We saw this with the medical registrars in 2013: that you can identify very clearly what makes people feel much happier at work and how you can improve their well-being in the workplace. So, we really wanted to focus on that. 

With the worldwide bit I wanted to develop the college's relationship with our international colleagues and partners. Most of that has gone reasonably well, but I will almost always be remembered as the president during the pandemic of 2019. 

That has been a massive distraction from trying to address the three Ws but, actually, if you think about it, they have been shown to be as important as ever because of the pandemic. The pandemic has shown that we don't have enough doctors.

It has shown that well-being in the workplace is really, really important, and that hospitals and trusts that don't look after well-being run into problems, and that we live in a global society.  We've learnt amazing things from our partners in different countries regarding the pandemic.

Just look at what has happened in South Africa. During the first couple of weeks of the Omicron variant I was communicating with colleagues in South Africa to hear how it was for them and to make sure that we understood the data. We just have to continue to work as a global community.

With climate change, that's going to be more important as ever. When we think about the challenges of the future, to me, climate change is right up there.

 

Why is there an issue with retention of doctors at the moment?

The reason that people want to stop working for the NHS is another complex one. Most people will stay in a job if they're happy. As doctors, generally we don't worry too much about the money. We're pretty well paid compared to many people in our society. But pay has undoubtedly reduced, comparatively, over the past 10 to 15 years.

The challenges for trainees coming through are greater than I had. I had a student grant, so I came out with a bit of debt, but not a lot, and nowhere near what medical students are finishing now with. The cost of living was relatively cheaper in my day. Getting on the housing market was easier, etc, etc, so I think that money is becoming a bigger issue for different generations.

Having said that, I think most of the things that make doctors  want to leave the NHS are to do with what it feels like to work. That comes back to the work we did with the medical registrars. We found there were four things that really determined whether medical registrars were happy. I think you can say the same about consultants, and particularly consultants nearing retirement. 

Number one is workload. If your workload is so ginormous that you just feel you can't think and you're running from one thing to another, you're unhappy. You would see retirement as a way to get out of that.

Another one is teamwork. If you feel that you're just on your own, isolated, you're not working with other people who are pulling in the same direction, again that's more likely to make you want to leave. 

The third thing is education. For trainees it's about having access and high-quality training. For consultants, it’s about being able to continue to learn. We found, before the pandemic, that attendance of our educational meetings was going up, year, by year, by year. They were coming off the hamster wheel for a bit, meeting with their mates, and learning about stuff they're fascinated about – and that works. 

The fourth thing is about flexibility. There is no doubt that generations coming after me want to work more flexibly. We did a survey recently, which showed that 57% of physician trainees want to work less than full-time. So, less than full-time work is going to become the norm. And if consultants can't have that flexibility, they will leave. 

To come back to the money, I do think that pensions at the moment are a really big thing. The NHS pension is very good, comparative to other pension schemes.

However, the punitive effects of the current pension legislation on many senior consultants means that they will leave because it will be pointless them continuing from a financial point of view. So, we're effectively pushing people out that may not want to go. That's a terrible thing. 

The pandemic has also had a massive impact. I've seen people really, really ground down by the pandemic and the amount of work and stress that it has caused. My ward was a Covid ward during the first and second wave. In the first wave, we were seeing three, four, five people die a shift from Covid.

We were a non-escalation ward. That had a measurable impact on people's well-being. People were working, and working, and working, and working, and working. Doctors, medics, and nurses will always go above and beyond, and work as hard as they can, but that takes a toll. At some point, that toll needs to be paid. I just wonder whether we're now seeing a lot of people retiring just because they’ve nothing left to give.

The tank is empty. If they don't feel supported by their trust with the other bits that I've talked about, they'll go.

 

You have said that medicine is “long hours, low pay, poor accommodation, indifferent food, lack of study time, and uncertain career prospects”. When is that quote is from?

