Your Life In My Hands: A Junior Doctor's Story

This Review appeared in The Times, 29.7.2017 Life, Death and Jeremy Hunt Mature students make interesting doctors; confident and committed, with a wealth of life experience to complement their medical skills. Dr Rachel Clarke comes from four generations of doctors, but her first degree was in PPE at Oxford. She worked in political journalism and TV production before medicine, and opens her memoir in the Democratic Republic of Congo, where she risked rape and death to cover the civil war. This didn’t, however, prepare her for the stress, exhaustion and exhilaration of working as a junior doctor in a health service bursting at the seams. Clarke is a skilful writer, and her passion shines through the many personal, moving and unsettling stories of life on the frontline. . One patient with cancer is told with extraordinary tenderness that she is going to die, another makes an astonishing recovery when all seemed futile. And there is a very intimate description of death itself. Clarke’s book also contains a hundred and thirty-three references to health secretary Jeremy Hunt. Hunt’s conflict with junior doctors in 2015-2016 weaves through the spine of this story like a rapidly mutating virus. Clarke details the lengths she and her colleagues went to avoid strike action, and how devastated she felt when the strikes were called. Our longest serving health secretary does not come out well, but neither does the British Medical Association (BMA). Hunt is portrayed as a career politician with a fragile grasp of statistics. Clarke’s experience of political journalism enabled her to repeatedly call him to account on social media for perceived bias, without resorting to trolling. This galvanised widespread support from NHS staff and the public but had little effect on Hunt, who recently confessed to paying no attention to Twitter (although he smiled at a junior doctor placard that read: ‘I’m not a gynaecologist but I know a Hunt when I see one.’) Clarke’s focus on patient safety helped shift the media debate away from Hunt’s line that naïve junior doctors were being hoodwinked by the money-grabbing BMA, to the public realisation that the NHS is dangerously understaffed, and that any attempt to spread more services over weekends, as the Conservative manifesto had promised, would need more staff. Hunt’s suggestion that not enough doctors worked at weekends was met with a vigorous #ImInWorkJeremy campaign on social media, with hundreds of NHS staff posting photos from their weekend shifts. When Hunt assured junior doctors that his door was always open yet refused to meet them, Clarke helped orchestrate a round the clock vigil outside the Department of Health, sitting alongside an empty chair with ‘Hunt’ on it. Sadly, it did not prevent eight days of strike action. I supported Clarke and her colleagues in their attempts to speak truth to power, but I did not support the strikes. 98% of junior doctors who voted did support strikes, which shows a measure of their anger and desperation, but there is scant logic in risking harm to patients in a protest about patient safety. Clarke realised that the conflict could only be resolved through negotiation but Hunt knew that he could just sit tight and effectively impose his new contract on doctors by not offering any alternative. In the event, the BMA self-destructed when private messages exchanged between members of the junior doctors’ committee were leaked to the press. The committee’s chair described a secret strategy to drag the dispute out for 18 months and another member claimed that ‘weekend pay was the only red line for junior doctors.’ Clarke was incandescent. Her carefully orchestrated patient safety campaign lay in tatters. A mortally wounded BMA agreed on the wording of a new contract with the government and although 58% of doctors rejected it, there was no alternative. Hunt had won the battle but at what price? As Clarke laments, half of junior doctors who complete their foundation years training are now delaying entering higher specialist training, and some have left the NHS for good. Her view is that this exodus could have been avoided if Jeremy Hunt had not repeatedly threatened to impose a contract on junior doctors. Towards the end of the conflict, Hunt and Clarke finally met in a cramped parliamentary office. Hunt admitted that Britain does not have enough doctors, and told Clarke that his desire to improve patient safety stemmed from the horrors of the Mid Staffs scandal. So how could two people with such similar aims end up poles apart? As Hunt admits; ‘I have totally failed to communicate with junior doctors and I have torn my hair out trying to think how I could have done it differently and better.’ Clarke’s prescription is clear. Stick to the evidence, staff the NHS safely and - above all - work with doctors, not against them. Amidst the politics, this fine book is peppered with the everyday acts of kindness that keep the NHS afloat. But there is also a clear warning. If NHS staff don’t have the time to care, and to do their jobs competently, they will walk away. Dr Phil Hammond is an NHS doctor, Private Eye journalist and author of ‘Staying Alive – How to Get the Best from the NHS’

I love medical memoirs, and this was a very interesting and fascinating read. Just marred slightly for me as I wasn't keen on the political stuff which kept popping up-I do realise that's what was happening at the time, but too many mentions for me, I would have preferred to read mainly about her medical experiences, with just one or two references to the government activity. As well as the anger she has due to the politicians, it's also emotional and warm, plus a few chuckles in there too. Not just about things happening to her patients-closer to home too. This is the second book I've read by this author, and I'll certainly read more.

