Dr. Samir Guglani (MBBS, MRCP, FRCR) is a consultant clinical oncologist and a writer. He is also the founder, director, and curator of Medicine Unboxed, an annual event which uses the arts to engage health professionals and the public in conversation around medicine.
Dr. Guglani obtained his medical degree from the University College Hospital London Medical School (1995), having also completed an intercalated degree in neuroscience there.
Following the completion of his training in oncology, he spent a year as a Clinical and Research fellow at the Peter MacCallum Cancer Institute in Melbourne, Australia, before becoming a consultant in 2006. Furthermore, he chairs his hospital’s Clinical Ethics Committee.
Dr. Guglani writes a column for The Lancet. He also had his debut novel, Histories, published in November 2017. It follows the experience of various characters in a hospital over the course of a week.
When did you first decide to become a doctor? Why?
I’ve wanted to be a doctor for as long as I can remember, to be honest. I don’t know that I could articulate the “why”, short of it being an impulse to contribute to others in some fashion. I’m not sure if it was ever the science that especially drew me.
The answer to the question of “why” has evolved with time. There’s a great TS Eliot line which says: “the end of all our exploring will be to arrive where we started, and know the place for the first time”. I think there’s something to it, in that the question and the answer of “why” unravel as you move through time.
I hadn’t really thought of any other profession when applying to university. Having said that, writing and performance were important to me as a young person in medical school. UCL was around the corner from the Royal Academy of Dramatic Arts. I used to walk by it thinking “What if?” and “Wouldn’t it be fun?” At medical school, I took on the role of president of the Medics Drama Society and put on a number of plays. I got a lot of joy and nourishment from doing those. I carried on writing a lot as a student doctor, too.
How/why did you choose the medical school you attended?
I liked its openness. I also liked its lack of conservatism as opposed to the slightly more Etonian notion of the medical school. I don’t think I thought about it consciously, but I found it warm and receptive.
What surprised you the most about your medical studies?
Nothing in particular. I think I just kind of got on with it, to be honest. When I switched to clinical phase, following a one-year neuroscience BSc—which I loved—I was really taken by the encounters with patients. I liked the transition out of lecture theatres. UCL was also very good at sending you to various parts of the country. You’d get on a train and you’d end up in Dawlish or Camarthen, or wherever. That was good for us.
What information/advice do you wish you had known when you were beginning your medical studies?
I wish I’d known there wasn’t necessarily one fixed way of being or becoming a doctor. In hindsight, I also wish I’d taken the opportunity to fraternize more with non-medical students. I think I was too nervous and sought refuge among medical students. As a young person, 18 or 19, I was pretty unsure of myself, on reflection.
Why did you decide to specialize in oncology?
As a student, I wondered about specialties like psychiatry, neurology, pediatrics. Upon graduating, my first job was in general medicine with oncology in Bath. I loved it then. On applying for registrar posts, I was torn between oncology, intensive care, and elderly care. They’re very different, but I think what drew me to all of them was that, besides their technical elements, they offered big encounters with human mortality, with ethical judgement, and with communication with patient or families or both. Those specialties felt like they had a similar set of veins running through them. I suspect it would always have been oncology, for reasons I can’t necessarily grasp.
As an oncologist, you grapple with the question of what you ought to do, not just what is possible. You also grapple with the question of how to engage human beings with these dilemmas at times of terrible suffering and vulnerability for them. The three strands of the science, the ethics, and the art of medicine are tangibly present in a specialty like oncology.
Has being an oncologist met your expectations? Why?
For me, medicine is as much an encounter with meaning as it is with the physical substance of life. The degree to which one wishes to meet these varies wildly between doctors. So much of medicine finds itself prioritizing the encounter with biology rather than meaning, which I think is to the detriment of good care. They’re both important. After all, we’re dealing with persons who are hopeful and frightened, and they hold values which we need to engage and navigate. Personally speaking, oncology permits and insists on this version of medicine, every day, in every encounter.
What do you enjoy most about being an oncologist? Explain.
Exactly that—this encounter with science and meaning and charged moments in human lives; all of it is a sort of wonder.
What do you find most challenging about oncology? Explain.
Medical progress has made such huge advances in the past twenty, thirty years. We can now control disease and prolong life in ways were never imaginable, which is astonishing and wonderful. But there is now an increasing expectation from both the general public and health professionals that life can, and ought to, be indefinitely prolonged. I think this is worrying because: human mortality remains an absolute fact; denying it so systematically leads to problems with our ability to be truthful; and the pursuit of incessant and sometimes ill-judged medical interventions can have real consequences for the quality of our lives and deaths, and for social justice.
Of course it’s valid and important to want to prolong life. It’s perhaps a question of wondering about the extent to which this is reasonable, and our approach: how truthful are we with people who are hopeful and frightened about the risks and benefits of treatments, and the limits of treatment? Finding a language or vocabulary within which one can be truthful and compassionate simultaneously is essential. It’s a great privilege to be a doctor and to hope and try to have these conversations honestly. But it’s interesting because it immediately exposes the fact that, as healthcare professionals, we need to be conscious about our own beliefs and values and biases if we are to do a good job with having these conversations.
That’s maybe where the arts have some role to play in exposing and interrogating what are often quite fixed and hidden values and preferences. The arts potentially provide a mechanism or route to identifying with other people, and to see ourselves more clearly. The knowledge of what it is to be a human being—a faulted, troubled, disorientated, frightened, ambivalent human being—is as important as the knowledge of the route of the facial nerve, or the overall survival advantage of biological therapies, or the postoperative complications of a colectomy. It’s as important, but not necessarily similarly prized or fostered in the practice of medicine.
What’s your typical work-week like?
It’s busy! The day goes from around 8 AM to 8 PM. It’s full of clinical encounters on the wards and in outpatients; of supervising chemotherapy and radiotherapy clinics. There’s a lot of strategic work in terms of quality improvement and development, clinical trials, the ethics group, lots of admin, phone calls and conversations with relatives, GPs, other hospital teams. Two years ago, I changed my working week to a four-day week, specifically with the hope of giving time to Medicine Unboxed and to writing more.
Tell me more about how you started Medicine Unboxed.
Much is achievable by just having a go. It started from asking: how do we get the public and health professionals into the same space and ask wider moral questions about how one understands the whole business of being human and fragile and mortal? We’re also asking about social justice and about what we mean by good medical care. In figuring out who would be necessary to those conversations, it turns out that writers, politicians, pianists, singers, philosophers, theologians, anthropologists, all have something to say. That’s to say that the knowledge required for medical encounters is necessarily wide.
The events are very loosely themed. This year was Maps; others have been Wonder, Belief, Mortality, Voice, Frontiers, Stories. The upcoming one will be Love. We have 48 hours of challenge, enchantment, provocation, and debate in a theater in Cheltenham.
Over the years, it’s grown organically. We started small, and we now get 300 people into a theatre in Cheltenham for our annual event. As it’s grown, we’ve been fortunate enough to get many incredible speakers and grants from local charities, the Wellcome Trust, and Arts Council England. It’s non-profit, and it’s driven by passion.
How has it informed your clinical practice?
It’s been personally rewarding, but I hope it’s also been rewarding for others. My writing and my engagement with Medicine Unboxed, go hand in hand. Both of them have been ways of untangling knots, of pursuing meaning over fact.
What do you like most about running Medicine Unboxed?
I guess curating and enabling some of these conversations has certainly been really rewarding and nourishing for me, and created an arena in which one can ask the sorts of questions I’m alluding to. I’m not superstitious, but I believe that if you push hard and are impassioned by something, the stars can align a bit, and you find yourself amongst talented, supportive, and generous people.
What do you like least about running Medicine Unboxed?
I enjoy it all, and there’s isn’t anything about it that I like least. I love doing it. It is practically challenging and places demands on my time, but that’s fine.
On average: How many hours a week do you work? How many weeks of vacation do you take?
I don’t count.
How do you balance work and life outside of work?
I don’t know the answer to that, really. I read a lot. I run, I write, I walk, I spend time with my family. My work-life balance is either really awful, or it’s perfect; it depends on your idea of balance. It works for me. I think there are more hours in the day than we realize. It’s all a continuum.
From your perspective, what is the biggest problem in health care today?
The absence of justice in it. The fact that I can invoke millions of pounds for immunotherapy, say, but not money for oral rehydration: this is astonishing in the modern world and an indictment of it. We need to have more conversations around the fact of human mortality and about the kind of society we prize or value or feel it’s right to live in. If we can start having these conversations—important, political conversations—at small levels, they might just join up and gain momentum.
Where do you see medicine at large in five years?
I have no idea. Who knows? I guess, scientifically, it will continue to flourish as it has done and is doing, which is astonishing. I hope it can get better at thinking about what it ought to do, and not just what it can do.
Where do you see oncology in five years?
Immunotherapy is manifestly the next big thing, along with the increase in targeted therapies and precision of therapeutics.
What is your final piece of advice for students interested in pursuing a career in like yours?
Be impassioned. And there’s this great line from a poem by WS Graham, which ends “Do not expect applause”, and I think that’s really important for us all to remember, because so many of our disenchantments are premised on an expectation of applause.
Also: feel wonder at other humanity, followed by a compulsion to act. Identify with the experience of others.