I think that was from 1977, t’was ever thus, as they say. I think we just have to realise that everybody, in many professions, feels that they are working in very difficult circumstances. We must be careful that we don't shroud-wave too much, because people will just say, “Well, they're always saying that. They're always complaining. Why should we do anything?”

So, we have to be careful, but I do think that currently the challenges are significantly worse than they have ever been. The ‘glass half full’ side of me also knows that doctors are highly resilient and often able to find solutions when solutions are not immediately apparent. 

One of the best bits of my job, by far, is our membership and fellowship ceremonies, where people who’ve either got the MRCP or become a fellow collect their diplomas. The absolutely amazing wealth of talent within the college on those days is utterly inspiring. It makes me realise that the future is in very safe hands.

We just need to make sure that we don't lose those individuals, that we encourage them to develop and grow, because they're the future leaders. I have utter faith that they'll do a fantastic job if we give them the tools to do it.

 

People say that the old surgical and medical firms used to really foster teamwork. Can we bring some of the benefits of the firm structure into the current system?

There is no doubt that working in a functioning team is really important for well-being, but also for development, both career and educational. The reduction in working hours that we saw in 2009 has had a significant impact on that. When I was a houseman I did a one in two. I was on every other night, which is just ridiculous when you think about it.

The volume of things that I saw was massive, but I worked with the same team, so I saw a patient, as a houseman. I then fed that to the SHO, who’d review the patient. The patient was then reviewed by the registrar and then, finally, by the consultants.

So, there was an iterative educational process, but actually, because you all knew the patient, you were all working together, you were learning from each other, and there was a real team feeling. 

That just doesn't happen anymore. How many people working in a hospital-at-night team don't meet anybody else on that team the entire shift? We work in such a more spread-out way, and that's not good. I'm slightly envious, sometimes, of surgical teams. There always seems to be more people there than I've ever had on my team, but that is the way. 

That a sense of belonging to a team is really, really important, but there just aren't enough people at the moment to make that work. To me, the solution, therefore, is to have more hands and feet, and make sure that you have definite team time. We probably don't invest enough in ourselves working together.

I always encourage people to make sure that they go for coffee together or go for lunch. With the pandemic, when we weren't allowed to mix, and we were actually banned from having team meetings off the ward, that had a negative effect.

We need to invest in that, but that's why I'm so supportive of groups like physician associates, because they’re additional hands and feet, that bit of glue that helps a team hold together. 

The team in the future will not just be medical. It'll be multidisciplinary. It already is, but it'll be even more so. I think that's a good thing. I think we can all learn from each other. The joys of working in a well-functioning team are brilliant. It's great fun.

I've worked in some pretty dysfunctional teams, as well, and sometimes when they were large, dysfunctional teams with lots of people. So, it's both having people so the workload is manageable, but also having leadership skills to make the team work well. 

One example brings it home. In the first wave of the pandemic, we cancelled lots of outpatient activity, which meant lots of consultant physicians were on the ward when they wouldn't normally be. Actually, the number of physicians on the ward was the highest it has been for many, many years. Everybody said that was really good.

Everybody felt that the team was working. It reduced the workload because there were more hands and feet, but there was better educational opportunity. Those four things I talked about earlier all came together. 

In the second wave, we went back to doing all the other stuff at the same time, and that all fell apart, so I think the impact and the hardness of the second wave was much greater because of that.

So, if we can find a way to build up the number of people within a team and work together more, that has to be a good thing.

 

Most medical specialties now require dual training with acute medicine. Is this a good thing? 

It's interesting you use the phrase ‘acute medicine’ there. Of course, it's not dual training in acute medicine. It's dual training with internal medicine, but actually, through the question, you've shown the problem that we face.

Nobody actually really knows what they mean. Everybody means a different thing when they talk about general medicine or internal medicine. That’s part of the problem. 

People will have heard of ‘Shape of Training’ and the Greenaway Review, in 2013, talking about trying to get more people to have generalist skills. The background was, clearly, we have an ageing population, and, as you get older, you accrue more long-term conditions and have more and more comorbidities. 

