The old person whisperer
The geriatrician behind the Bristol Stool Tart
Muna Al-Jawad is an elderly medicine consultant at the Royal Sussex County Hospital, Brighton. Alongside her work on the wards, she bakes and also works in graphic medicine under the pseudonym “the old person whisperer.” She uses her drawings as tools in research, teaching, and self-reflection. She is writing her PhD thesis in comic format, pioneering a new way of approaching qualitative research. Her comics explore hospital culture; the ways in which medicine affects its practitioners; and the challenges of staying human while working in the NHS. Al-Jawad is also the unsung hero of the “Bristol Stool Tart”—the “poo cake” whose photo went “noroviral” on the internet earlier this year.
How did you become a geriatrician?
I think I’m slightly odd because I’ve always wanted to be a geriatrician—ever since my first geriatrics placement. I’m a bit of a fighter of lost causes—I was always on demonstrations at medical school and tend to support the underdog. I had travelled to Thailand and seen how well older people were treated there. Coming back to the UK I saw with new eyes how poorly we treat that generation here. Geriatrics seemed a way of addressing that.
What do you think makes a good geriatrician?
Deep down, you have to believe you’re a superhero. I think what a lot of geriatricians have in common is a strong moral sense and belief that they’re doing the right thing. When you first talk to a geriatrician they seem modest and humble, but when you dig deeper, we think we look after patients better than anybody else.
Clinically, it’s the balance of being thorough, but also knowing what you can ignore on a lengthy problem list. Geriatricians also need to be able to deal with diagnostic uncertainty as we sometimes don’t investigate.
How did the idea for “the old person whisperer” come about?
I liked the idea that a geriatrician would be a superhero, although it seems slightly ridiculous. We’re not super-trauma surgeons who run in and save the day. Helping someone onto a commode might be the best thing I do all day. But beyond that, “the old person whisperer” stemmed from a realisation that I liked talking to confused patients. Other people would struggle to get a history, place a cannula, and take bloods, and I would come along and just be able to do it. So I started thinking: it’s not a magic superpower, what is it that I do differently?
Have you boiled it down to a few nuggets?
There’s a lot in the curriculum on communication skills, but very little teaching on talking to confused patients. Just paying attention to it as a different form of communication works well. There are instinctive things like making eye contact; not talking to someone’s deaf side; using their name . . . but other things are more counterintuitive. If a confused patient doesn’t immediately understand what you’ve said, it’s better to repeat exactly the same words rather than trying to rephrase. That idea definitely helped me when I discovered it.
What are the challenges of geriatrics?
Old people just aren’t valued in our society and that translates to the hospital hierarchy. Some people regard geriatricians as glorified social workers. We tend to be interested in compassionate medicine, but it can distract from the fact that geriatrics is a complex, interesting medical specialty. What do you do when you’re bottom of the hierarchy? I haven’t figured that out yet. Just the stigma of being old means that attitudes to geriatrics might take a long time to change.
It’s also low tech. We don’t have clever, whizzy things to play with. It’s hard to persuade a trust to spend money on two more nurses, whereas if you say “we need this really cool new scanner,” the answer is normally yes.
Why do you do comics?
I think it’s important for doctors to be able to step outside of what they do day to day. Comics allow me to do that: to process and reflect on my experiences.
They also allow you to address emotive topics, but with a protective cloak of humour and the symbolism. The disguise is in the gag, and the power is in the symbolism. If you want to draw a person crying you just need to draw one tear, and that is enough. It can be much more powerful than any lengthy prose.
What’s your research about?
Through comics I’m exploring what medicine does to its practitioners. One of the starting points was Foucault’s “regard” or “gaze,” which is the way doctors see patients. How we see people depends on whether we’re in doctor mode or normal person mode. Alongside that I’m also interested in compassion in healthcare. Being caring is difficult—there’s a complexity to being compassionate all the time. Combined with the stuff about “regard,” it got me thinking: what does constant compassion do to you when you also have to keep detached? It’s integral to the job, but it affects you. And how do you resist when medical culture has gone awry? If the prevailing culture is to walk on by when the old lady is shouting for help, how do you stop yourself from assimilating? Realising we’re doing it is the first step.
What’s the story behind the “Bristol Stool Tart”?
I’d had the idea for it just before our Christmas geriatrics bake off, but it got to the day before and I knew I wouldn’t get it done in time. So I told the team, who decided among themselves who was going to make which numbers. The next morning they assembled the cake on the ward: it was teamwork in action. If only the NHS could replicate that. We won the bake off, then the next month I got a text from my F1 telling me “We’ve gone viral—5000 likes on Facebook.” Even Ben Goldacre was tweeting about it. My consultant colleague, Tom, reckons we should get a professorship off the back of it.Ania Crawshaw, academic foundation year 2
1Royal Sussex County Hospital
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
- Al-Jawad M. Comics are research: Graphic narratives as a new way of seeing clinical practice. J Med Humanit 2013.
Cite this as: Student BMJ 2013;21:f6895