2013 seems a long time ago, a time of innocence when it was
possible to say someone “came up trumps” and not immediately blush
and apologise. It was also when I was running for the post of
President and had to write a manifesto.
Most manifestos are largely commitments so bland that no one
could disagree – one way of testing this is to see who in their
right mind would ever suggest the opposite – “we will reduce crime”
and “be nice to old people”. If they are too specific things can go
seriously wrong – just ask Nick “No Tuition Fees” Clegg.
But in mine, I did make one concrete commitment – that I would
visit every UK medical school to talk to students about the virtues
Since then there have been times when I have sympathised with
Nick Clegg. This usually happens on the last dreary train back to
London wondering how the noisy drunks in the carriage had managed
to get hold of any refreshments, given the bar was always closed,
and why do we always stop at Milton Keynes when no one ever gets
Do I really have to go to every medical school as promised? For
a start, there are 34 – who knew that? Certainly, not me in
But a promise is a promise. I have now visited 33, just one
left. If anyone else has managed to visit every medical school in
the Kingdom they have kept quiet about it. Louis Appleby wrote “A
Medical Tour Through the Whole Island of Great Britain" back in
1994 - ask him for a copy, there is a pile of unsold ones in his
attic. But he never visited a single medical school. Nick Black’s
“Walking London’s Medical History” includes a few, but the title
tells you it’s written for the “liberal metropolitan elite” that
lost us the referendum.
So, what did I do on this Grand Tour?
It varied. The first thing was not to do “The Speech”. Cast your
minds back to when you were at medical school, think of your
graduation ceremony. You have your degree. You are now a doctor.
But before you can get out of the hall, spend some polite time with
your parents and impolite time with your friends, you have to
endure "The Speech".
It’s given by someone three times your age, whom you should have
heard of, but never have. They have achieved or won something, most
probably a prize for smugness. And inevitably they will share with
you the secret of their success, which is usually “you need to be
in the right place at the right time”. Which is just about the most
useless piece of advice ever.
And now I am that person. So, I try not to give “The Speech”. If
pressed, and I often am, to give advice, I will with reluctance
share three tips. Don’t invade Russia. Don’t email when drunk.
Don’t accept a police caution. All very sound I think.
So instead we talk about anything and everything. Sometimes they
want a “set piece”, but more often it’s a PowerPoint free for all.
And all sorts of things can happen. The GMC would like the public
to believe that all medical schools are the same. They aren’t.
A slice of student life
Some things though don’t change. Medical students’ desire for
pizza remains insatiable. Birmingham and Manchester had the best
selection. Nottingham meant well - pizza was ordered, but
unfortunately in the singular not plural, and one duly arrived for
a full lecture theatre.
Audiences varied - Brighton filled the main lecture theatre,
only to be beaten by Newcastle where we had an overflow. Wooden
spoon to UCL though - we barely filled a broom cupboard because of
a clash with a surgical revision lecture. Exams still conquer
Some were more active than others – at QMUL my visit was linked
to a premiere of a Wellcome-funded play on veterans and PTSD. Cue
an amazingly lively discussion – ditto watching films on trauma in
Topics raised also differ. Oxford seemed split down the middle
on the need for safe spaces and trigger warnings, but Swansea
didn’t seem to know that the debate was even happening (and no, it
wasn’t because the Welsh have a different word for it).
But the least PC evening of all was spent at the Med Soc dinner
at an unnamed Cambridge college, where I gave what I thought was a
slightly risqué after-dinner speech.
I always try these out first on my sons, who like most of the
youth of today turn out to be rather more censorious than we were.
"Dad, don't you dare say that" being both frequent and wise
But after I had finished, each student had to tell a joke, and I
was transported back 35 years to a junior doctors’ trip to a
Gateshead Working Men's Club to listen to Roy “Chubby” Brown, a
northern comic whose act was so utterly blue that he made Jim
Davidson or Bernard Manning sound like Marcel Proust.