So, the idea is you have people who are able to look after more conditions, be better generalists. You will then need fewer handovers between different teams, which is difficult. So, if I was only able to do gastroenterology, but then I've got somebody on my ward that has got diabetes and heart problems, and I say, “I don't understand the heart and I don't understand the pancreas, I'm just doing a referral to my cardiology and my diabetic colleagues,” that’s clearly not the way forward. 

As a physician, and even though I’m a gastroenterologist, on my ward half my patients have significant general medical problems. Most of them are over the age of 70 and have many comorbidities. The ward would grind to a halt unless I was able to manage those conditions. 

I trained as a general physician, as well as a gastroenterologist. Actually, I was appointed as a physician with an interest in gastroenterology. That's how they were described in those days, but it's really important. 

It was William Osler who said, “The good doctor manages the disease. The great physician manages the patient with the disease.” That is the rationale: to try and make sure that most of us, as physicians, are able to look after internal medicine. Now, the problem that we've got, of course, is that the NHS needs people to service the acute medical take.

Therefore, the ‘Shape of Training’ review should have been renamed ‘Shape of Service’ because it was an attempt to try and improve the number of people that are around to deliver acute medicine. There lies the problem because we haven't got enough people. If there were far more people, actually it would be much easier and people would feel that the workload is being shared. 

The other thing is that our specialties have become more and more complex. The treatments for managing inflammatory bowel disease now are so different from when I was a registrar. I've become an immunologist as much as a gastroenterologist now.

Learning all of that, and all the new endoscopic techniques, and having to do more internal medicine, it just feels like there aren't enough hours in the day.  

When ‘Shape of Training’ was coming through, I argued very strongly that we should lengthen training. Asking people to do more internal medicine on top of their specialty training within the same length of time is trying to get too much into the glass. 

But it was made very clear that we couldn't lengthen training. We were not allowed to, which was just very short-sighted. It's cheaper for the NHS to employ a registrar than it is a consultant. So, I don't see how the business model worked, either.

Actually, most medical registrars take far longer than the length of training that's on the piece of paper.  The average renal registrar basically takes 11 years from leaving core training to becoming a consultant. I look back on my time, and you think that I did 3½ years in research after I stopped being an SHO, and then I did 5 years as a registrar. I was 8½ years. Everybody takes as long as they need. I think that's important. 

I completely get why people who are going into a specialty are worried about the demands of acute medicine. All I would say, though, is that what the NHS needs is doctors who can manage patients with multimorbidity. Therefore, all of us have to be able to do that.

Otherwise, the system would grind to a halt. We need more specialists. We need more generalists. At the moment, we have to try and make the two run as one. I think being a good general physician makes me a much better gastroenterologist.

 

You created a document in 2016 called ‘Keeping Medicine Brilliant’. Do the recommendations still stand?

The reason for producing that document was this feeling that medicine is just rubbish, which I could understand from some specialists. But most people actually love their job and they love their specialty.

They love being with patients. They find it absolutely fascinating. It's not the job they don’t like, it's the system they need to work in. So, the purpose of creating that document was to try and find ways we could improve the system, to make people learn to love medicine again. 

Many of the things in that document - working conditions, training, teamwork - are as true today as they were five years ago. I would just love it if we had some headspace in the NHS to start to apply these things.

I would love it if people actually meant what they said when they say, “We're going to really look after the well-being of our staff and we’re really going to make working conditions as good as possible,” but generally those words are said, but nothing properly happens on the ground. 

I continue to think medicine is a brilliant career. Given the chance, I would do it again without a second thought. The moments when I feel that I've made a difference to somebody's life, that is a unique privilege. 

It stretches your brain in a way that nothing else does. With endoscopy, I get to do stuff that, when I was a registrar, we used to send off to the surgeons, and I’ll now take out polyps, which are scarily big.

So, I think it is a brilliant career, but the system that we're working in at the moment is very hard, and it means that sometimes you forget that. It's good for people to try and remember that.