Eloquently and sensitively delivered , this true story of the life of a popular, successful journalist turned medical professional, is an eye opening and explicit account of the incipient demise of our NHS. The difficulties caused by ever increasing cutbacks by the government, and the slow disillusionment of the workforce at the coal face is described in painful detail by the author as she progresses in her career as a doctor and lets us into her life. This autobiography has been a joy to read, not only because Rachel’s conversational style of writing is so articulate and accessible, but also because anyone who has worked in the NHS will be able to identify with her lived experience. I reluctantly finished reading this book wanting to know more and what happened next. Thank you Rachel!

Rachel Clarke has interesting stories to write about and some pretty valid opinions on the bureaucratic shenanigans which bog down the way the NHS works. Yet somehow, I get a strange feeling whenever I'm reading one or the other, I come to want to read about the other more. Is it some strange kind of realtime disillusionment which is only happening to me? While the patient stories remain interesting and at times funny, the political spin side and the description of the stress and the personal struggle becomes repetitive and does not necessarily provide more insight than what we have already been told. To give her credit though, this piece appears to have been well researched, the sources are helpful (especially to the me who has been living under a rock and which most of these shenanigans have gone over my head). For a first book, this has been a compelling attempt. Perhaps what is holding her back is the decade she spent in journalism, where excessive repetition is not necessarily a bad thing.

When I came on site to write this review I noted there were quite a few 1 star reviews. I was surprised to say the least considering its content. When you read through them many are complaining that it was a political rant, that they wanted more stories about patients and life on the wards. It seems so unfair to me, to give a book a 1 star rating when you openly admit to not having read it properly, to skipping chapters, skim reading or not even getting past the first chapter. If it wasn't what you expected then all I can say is you didn't read the 'blurb' before buying because its there in black and white for all to see. Maybe you ought to quit skim reading things even before you buy! I always say words are written to be read, if you don't read all the words, you won't get the full story, a bit like eavedropping. So anyway, rant, diatribe over. This is what I thought. I enjoyed every aspect of this book. I thought it was intelligently told, but with so much warmth and compassion for those patients whose stories were covered. I never realised how many ways there were to die, and that some of those deaths have the potential to cause great suffering in a persons last hours. Good that we still have Doctors who can try to do their very best to ensure the suffering is limited and that a person can die with dignity, surrounded by those who love them. It is quite frightening to think that in a not so distant future, if certain members of our ruling classes had their way, we would end up more concerned with whether we could afford the treatment and whether our insurance would be willing to cover it than ensuring our loved ones received the best care. Is that really what people want? So no, the book isn't funny, it doesn't have witty little passages, it doesnt really contain many anecdotal stories but what it does do is tell it like it is - with passion!

I've eagerly anticipated this book ever since it was announced. And, having got my copy, I devoured it in a single sitting. I'll go back to it again soon, and read in a more measured fashion. But it is a lightning account. Very well written, full of power & passion, leavened with numerous - often heartbreaking - real-life illustrations of how the current govt. - largely via the efforts of Jeremy Hunt MP - is driving the NHS into probably terminal collapse. This is seen through eyes & experience of the author, a junior doctor in the midst of it all. Catalysed & maintained by her anger at what govt. was doing, she describes what the NHS has become and, even worse, where it seems to going. She describes the calculated lies & spin that have eroded the work of the NHS, and undermined, demeaned & insulted the work of all who care for the patients. She describes the response of the NHS staff ... and in particular both senior & junior doctors. It makes uncomfortable & disturbing reading. It provides the polemic & facts that fill in some of the gaps in two recent, popular and - in themselves - worrying TV documentary series: Hospital & Junior Doctors. The author had done us all a service with her shocking description & analysis. We simply cannot afford, in any sense, to allow the present govt. to pursue its genuinely immoral policies concerning our NHS

This is a very powerful account of life as a junior doctor on the NHS frontline. It is a very elegantly written, moving and honest account by Rachel Clarke, who was an accomplished journalist before becoming a doctor. She writes with compassion and humanity, describing the physical and emotional exhaustion of the job. I think it should be mandatory reading for all medical students.

This book is not an ideal holiday read yet that's where I've managed to read it! It's incredibly well written with many passages that are reminiscent of Hemingway in terms of the directness and getting across emotion, fact and drama in as few words as possible - an art. Surely the political class will be hanging their heads in shame at this reasoned response to their machinations. The frontline stories are very emotional and real - so much so I'm expecting to self diagnose several symptoms as they occur in the coming years! They get across the stark reality. The commentary of this dispute is essential and shocking. This is a must read. This is not only an important book, but it's clearly been written by a talented and important person. Here is someone who has that rare quality of making us all feel better about ourselves whilst also coming across as entirely real and likeable. I await her subsequent books with great enthusiasm!