In this episode we have the fortune of speaking with Consultant Paediatric Neurosurgeon Mr. Jay Jayamohan. This was a very pionient and moving conversation about the importance of 'Empathy' and caring for not only the patient in ones care but the whole family.
Dr Jay works at our local Hospital, the John Radcliffe Hospital, Oxford and is also an Honorary Senior Clinical Lecturer at Oxford. He has been the star of two highly acclaimed BBC fly-on-the-wall series following the work of neurosurgeons.
Dr Jay's work breaks down into three primary areas: Paediatric Neurosurgery - tackling tumours and congenital problems in children; Craniofacial Reconstruction - working with a plastic surgeon to give babies or victims of accidents a shot at a normal life; Expert Witness - employed by the courts to help solve head related crimes or provide the case for the defence.
Jay is also the author of acclaimed book "Everything That Makes Us Human: Case Notes of a Children's Brain Surgeon". Described by Dr Amanda Brown, author of The Prison Doctor as "an inspirational book written by a truly remarkable man" and 'Extraordinary' by the The Times.
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Thinking of Oscar website and contact details can be found here.
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Theme Music - ‘Mountain’
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast editing - Right Royal Audio
Podcast artwork thanks to The Podcast Design Experts
That was a really pivotal moment where you realise that however young you are, your inherent desire should be taken into account if you're able to understand it. And kids may not understand the details of nuances of different types of outcomes. They sure know about life or death. And when they've been through it so many times they know what they're prepared to put up with, to keep going, to keep having some quality of life. And we have to always be aware that they are listening and they are taking in and if they don't get listened to, we're basically sending them to a court and making a decision over their life without getting them any any involvement in it.David:
Hello, everybody, and welcome to Episode Four of the third season of the not mini adults podcast, pioneers for children's health care and wellbeing. My name is David Cole. And you've just heard Jay Jayamohan, who is a consultant paediatric neurosurgeon at the John Radcliffe Hospital in Oxford, UK. Once again, I'm also joined by my wife, Hannah. And together we are the co founders of children's charity thinking of Oscar. This week, we have the absolute pleasure of speaking to Jay and the theme that we're going to be discussing is all around empathy, as you might imagine, as a neurosurgeon it is a very important part of his work. Those of you in the UK may have come across Jay when he appeared in two highly acclaimed BBC flying the war documentary series following the work of neurosurgeons. Jay is a specialist in three primary areas. Firstly, paediatric neurosurgery, where he tackles tumours and congenital problems in children. Secondly, cranial facial reconstruction, working with plastic surgeons and others to give babies a chance of a different, hopefully better life. And finally, as an expert witness employed by the courts, the police and lawyers to help investigate potential crimes, or to analyse alleged child abuse cases, we really wanted to talk to Jay not only to discuss the amazing work that he is doing, and the ways in which he is employing empathy to help to speak to both patients and parents, but also because of his mission to give a voice to those patients, so often overlooked, because of their age. Jay, Hello, welcome to the not mini adults podcast, thank you so much for for agreeing to come on.Jay:
Good morning. Thank you for inviting me.David:
Jay, we'll talk a little bit about kind of how we heard about you and your book and all the work that you're doing. But it'd be great if you could just maybe start by telling us a little bit about yourself and what you do and how you got there please.Jay:
Yes, short version is I'm a paediatric neurosurgeon. So that's a children's brain surgeon at the John Radcliffe Hospital in Oxford. And I've been here for 17 or 18 years. And I sort of go through the standard training of being a doctor and then deciding to do surgery during my basic surgical training, and then neurosurgical training. And then I after I did that in London, and then I went off to Glasgow and worked there for six years. And then I, at that point, I realised I wanted to do children's neurosurgery. So then I went off to Toronto, which is one of the world's sort of big centres for children's neurosurgery, I spent a year there, which was a real turning point, realising This is what I'm really want to do. I came back and got a job at Oxford. And like many of us, once you get into a place, you really get your, your group settle down, and so really have been here. Since then, I can't really see myself moving now until someone puts me underneath a tree, hopefully many years from now,Hannah:
what was so important about your experience in Toronto? Why was it so pivotal for you?Jay:
It was a time when I'd done my training. We're always learning but done, my basic training of neurosurgery. I had done, my exams are passed. So I kind of knew that I was going to become a neurosurgeon. You know, I was going to get a consultant job somewhere. But it enabled me to really concentrate and focus the mind on just kiddies neurosurgery. The set up in Toronto for children's neurosurgery is very intense, highly academic, which I'm not. But it enabled me to see the level of academia that you can do if you want to do that. Lots of operating, fantastic bosses. I did have fantastic bosses before, I should say in case any of them are listening. But I went by myself. So I left my fiance in Glasgow, and she was doing a PhD. So off I went and I basically could just live in the hospital and a small pub around the corner. And between those two, I could spend a year just doing children's neurosurgery, which was really what I wanted. I didn't have to think I need to be somewhere else or do something else. Not that I didn't miss my field search at all. Have a case she's listening in. But you know, when you are doing something, and you're so engrossed in it, that you don't really realise what's going on around you. And sometimes if you're reading a book, you know, you don't realise that everyone's gone, and the lights are all off. And you there's one light on there. And actually, that was, for me, it was like a year of that. And it just went past without me realising it. It was an amazing year.Hannah:
was an amazing experience to have been able to. I don't mean it was selfish. But as in just to be able to devote, there are very few moments in your life, when you can really invest in yourself like that.Jay:
It was. Lots of people go off and travel after their A levels. And you know, or take a gap year, I didn't do that I basically spent my entire life from school onwards, just moving almost one day to the next from one job to another. So the maximum I ever had off between jobs was a Friday to a Monday, I just went from job to job to job and never took any time out. I never really travelled around the world, I went on wee little holidays, but never really travelled around the world to find myself. I never really found the need to do that. But what was interesting was, I could realise that this is now on the cusp of becoming a consultant being in charge, having all the responsibility of being the person in charge of looking after a little person. And so this gave me a year to really polish my armour, sharpen my sword. Before I in my mind went into independent battle.David:
I think I heard you actually on the Chris Evans Breakfast Show, I think that's where I first first came about you and you were talking about your work everything that makes us human. And I remember just kind of stopped in the driveway, just dropped the kids off at school and listening to what you had to say. And then when I managed to, you know, pick up the book and find it there was very early on, there was a there was a line that you said or a couple of sentences that you said that I'm just going to read out, which made me just know that we had to try and get you on here. And if you don't mind, I'm just going to read them, which is I became a doctor to save lives. I became a neurosurgeon, because I believed it to be the highest achievement in medicine. I became a paediatric neurosurgeon to give a voice to those patients. So long overlooked because of their age, to give them a life, to give them a chance, to give them respect. I'm quite emotional kind of reading that, because that's what we, I guess, trying to do from a charitable perspective. But that is such powerful words and such powerful kind of vision that you took on and wrote down there.Jay:
Yeah, it wasn't an instant decision. Clearly, each of those have happened at a different point in time. But each of those decisions have, again allowed me to focus and concentrate the big soup that is wanting to help people into Well, how do I do it in the best way that I've got skill to do? And not everybody can do it the same way? How do I use my skills and abilities to do the best I can for the people who I really see as needing my skills again, of course, I'm going to say that children are the most important. But somebody who does adult work, equally has a valid argument for that. Every Adult was somebody's child at some point. So it crosses over. But for me, I felt that, you know, having heard so much discussion about the need to go back if we think back to why people concentrate on certain jobs. So if I just divert for a second, think about when you do surgical training, we used to do surgical training, everybody had to do general surgery, and everybody had to do A&E, basically, the reason why is if there's a war, if there's essentially an adult orientated world, which is, let's face it, not a pleasant one, this is what you need surgeons to be able to do is to be in the field and treat abdominal thoratic wounds, and do emergency work. That's how all of surgical training was designed from war time. And for so many years, it just seemed that kids just kind of got the bottom end of that deal. Because the investment was never in children's services because if you really get down to it. If you save children's lives, they don't automatically go on to make money for the state. If you fix a broken leg on a 25 year old, they're going to go back and own taxes and give money back to the state. So if you like they're going to pay for their medical treatment by going back and working. Most children especially again, neurosurgical children, lots of neurosurgical children. They never really earn huge amounts