 

What makes a great physician?

Beauty is in the eye of the beholder. It comes back to that William Osley quote: people who are able to take in the whole patient. So, the people that have inspired me are those people who are able just to take their time when they see a patient, take a little bit of a step back, see the bigger issue and the bigger problem, and then be able to communicate that with the patient.

That rapport means that they learn so much more from that patient. They're then able to communicate the balances and come up with true shared decisions, but they're also bright enough to know what is the best treatment, based on the evidence.

They're also great team leaders and, hopefully, they’ve also got a sense of humour, because that's a really important part of being a physician.

I love ward rounds when I have that bit of extra time with the patients, and find out a bit about them. I think that creates a bond between physician and patient, which is really therapeutic in many ways.

You’d be amazed how much more history you get that's useful. You get to the real, underlying problem. In this time-pressured world that's what makes a great physician.

 

How can readers be exceptional physicians?

When we get all the MRCP candidates together to give them their diplomas, I use a phrase which is very simple. To be a good physician, you need to work hard and be kind.

If you do those two things, you won't go far wrong, because if you work hard, a) you'll have the knowledge base you need, b) you're unlikely to miss much, and c) people really, really respect that.  But kindness is incredibly important.

If you are kind with your patients, you are automatically listening as well as talking, and if you're kind with your colleagues, you will work so much more functionally as a team. 

Again, a phrase that I use commonly is, “Beware the shadow you cast.” Say I’m on call this weekend and I know it’s going to be really busy, so I have to work very hard at starting at a high level. 

I could turn up on Saturday morning, really grumpy, saying, “I don't want to be here at the weekend. Look at all these patients I’ve got to see. And I’ve got to do this endoscopy and so on.”  What happens? You've immediately demotivated everybody you're working with. And if you're a patient lying in bed and you've got this bunch of grumpy people talking about you when you're feeling pretty sick and frightened, that's not a good thing.

So, it's really important that we're kind with one another, we’re as positive as we can be, no matter how we might be feeling on the inside. 

That then produces a buzz within the team, and people going, “Okay, we’re going to work together. Yes, we've got lots of patients, but we're going to do this.” Then the patients sitting in the bed see this as a team: “This is a team of engaged people who want to help me.” That's fantastic. That very different situation is all about how you go into it and how you respond to how you're feeling internally. So, yes, be kind and work hard. 

 

What insights have you learnt about leadership?

A lot. I haven't sat down and done an analysis of that yet. Maybe I will. But you see a lot of people do things well, and that includes our politicians. The pandemic has been a fantastic opportunity to watch leadership in action, or not, as the case may be. The first thing I would say, from both observing my colleagues and politicians, is, “Communication is the root of all evil.” How we communicate really establishes how successful we are as a leader. 

If there is a discord between what is coming out of your mouth and the actions you are doing, that completely undermines you as a leader. You have to be what you say. We saw that with the pandemic, with Mr Cummings, for example, saying one thing and behaving in another way.

A leader has to walk the walk, as well as talk the talk, but they have to talk the talk in a way that people understand and listen. 

My biggest criticism of the government in the pandemic was about the mixed messaging and the different messages between the four nations in the UK. That really made me angry because the public needs a strong, simple message. We never really had that. 

The other thing about leadership is that you do need to work very hard. It always takes up more time than you think, and it is extraordinarily stressful. Successful leaders have a way to defuse that. That might be by having really good networks at home so you can offload.

It might be by having hobbies that offer a complete distraction. I could not have done the job without my family and my colleagues. My family have had to put up with me disappearing down to London for the week, for the past 10 years. The kids have grown up remarkably functional, probably because I haven't been there, actually, but I think I have a really good relationship with my kids. 

My wife has been my rock; if she hadn't supported me, I think I would have struggled. And my colleagues in Derby have all been fantastic. They said, “You should do this. You should go for it. You should do these jobs,” and they’ve backed me to the hilt. When I've needed to be flexible, they've bailed me out. I've worked in a number of hospitals where those links between consultants aren't there, and I think that that really limits people. Successful leaders have good people around them. 

