Talking To: Tim Howard
Tim Howard’s ‘Lets Kill All The Lawyers’ is his debut novel. It follows Nick, a GP, who is being hit with a claim of medical negligence. Nick enlists the help of medical lawyer Antonia to fight back the claim. The book touches on so many important themes like loss, justice, and one of my personal favourites, finding love in the midst of hardship. I rated the a book a 4.75 out of 5 stars. I would highly recommend it, it was such an insightful read, and it really helped me acknowledge that as much as our GP’s are our superheroes, they’re human. They can make mistakes, but they never intend to. I was lucky to have the chance to speak to the brains behind the beauty of ‘Lets Kill All The Lawyers’, and we spoke about some pretty cool stuff!
Hi Tim! Can you tell us what inspired the book?
Well, I’d been a fairly ordinary doctor for many years, and like many doctors I was quite surprised at the lack of understanding in many people, especially in my patients, about the way in which doctors think and work so I wanted to try to explain that a little bit to the public. I also wanted to try and get across to them the stress and the problems faced by doctors in making decisions, and the way that the consequences of making those decisions were very often actually not in the doctors hands, they can actually work against the doctor and the doctor can be blamed for it. And say that I felt there was a story to tell in that, and I portrayed it in a doctor being blamed for a mistake that he thought he hadn’t made and turned it into a gentle love story.
Do you think you achieved the purpose?
I think so, I’ve had a lot of positive feedback from it both from doctors and from patients. The patients especially said it was actually very interesting to actually understand how doctors think and work. The doctors said to me, thank goodness you’ve actually put our side of the case if you like to the public, to explain the problems of a doctor working at the front face under a great deal of pressure. And, so yes, I hope I got some of the message across.
Well you did for me…
Thank you very much for that. They haven’t made the human yet who has never made a mistake have they? We all make mistakes, whoever we are, doesn’t matter if we’re doctors, lawyers, politicians, whoever we are. But if we beat people up when they make mistakes, honest mistakes, when they’re trying to do their best but their decisions turn out later to be less than perfect, then we don’t achieve anything, we just make people defensive, and we make them retreat into the bunker. Whereas if we help them to learn from it so they don’t make the same mistake again then perhaps we will achieve a positive outcome from a bad event.
I also wanted to try to get across in the book that the law is a very coarse tool at actually judging whether doctors, or any other profession when it comes to that, makes a mistake, because it uses hindsight, it’s being wise after the event all the time, and that tends to make doctors very risk averse, very nervous about doing anything that somebody might get at them for later, and I think that’s potentially hazardous.
For many doctors, a complaint from a patient is one of the biggest dilemmas, especially since the patient comes first.
If you're a busy doctor and you're confronted with 30 patients to see at a two or three hour clinic, you’ve got a responsibility to all of them. If one of them is very very complicated and takes a long time you’re all the time aware that the other 29 are sitting there and their problems may be just as acute, just as taxing and just as complicated. And so your obligations are split and it’s that that challenges one, because you're effectively rationing your time all the time, and especially with the present huge pressure on the NHS produced by Covid and all the other things, you’re constantly under pressure and that produces some of the irritation that lots of patients feel with their doctors. You know this whole business about how you can never get an appointment with your GP for instance. That’s because the GP’s are just overwhelmed with requests for appointments, they're actually seeing more patients now face to face than they were before the pandemic. And yet the demand for appointments has gone up by about a 3rd
You are a GP too, is ‘Lets Kill All The Lawyers’ a reflection on your time?
Well it is. I was a very ordinary GP for almost 30 years before I went on to do something else. I suppose the story in the book is a combination of lots and lots of things and situations that I came up against or came across during my time as an ordinary doctor. I think that the descriptions of the way that people die, the different ways that people can die in the book, and the passages I’ve included in it about how people die is an attempt to explain to the public that modern medicine isn’t an all encompassing cure for everything. That there isn’t a simple solution for everything. That there are many situations where you simply can’t solve a major medical issue.
We tend to think of modern medicine as being absolutely wonderful because that’s what we see on television and that’s what the experts publish. But in fact sooner or later we’re going to come up against a medical situation which can’t be solved both for ourselves and as doctors. Sometimes coming to terms with that allows people to have a much better insight into what's happening to them. I think doctors tend to be reluctant to be open and honest with people. There’s a hazard in over-egging things and giving people false optimism. And I've tried to share in the book how that doesn’t always give people a good end to their lives.
I think you did this incredibly well, especially when Antonia and the doctors were placed in a difficult place where they had to tell her mother that she didn’t have long left. Did you feel that this was an important aspect to include?
I think honesty and openness is terribly important. We’re very good at selecting doctors who are very, very clever, but who are not necessarily terribly good at communication. And I think that communication isn’t particularly well taught to doctors and I think we should work at that because it should be one of the basic tools of the trade for any competent doctor, to be able to communicate well.