for the state, may get jobs that pay taxes, but will always be slightly lower than the average amount of tax income for various reasons. It doesn't mean that what they do is going to be any less important for them or for society, but financially, they're going to be lower. And that means that kids get pushed to the side when money is allocated. So I felt that natural sense of injustice as to why should kids who haven't done the bad things in the world get the bum end of the deal when it comes to allocation. So again, it's that thing that kids don't get a voice. And that's in medicine that's in society, that's a home. If I think about my personal experience, I was once I was telling up one of my kids, and my wife said, we really should try not to do this, because we would never talk to adults, the way we talk to kids, we would never treat adults the way we treat kids, because you'd get punched in the face by most adults, if you shout at them. And you certainly wouldn't expect them to do what you say. So why, why do we do that to kids, and that there's this thing that goes through society, I think that kids are still to some extent, to be seen and not heard. And that I wanted to get into that and make them heard.Hannah:
I told our three year old off yesterday morning, because he'd been in and out of our room since 4:30am, telling us his bedroom was boring. So once we've come into the hours of the day that we were meant to be spending time with him, I was a little groggy, and just frustrated. So I tried. So I told him, I first thing, Leo, tomorrow when you wake up, if you wake up in the night rollover, go back to sleep, then you won't be bored, because you'll be asleep. So I told him my first thing, and then later, an hour later, I'm still groggy, and I repeat this in front of our eldest. And Leo instantly objects and said, but Mommy, you told me, You know, I said, Sorry about this already. But it is the point that you've just like he was justifiably objecting that, you know, I was bringing this subject back up when he had already addressed it. So I hear what you're saying it's fresh in my mind.Jay:
It's a painful lesson, isn't it? When you realise that that's actually asked that we do that without even thinking as parents and as not usually for anybody else's kids? Or where you'd quite like to sometimes, but we do, we run that strict hierarchy. And then we object when society runs strict hierarchy on kids, but it just reflects what we do ourselves, doesnt it.David:
it? One of the the interesting things, I think synergies around some of the conversation are quite a lot of conversations that we've had, that you are kind of portraying is empowerment. So you know, empowering the child its just a constant thread that we have through many of the conversations that we have. And that is a big thing for you as well, right? So you want to make sure that if a child is able to understand what is happening to them, then then you're able to try and convey that to them and give them the opportunity to really understand Can you talk a little bit about that,Jay:
Really important is avoiding the automatic assumption that a child or somebody who has different abilities from everybody else, is not able to comprehend and be involved in decision making. And that's, I can't remember if I did talk about it in the book or not. But there was a wee kiddy that we talked over this patient for a good 10 minutes about a tumour that had come back, I was I was essentially going to kill them, whether we may have thought about trying to do this operation. And was it fair? Was it going to be too painful and difficult for the child to bear? And the parent was barring towards No. And we were barring towards No. And eventually, after about 10 minutes of this conversation, where we were basically settling on no and this kid said, Can I can I say something? I said, Oh, yeah. And this is your, I'll probably start weeping when I say it. But this kid just looked at the parents who asked and they said, I want to live. Because that was a really pivotal moment where you realised however young you are, your inherent desire should be taken into account, if you're able to understand it. And kids may not understand the details of nuances of different types of outcomes. But they should know about life or death. And when they've been through it. So many times, they know what they're prepared to put up with, to keep going to keep having some quality of life. And we have to always be aware that they are listening and they are taking in and if they don't get listened to. We're basically sending them to court and making a decision over their life. Without getting them any any involvement in it. It's really important. And then you move on from that young child to an area which I hope we don't do but which I know does happen is that if you have difficulties in expressing yourself, if you're physically unable to express yourself with words, or with very clear actions, there's an automatic assumption that that means you can't understand. And again, this happens even to older kids and adults, where people make decisions for them. While they're able to hear understand what's going on. And if you just wait or give them a different way, you can get their involvement and they should have that autonomy needed to be able to make those decisions? And we take that away from people who have different abilities as well.Hannah:
You've just touched on the answer to my question, but I'm curious to understand a bit more. You said that for older children, or were they maybe it's harder for them to express themselves? And one of my question is about the methods that you've developed to, you know, solicit their points of view and one that you've suggested a minute ago was time, you know, how else have you made that work, so that you feel that they're being respected and heard?Jay:
Well, with kids, the first is you, you've got to talk to them, you sometimes you have to talk to the parents about more build risks and benefits that they won't understand. But at some point, and a fairly early on, you need to talk to them in a way that they can understand. And then they feel that they're part of the conversation. They're part of the team, trying to fight whatever the illnesses that they've got, if they're not part of it, then they're not fully psychologically engaged in it. And we know that being psychologically engaged in treating illness is hugely important in recovery. If you give up, you tend to do worse than if you say, and I'm going to really, I'm going to fight this. And we know that. So you talk to them, you talk to them at their level. And again, if you think about what it must be like to lie in a bed, and have four or five, six foot giants stand around you talking in a way that you may catch a few words, which are probably the most terrifying words. You know, for me, the words must be things like tumour, operation, scar, for older kids, all of these catching these words, but not really getting the gist of what the rest of the conversation is. Well, that's got to be pretty scary. If you were an adult in that situation, you'd be utterly terrified. Imagine being a kid. So you get down, get down to their high physical height, make eye contact, and then they know that you are talking to them, not about them. And I think you've once we do that, it can usually mean that when you then talk to them that they know that you are talking to them not about them. And they can trust you. So you also have to be as honest as you can be to them. So I tell my patients, I tell my kids, that it's going to hurt, when they wake up, it's going to be sore, we'll give you lots of painkillers, we'll make it as little soreness as possible, but it is going to hurt. There's no point in saying to kids, it's not going to hurt, because we're going to wake up with a scar from ear to ear, you know what, it's going to hurt. But again, we tell them that and I say to them, that means that when you wake up, and it does hurt, you remember that Mr. J said it will get better. And again, it's about them saying, Oh, yeah, he told me it would hurt. But he also told me that it will be better by tomorrow. And once they know that you are telling them a big true, they will take comfort and benefit in knowing that it will get better. Whereas if you say to them is not going to hurt, and then it hurts. Why should they trust you, that you tell them is going to get better by the next day or by the next week? Or if they have a weakness, you say look, it may well be weaken your arm, what we'll do lots of physio, it may take weeks, but it is probably going to get better. And if it doesn't, we'll work around it, then they're part of the conversation there. They know what's going on. And that always ends up with a better outcome.David:
There's a code I think that you have, you know, code review, if you will, within surgery, which is watch one, do one, teach one right, which I think we've you know, heard a few times. But is, first of all, it was interesting to understand that and just you know the kind of nuance of that of how that works. But I'm hoping that that has also happened when it comes to that kind of bedside manner and the compassion elements of it and teaching your kind of students as it were, or the medical students coming through how to have that interaction as well, because I think, I don't know, maybe it is maybe it's not, but it feels like it's a relatively new way of, you know, being able to think about how how one discusses what's going on with children and that empowerment element of it. And the reason I say or maybe guess that is because we're starting to see technologies to try and help with that element to try and empower the child to try and bring them into the decision making process more than they are already.Jay:
Definitely kids adopt technology so fast, that we are struggling to keep up to be able to make the apps or make the devices to keep up with their ability to use them. So the answer to your first question is yes, absolutely. We don't do see one, do one, teach one any more thank goodness. You see a lot, you do a lot and then you start to do them by yourself. So it there's much more oversight of what happens in the operating theatre from the more senior members of the of the team than they used to be. But we do Ward rounds with our trainees. And they're involved in the conversations, they hear how we do it. And you'll hear different ways from different people. And it's not the one person's is right. But what you get to do is by doing as many Ward rounds, and as many of these in depth difficult conversations, you get to start to pick and choose bits from each of your bosses and go, I like the way they did that. I like the way they did that. I didn't like that. So we'll get rid of that one. But you can still take positives from everyone that you learn from, and then you build up your own style. But I think as long as the style respects the patient, and gives them a voice in it, it's fine, how you want to do it, you know, some of my colleagues are much more, nicely patriarchal, so much more about, don't worry, I'll sort it, it'll be fine. If you genuinely can do that, with honesty in your face, people will go with that system as well. That's not usually my method, I'm a bit more of a of an equal conversationalist but it's not the ones better be on the others worse, doesn't matter. As long as the patient and the parents feel that connection, feel that trust, feel that unspoken, signing on a contract that you do, when you look the parents and the child in the eye and you tell them what you're going to do, you're making a contract there, you know, you are signing on the dotted line with that family that you will look after that child as best as you possibly can, however you do it, you've got to be able to make sure that you make that contract. And you're right, using technology to help kids involved in that. So there's watching things about operations, watching, you know, animated versions of treatments. Understanding and reading, enables you to have a thought about what questions you want to ask the health professional when you finally meet them, or when you meet them for the second time if need be, there's downsides. Because there can be unregulated education on the internet, some of which can be very wrong. But we usually try and send them to various websites that we know or are trustable. But technology is here and can only help to educate and education lowers anxiety, education, lower stress, it's got to be good for the kids.Hannah:
I know that one of the areas that David was wanting to cover this afternoon was around the role of technology, not just for aid in communication with the children, but practically, perhaps in the operating theatre as well, just in an angle that you've been thinking about was to what extent can technology reduce risk of some of these complex procedures, but the sort of flip side of that that I was also curious about was in a when you're talking about innovation and new technology, then there is also some inherent risk there. And you know, when you're in the most vulnerable of vulnerable situation dealing with children and neurological issues. So in my mind, that's a very delicate space to be I mean, working and not operating. And then how have you been able to pull technology in ways that you're comfortable with where it's the the potential that it lends to you goes far beyond any concerns that you might have, by the fact, by virtue of the fact that it is a new way of doing something?Jay:
Yeah, the additional levels of technology that are being promoted to, for example, us as neurosurgeons is exponentially increasing, and not always for the better. So I have driven my car into what was quite clearly a field, because the satnav told me to turn right. And my wife said, I wouldn't turn right if I was here that looks like a field. But I said her but satnav, I mean, it was a Volvo. So I don't know how it told me that lie, but it did. And I think we, we all have a natural ability to switch off our own thought processes and trust technology. And what we have to do when we're doing operations, is be very sure that you use technology along with your highly trained knowledge that you have, and constantly be checking that what it's telling you is correct, and is the best thing for the patient. If we think about the technology that we use now, for example, guidance in theatre, basically a satnav for the brain when we're doing an operation. Now that indeed can help us to remove all of the brain tumour or to get a tube into the correct part of the brain. However, the decision making about how much of that tumour you want to take out, cannot rest just on, this as the abnormal area and therefore we want to take it all out, it's having a knowledge about the pathology? What is sort of tumour is it? Do we need to take it all out? Or is it something we can leave a bit in and treat with another way, but also about that relationship you have with the patient. What a concert level pianist may choose is different from what somebody who works as a shelf stacker in Sainsbury's may choose from the point of view of risk benefit for it. Not so much as a children's neurosurgeon. But when I was a trainee, I remember that very example, because we had a concert level pianist who chose and said, Do not go for this bit of tumour, if you think it's likely to cause me to be unable to play the piano, because if I can't play the piano, I might as well not be here. And I am willing to take a shorter lifespan with my piano than a longer lifespan without whether we agree or not. If you don't know the patient, you haven't taken time to talk to them. It's just another tumour, let's get the tumour out, let's take it all out. But that again, removes the autonomy from the patient to make that decision about what they're prepared to do. And, you know, we've taken on and we said, we will fix you, but they didn't ask to be fixed in that way. So you need to have that conversation to know what the personalised. It's a big thing, isn't it personalised treatment. And that goes right, the way down to it comes down to the fact you need to know your patient, to be able to have that conversation and make that call with them.Hannah:
Only in recent years, I've really understood the value or power of judgement and instinct. Because before this moment of realisation for me, which was actually related to Oscar, I had just seen that as I would have said, that a reference book or a computer or somebody with a different job title, to me that was rated in the field, that that fact coming out of those sources would be of greater value than my judgments coming or my perspective coming from instincts or judgments. And I know now that that's not the case, and that these, the instincts and judgement are, in a sense, many, many data points formed over 10 or 20 years in my life that have validity. Of course, that's further accentuated when yours is very specific training that's come to bear, but it's a useful life lesson that you can apply beyond theatre.Jay:
It is, but it's also, it's the reason why you can't, for some conditions, you can, but for the majority, especially surgical, you can't use a computer yet to do that. You can use a computer, you can use AI to show you the abnormality, but you can't yet use AI to decide how you're going to treat it best for that particular person. You can't use it to be able to have a conversation with a person about what risk benefit ratio they are prepared to take for any particular treatment. And until you do that, until AI is so far advanced that they can have that conversation. And it can make analysis far beyond what we rely on which is having a relationship that they can trust us and tell us the truth. But also being able to gauge Well actually, we've not really been able to look them in the eye. While you've been saying this. Are you sure this is actually how you feel? Or are you just going along with it? And getting that sense of are they telling you what they actually want to do or not. And of course AI is coming in. It's coming in a rather nefarious way that I've been reading about, you know, looking at pupils, and sweatiness when they're interrogating prisoners, but eventually that will come down to a hospital setting where we're talking to patients and wondering if they're telling us the truth or on using that information. But until that comes, which is probably a long way away, it is about the patient trusting us enough to tell us what they honestly think rather than what they think we should be told. And I can't see the time in my life span that a computer will be able to do that.David:
I'm gonna I'm gonna try and do a kind of, you know, link here between, you know, so we're, we've both been I've worked in AI, currently, Hannah, Hannah has worked in AI and looks at it. And I think we certainly recognise that in order for AI to really be the best it can be. And one thing that AI will never be able to do and what we've really kind of the substance. And I guess the underlying theme of this conversation is around empathy, and understanding, you know, the patient in front of you, the child in front of you, the family in front of you. And we were discussing just before we kind of pressed record, that element of how important it is to be able to really kind of trying to step back and understand more about people around you and what they're going through and having that kind of empathy and understanding around and compassion I guess just you know, generally, and I know that's a topic pretty close to your heart.Jay:
It is look AI is going to get here. But I think back to real basic AI. It's not very high. But my kids used to have this, it was a seahorse with a rubber tummy, if they woke up at night, they've pressed the tummy. And it would do a little glowing light and play a little song. So there is a an interaction between a human and the machine that the human told the machine, I am feeling sad, or distressed, or I need soothing. Right now, okay, granted, it was a one year old human, but they were still able to tell the machine that by pressing its tummy, and the machine was able to respond by doing the correct soothing actions to help that person. That's a very basic, but that is, it is artificial, and to some level is intelligent. Now, you're going to have to go exponentially higher to be able to do what we would like it to do for our patients. But it will get there, it will get to the point where it will be able to understand enough to be able to come up with a conversation that will probably serve that person to some level. It's all being made by a human and learned from a human, it hasn't learned it by itself. But it will come. And that's not a bad thing. It's no different from putting on classical music, when you're feeling anxious or me putting on techno, if I wanted to concentrate that's AI, some level, it will come. But it needs a human to put the information into that intelligence. And it's what information it puts in, it's the programmer, that will become absolutely vital. If you programme the computer to be harsh and cold. And to tell people to just get on with it, it will be a fascist AI. If you programme it to be much more gentle, and have much longer time to be able to hear answers and not log off and not start thinking you know, I can't hear you say it again, well, then you're gonna have a more caring machine. So it all comes down to what the person is thats doing it. It's the same as whether it's a human who's a horrible, uncaring human or a caring human. They're just putting that into a machine. And then that interface will reflect the programme.Hannah:
And taking the technology aside again. And one of the conversations we were having before we press go on this podcast was around how we deserved more kindness in the world during the peak of COVID. And how people were giving others, where being more generous as others are going around their day to day work. But that was something that you had a point of view on your in your professional role around, you know, not knowing not knowing what's going on in somebody else's life, could you talk for a moment around, you know, when you're thinking about empathy and how you communicate with your patient, it's not only the child that you're concerned with that, but there would be others, other stakeholders that you're looking out for?Jay:
Yeah, you are not just treating the child, you are always treating the family, as well as the child and taking them on the journey. The child is the Centre for the parents as well as for you. But the parents are the next ring out. And if you don't take them with you, the child will pick up the child realises the parents don't trust you, then the child's not gonna trust you. And so we have a selfish responsibility to do it. But also we have a caring responsibility to make sure that parents understand what their child is going to go through and be ready for it, it reflects a society issue of being able to put yourself in someone else's shoes, as we were saying people did do for a while, and are now stopping doing is my experience. They are now looking into themselves into what do I get out of it? What's best for me, not what's overall best or what's fair or what's right. It's about what is best for me. I try not to be political, but to me. It's reflecting all parts of society, from our government, right the way down. We're being encouraged to think about ourselves much more than we are about society. And we will be much worse off with that decision that the country appears to have already made. To go back to that. Literally just stopping and waiting permanently. I try and think about this all the time. I think if you see somebody who's driving very slowly, who's really at the roundabout and is not able to get going and a gap that you think well. Of course you can do that. Well, perhaps they've left they're really sick spouse or child at home or going to work perhaps they're going to hospital for chemotherapy. Perhaps they have a good friend who's overseas who's desperately sick and they can't get to see them because they can't travel, perhaps lots of things. Perhaps they're thinking how the hell am I going to fill my car up with petrol? Because I've got no money. And how am I going to feed my kids tonight, it's being able to think about how not everybody in that queue waiting to do with that roundabout, is finding it as easy or as straightforward as you are that day. I was I was once in a queue. And there was a turn out to be a colleague of mine, a surgeon who was in a large Porsche, four by four behind me. And I was pretty tired. And I'd had a, you know, some difficulties with some patients. And I was quite tired. I was just waiting to leave and I wanted to pick it up. I didn't want to try to freak out. And he started horning. And I didn't realise who he was. And I wigged out, I should never do this, advising anybody to this, but I got out of the car. And I went around and I said, What is up? What is the matter? He said, Oh, you could have gone there. I said, so what? what was going to happen? I waited. But if that had been my 81 year old dad, at that cue, he would have jumped with his car, panicking because someone's falling behind him. And he may have had an accident, because his I mean, he does not go fast at the best of times, and he could have easily had an accident. And what would that have gained, you would have gained you the phrase I used I work for now, but it would have gained you not very much. So just take a breath, I shouldn't go back to my car and I went, but it just encapsulates how we can be super caring. I mean, get in a car, or we can go to the pub, or we can do lots of other things and disconnect our caring side and become a real chump again, I can be a real chump as well, let's not beat around the bush there but what I'm trying to try and bring a more caring part to everything I do. And I think if we all do that a wee bit we will be better overall.David:
There's one thing I want to talk to you about before I kind of ask you what, what tends to be our last question, which is around and it's coming back to what you talked about in terms of just, I think, bringing everyone in and thinking about everyone, but when you bring your team together within the operating theatre, and the collaboration and what have you. So first of all, you've touched on it, but you have we already talked about but you'd like to have loud blaring music and just from a concentration point of view. But the more important aspects for me is that culture that you bring to allow everybody, you know, the kind of meritocracy of anybody can speak up if they see that something's going wrong. And to me, that's a really important lesson that we should, you know, at least hopefully get out to the listeners.Jay:
Yes, I mean, be clear that's not just me, that's instilled into I think everybody nowadays, in hospitals is the ability to speak up if you think something is not right. But also, I guess, you've got to go beyond that and actually have a relationship with other people. So knowing the names of the nurses, knowing the names of the porters, if you know each other's names, you're much more likely to say something than if they go or there's that person who I can't really speak to because they're the surgeon, and I'm, quote, unquote, just the porter, well actually everybody's there looking after the patient, and everyone wants the same thing, which is the patient to do well. And while I probably I think probably most people who know me will say that I run a democratic system, it is slightly autocratic when we're operating, I think that there's there's a time and a place for it. And it's people knowing there's a difference between being a leader and being an autocratic leader. And I hope that I can do one without doing the other. So you have to lead, you're in charge, you're the surgeon, the consultant surgeon. And along with your anaesthetist, you are very much running the show in that operating theatre. Officially it's the scrub nurse who's in charge of the operating theatre. So officially, the scrub nurse can check us out if they want to. As a junior, that certainly happened. But they weren't. If you're the person doing the operation, you're a team. And the less experienced or the more junior staff will look to you in a crisis. So the first thing is you do have to be a leader in that you need to be able to lead when everything hits the fan, as well as when everything's going great. And at that point, you've got to be able to say, right, this is what we're doing. This is how we're doing it, you do this, you do this, you did this. But to avoid getting into that situation, you want everybody to be able to feel to say, Actually, I don't think this is right. I'm not sure about that. Are you sure about this? And again, it's being able to say to him, if you see me doing something wrong and I verbalise this to my team a lot. If you see me doing something wrong, don't wait and go. Yeah, I thought that was a bit odd. You know, a baby, you knew what you're doing. No, tell me and if I'm alright with it. I'll say that actually, yeah. Now I know it's a bit unusual, but for these reasons I wanted to do that bloody hell your right thanks very much. Let's look at the other side of the patient's head. And maybe we'll it will be an easier operation. right down to the basics of checking the side is everybody happy, this is the left side of the head, look at the scan, that's the left side of the head, real basic stuff, and everybody can get it wrong, which means everyone can help to avoid a mistake.David:
Thank you. I was I, as I said to you, I think before we came on, I'm a bit of a kind of nerd when it comes to the leadership side of things. So I did want to get that across. But it's been so fascinating talking to you. And we could absolutely go on forever. But I'm sure that you've got very important things to be doing, so our kind of final question that we asked to everyone is, if you could, if you could change anything within child health, within paediatrics, what would it be? If you had that kind of magic wand?Jay:
It probably wouldn't be within a hospital framework, but it's recognising how the environment that children are brought up in at home is the most important thing to how children's health will be long term. So food, nutrition, love, a roof, things that not all kids have, even in Britain. That's the most important thing that we can do for our kids. What I do, the stuff that I do is high faluting fancy, expensive, but in brutal terms, small numbers of children. And while what we do is really important, because it's what sets us up as an advanced society caring about the weakest, we haven't even done a very good job of just caring about kids full stop, you know, hungry children, and unloved children uneducated children. This is happening in Britain in 2021, which is a shocker. Frankly.David:
I don't think we could obviously disagree with that in the in the slightest. And one of the things that, you know, we're trying to do with this with this podcast is to highlight some of those areas and try and share stories of people that are trying to do things differently. So thank you so much for your thank you for everything that you do, first of all, and for joining us today. Thank you for sharing your thoughts and your experience. And, you know, we're really grateful for your time.Jay:
My pleasure. Thank you very much for having me.David:
Thank you so much to Dr. J for joining us this week. As you would have heard, it was a pretty emotional conversation both for him and us, given the work that he does, but also the reasons behind the job that he has, why he is doing it and why that's so important. We really do feel humbled to speak to amazing people like Jay and we really hope that you are getting as much out of these conversations as we are next week. We're speaking to Richard Hebdon who is the director of healthcare and Life Sciences for the British government's innovate UK department. I'm delighted to say that we will be discussing with him how he is helping to support Child Health and bring more innovation and finances into Child Health innovation. We really hope that you can join us then please do subscribe to the podcast. And if you're enjoying it, please do leave us a review as well. We hope you'll join us again next week.