I think successful leaders have to be very sensitive to what the mood of the situation is. Also, you often have to go against the flow. You have to say stuff that is not necessarily what people want to hear. 

Perhaps I can give one example of that. If people can cast their minds back, when the Covid vaccines were first being rolled out, we had a huge shortage of vaccines. There was a big pressure because all the trials had been at three weeks for a second dose, but there was a conflict between that and getting more people vaccinated. 

At the time, the BMA said, “Everybody in hospital needs to have the three-week dose.” But we said, “No, that's not right. Actually, there's only a limited amount. We know that it's probably going to be as effective at 12 weeks,” because most vaccines work better if you have a longer interval between the two, so immunologically that made sense.

And the risk of me, at the age of 55, dying of Covid is substantially less than somebody aged 85, so we should maximise single doses to as many people who are vulnerable and at risk as possible. 

That was deeply unpopular and it was a real challenge but we look back now and that was clearly the right decision. That decision has saved lives, but many of my colleagues wrote me some pretty horrible emails at the time. 

I couldn't sit with that, knowing that a patient in front of me, 85, could have a first dose and get 60% or 70% protection. Or I could have a second dose, having already got 70% protection, that might put it up to 80% or 90%.  To me, that was just inherently wrong, so I was happy to be shouted at.

Thankfully, time has shown that was probably the right decision. Yes, but you do other things that turn out to be the wrong decision. You look a bit of a fool, but you have to be prepared to go against the flow, because people who just go with the flow all the time will not be good leaders.

 

What are some of your proudest achievements?

It’s really hard. I'm really proud of the iron deficiency guidelines. We started that in 1999, the first version. We've just published the latest version in 2021. Iron-deficiency anaemia is really common, both in this country and in the world, but there was no national guidance before then.

I'm still on a mission to stop people prescribing more than once-a-day iron. There's no evidence to support giving it twice or three times-a-day iron, but it’s still in the BNF. I will go to my grave happy once we have achieved that. 

I'm really proud I set up the bowel cancer screening service in Derbyshire. I was really pleased with that. That, undoubtedly, has saved lives. I've helped design the endoscopy unit in Derby. I'm very, very proud of that. 

When it comes to the college stuff, I've led the college through the pandemic. We've had some of the hardest financial choices that we've had to make. The college lost a third of its income, which is really quite a challenge, but we kept training going, kept the exams going, through the pandemic. 

Physicians took the real brunt of Covid. Around 90% of patients with Covid in hospitals were looked after by physicians. We were hit really hard as a breed. Intensive care had an equally hard time, and the press has focused on them, but the 90% seem to be forgotten.

So, I have been very proud to be able to lead and represent them in the corridors of power. 

We still have a long way to go. The challenges on the NHS and social care at the moment are as hard as they've ever been, so I think that there will continue to be major, major challenges, moving forward. 

On a slightly lighter note, back in 2018, before I became President, I helped write the charter that we had for our 500-year anniversary, which was an expression of what it meant to be a physician. I took that, on my bike, around 50 different hospitals in the UK, getting people to sign that charter.

I'm really proud that we helped celebrate what it was to be a physician in 2018. We raised lots of money to develop the College of East, Central and Southern Africa Physicians, and help that college in a very challenged part of the world. Workforce is bad in the UK, but we've got 280 doctors per 100,000. In Malawi they've got 2, so, if we can help train in other countries, wouldn’t that be brilliant? 

Those are sorts of things I'm proud of. There are many things that I've done. There are many things that I'm not proud of, but I think I've been supremely lucky to be where I am, and I've had some fantastic people around me.

Any achievement that you make, in any of the roles that I've done, you can't do on your own. Anybody who believes that is wrong. Most of those achievements have been because of the hard work of many other people.

 

What lessons have shaped you as a physician?