Well I suppose it’s part of the service isn’t it? Corruption in the judiciary is often kept secret, did you feel that this was an important theme to address? And why?
Well I hinted at it in the book. Not because judges are corrupt and I think judges are hugely honourable and honest people on the whole. But that they are human too. I wanted to get over the message that they are ordinary human beings like all the rest of us, and that they can be influenced by their background, their upbringing, their decision making, their circumstances and their friends in just the same way as we all can. And people do get at the process, people do try to influence judges. You’ve only got to look at the way judges have been attacked in some of the newspapers over the last few years for making judgements that go against a policy that a newspaper supports and they've been personally criticised for it. So they’re susceptible to pressure just like the rest of us.
You mention that you have began to question many of the regulatory elements of medicine. Which ones? And in what way?
I think the main one is the fact that we use the law as a very blunt instrument to regulate what are very grey, very balanced decisions. Very often a doctor will make a decision that turns out, with hindsight, to be less than perfect. Sometimes to be completely wrong. Now if that decision is then held up as a failure by the law and the doctor is threatened by it, his career is threatened, or he has to pay damages or something like that, then it becomes very black and white, it becomes confrontational, it becomes about winning and losing which is basically what the law is about. And I wanted to try and get over the message in the books that the balance is much, much finer than that, it’s a much more grey area.
If for instance you see a child with a cold as a GP, 999 out of a thousand times it will turn out to be a cold. One in a thousand, or maybe more than that, one in ten thousand, it may be the very early onset of meningitis. You can’t know that as a doctor. You can look out for all the danger signs and you can check them, record that you’ve checked them, but six hours, twelve hours later the child may go on to develop meningitis. Now if you then blame the doctor for not having spotted it earlier, all you're doing is being wise after the event. You're just saying that the doctor hasn't managed to ... be perfect. He hasn't managed to see the future. But that's inevitably what the blame culture that the law works to tends to think.
And so, I think there should be a better way, I’m not sure what it is, but I think there could and should be a better way of judging failure in not just doctors, within many professions. Obviously there are exceptions to that, there are some very bad doctors, there are bad people in every profession who make bad mistakes. And they need sorting out, they need picking up, identifying and dealing with appropriately. But most doctors are doing their best and are motivated to do their best. And if we beat them up with hindsight, making failure, making mistakes, then we don't do anything for the system.
I think there is a bit of an unhealthy standard of perfection. Patients assume it’s something that’s going to be fixed.
You're absolutely right. I think that we all expect a solution to every problem don’t we, and I think medicine is it’s own worst enemy in this, because it tends to say there’s a cure for every ill, or there's a pill for every ill, or that we can do our very best for you. That doesn’t imply we can solve every problem. One of the huge increases in presentation to doctors and patients coming to see doctors with is stress. People are stressed, we‘re all stressed. By our jobs, by covid, by global warming, by all the other things in life and that is presented almost as though it’s a disease. There's a difference between being stressed, which is a normal human response, and pathological mental illness. Medicine has tended to sell itself, or give itself the reputation for being able to solve all these things. It can maybe help a bit by training people how to deal with stress. But to say that it can somehow cure these things is, I think, misleading. And I think it leads to dissatisfaction when medicine is proved to be incapable of curing all these things. Very philosophical point, isn't it really?
That’s quite an eye-opening thought, and I couldn’t agree more! Have you always enjoyed writing?
I’ve always loved literature and writing all my life and I’ve been a member of a writing group for many years. And when I went on and did a different career as a chair in a tribunal that made judgements about whether doctors had failed or not through this organisation called The General Medicine Council, effectively being a disciplinarian for all doctors, that led to writing judgements. So yes, I'm used to writing a lot. But I just enjoy the pleasure of writing and trying to tell a story and trying to get a point across.
What book are you reading?
I'm reading a book, ooh gosh, the name escapes me. It’s one of the shortlisted books for the 2002 Man Booker prize. I can’t remember the name of it at the moment, but it’s a brilliant book about those who were at home during the Blitz in the last war and the effect it had on them. So it’s really a psychological analysis of stress, which is what we were talking about.
Can we expect more books?
Well there’s one on the stocks at the moment, almost ready too. I’ve written a collection of short stories and talking heads. You know, the person we all look up to as the most brilliant short story writer ever is Alan Bennett, and his famous Talking Heads which are brilliantly insightful analyses of people’s behaviour and circumstance. They’re impossible to copy or to emulate because he’s so good at them, but I’ve tried to do so, and I’ve written a collection of short stories and talking heads which covers a whole range. Some of them attempt to be amusing, some of them are quite emotional, sad. Some of them are an attempt to analyse things like people’s religious belief and why it stands or why it fails, things like that. So that’s on the stocks and it’s ready to come out after Let's Kill All The Lawyers. I hope to have it out in February, it’s called Flying Like Angels.
You can get a copy of ‘Lets Kill All The Lawyers’ here.
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