I gradually became a convert to new medical schools and graduate
entry. At Lancaster, UEA, Brighton and elsewhere there seemed to be
a correlation between the number of graduate entrants and interest
There was also a correlation between senior turn out and student
interest – step forward Belfast, Birmingham, Exeter, St Georges,
York and a few others. The presence of the Dean made a difference –
chapeau to Plymouth, Swansea and York. And so on.
Ask the audience
What was obvious everywhere is that interest in mental health is
soaring. Sooner or later I was asked about why there has been a
rise in mental disorders on campus, and what should we do about
As I don’t know the answer to either question I would usually
ask the audience.
Inevitably there was a range of opinions and solutions, although
not many went beyond the need for more counsellors.
Many quoted the recent NUS survey (or indeed had carried out
similar surveys on their own campus) that found that 80% of
students had “mental health problems”, but fewer seemed to be
willing to critically evaluate this unlikely finding.
It’s important that we apply some critical thinking and
appreciate the difference between “mental health” and mental
disorder. But NUS surveys aside, mental disorder is indeed on the
rise, at least among women who are aged between 18 and 24.
However, the best estimate is a prevalence rate of 26%, not 80%.
So we can agree that there are more students needing more support,
including on occasion specialist support from psychiatrists.
Beyond that I found myself falling back on the need for more
evidence about the causes of this increase and the need to respond
in an evidence-based way.
This is not a final appearance in these columns by my old friend
“Pedanticus” – it’s because if we don’t we may end up sometimes at
best wasting resources for no benefit, and at worst making things
So in order to encourage more critical thinking I sometimes ask
the audience how many of them are making friends that they would
keep for life - 80% raise their hands, and then how many were being
intellectually stimulated by their studies (a similar proportion)
and finally how many were having better sex lives (we don’t vote on
this, but judging by the smiles it was also a majority).
A time of challenge and change
I did this to suggest some continuity – university remains a
time of challenge and change, incorporating both the negative (such
as loneliness, isolation, exam stress) and the positive (such as
emotional growth, friendship, stimulation and experimentation), and
that we should be cautious of invoking mental health problems for
all of these.
Of course, there are also discontinuities - social media acts as
a great amplifier of both the bad and good, but we should be
careful of blaming the medium for the message. Parenting styles and
risk obsession have changed over a generation. And let’s not forget
the additional burden of debt (thanks, Nick).
But whatever the answer to rises in mental ill health, and at
the moment I think we have to say we don’t really know, the
challenge for us in psychiatry is to harness this interest into
making more psychologically minded doctors in general, and more
psychiatrists in particular.
The interest is there, believe me, despite the rear-guard
actions of some of our colleagues in other disciplines (when I
asked those who had decided to do psychiatry how their teachers had
reacted, the answers were predictable and depressing). The
challenge remains to translate this enthusiasm and interest in
mental health into a similar enthusiasm for psychiatry.
And then we would finish. Sometimes we adjourned to a lovely
country pub (Plymouth and Swansea score highly) or a student bar
(Birmingham, Glasgow remain in the memory) or trendy restaurant
(Leeds and Brighton). And then to either a nice hotel (thanks,
Edinburgh and Exeter), a not so nice hotel (lips sealed) but more
often on to that dreary last train.
Which was the best? As Bruce Forsyth tells every Strictly
contestant “You are my favourite,”, and so it proved. Wherever they
are, medical students remain bright, committed, lively and engaged,
much more so than my generation ever was.
And now there is just one medical school left to visit. Dundee
in May. So, if you reading this, Dundee, you know how to make me
Lively students please – although I am not sure there is any
other kind which is reassuring. Some food afterwards – a country
pub is good, pepperoni pizza if not.
And if there is white wine, any chance that it might be chilled
and not served in plastic cups? And please can I take the train
home that doesn’t seem to have a fatal attraction to Milton
Professor Sir Simon Wessely
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