When things go wrong, that often teaches you a lot. Most of the major clinical errors that I've seen have been because of poor communication or getting stuck down a diagnostic line of approach. So, keep your mind open, listen to the patient, and be prepared to be wrong and review your thoughts.

It’s amazing how often the patient has a really good idea what's going on. Life will always bring you back down, but patients are also the things that inspire you and lift you.

I've got this fantastic letter above my desk at work, which is from a lady who has now died. I got it quite a few years ago, but she was over 90. The letter said, “Dear Dr Goddard, you won't remember me. I’m the 91½-year-old that you saw a few years ago, and you told me that I still had all my marbles. I've woken up to that thought every day, and it has kept me going. Thank you so much.”

I would have said that as a throwaway comment. She would have said something like, “My doctor thinks that I've got early dementia,” and I would have said, “Well, I think you've got all your marbles. Talking to you, I think you're alright,” as a way just to relax and develop that rapport, but that throwaway comment had stuck with her throughout her life and had kept her going. 

What a privilege. What an awesome thing. Again, beware the shadow you cast. What you say, what you think is a throwaway comment, people will take on board, so communication, communication, communication.

 

What habits have helped you to excel?

Dogged determination, asking for help, being a bit of a control freak, liking detail. I think those things all help. I try and work hard at figuring out how I'm being perceived, and adjusting my angle of attack if those who I trust tell me I'm doing it wrong.

 

Have there been any key role models?

So, Gervase Kerrigan, my gastroenterology boss in Bury St Edmunds, Robin Spiller, who oversaw my degree, and Brian Scott, who was my boss in Lincoln. But the person who really converted me to hospital medicine, as opposed to anything else, was David Rubenstein, in Cambridge. His ‘Lecture Notes in Clinical Medicine’, by Rubenstein and Wayne, was the standard textbook of our time. It’s what we had to learn to pass your finals, but he was a fantastically calm, bright, enthused person.

Doing ward rounds with him, when I was his houseman, was just awesome. He’d take the mick out of you but it was never done maliciously. It was all part of, “Well, you've made a bit of a mistake there, haven't you? What can we learn from that?” in a nice way, but his patients loved him. You could see that rapport that he had with them. 

He took his time, but he had a brain the size of a planet, and an ego the size of a walnut. That's what you want in somebody, isn't it?. He's alive. He's a fantastic guy. I still communicate with him. I'm lucky to keep in touch with him.

He made me realise that medicine was fascinating, could be brilliant, and the skills that you need to be a successful physician. I was very lucky to meet him.

 

What's your favourite book?

That’s actually fairly easy because it has been my favourite book for quite a few years. It's a book called ‘Into Thin Air’, by a guy called Jon Krakauer. I suspect many people won't have read it, but it's about the Everest disaster of 1996. It is a really easy read, but it is amazing because he was a journalist.

Basically, he was a journalist who had gone on one of these expeditions. Everest tourism was the big thing, so he was going to do a big piece for a magazine called ‘Outside’. It was May 1996, there was a huge number of people on the mountain, and a very nasty weather system came in.

Many people died. There have been films, television programmes and all sorts, but his is the definitive book. It is really easy to read, but it'll teach you so much about human spirit.

There are some amazing stories about survival, and some amazing stories of stupidity. It sums up the human condition and it's a cracking read. I was obsessed with Everest at the time. I've been to Everest since.  I would strongly recommend it.

 

You're the second president who has recommended that. Katherine Henderson, I think, said it's her favourite book, as well. 

Oh, wow. I didn't know that. I'm seeing Katherine in five minutes. Yes, because Katherine loves mountain climbing. Her family live up in Scotland. She's much more at home on the mountain than I am. That's fascinating. Thank you. We will have a natter about it. 

There is an illustrated version, by the way, which I got as a present about 20 years ago, which has got all the images in woodcuts, which is really impressive, but paperback you can get online for a handful of quid. I'd recommend it. 

 

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers