On Embarrassing Bodies, you seem unembarrassable. What does embarrass you?
From the medical point of view, nothing. But in a non-medical way, I definitely become embarrassed. If you are on television, it is thought that you must be outgoing and confident, but I’m actually shy; I was an only child. I grew up in a fairly academic background, surrounded by books. Television people don’t know much about the business of medicine, while I knew nothing about television and have had to learn.
Has your medical career been entirely overtaken by being a media doctor?
I still do two days’ work in the clinic I’ve worked in for years; normal doctoring. Television was always supposed to be on the side, but …
Is the public’s fascination with bodies the same as a doctor’s interest?
I don’t think a doctor has the sense of voyeurism which people have. A doctor has seen it all before. Doctors lust after the rare thing they haven’t seen in ages.
Speaking of voyeurism, how would you answer the charge that your programme is sensational, making entertainment out of suffering?
That has been talked about. The word “exploitation” has been used – it drives me up the wall. Television is a question of choice. I’d like to do a show about the show, so people could see what happens behind the scenes. Anyone who appears on the programme has to pass a psychiatric evaluation and understand how ruthless Twitter and social media can be.
What is the most heartbreaking situation you have ever experienced during the show, and have you ever cried off camera?
Yes. I’ve cried on camera too. The case of Charlotte with the appalling verrucas. When she took her Ugg bootie off, the camera was on my face and I was destroyed: her foot was consumed by verrucas, it was appalling. The GP had told her to scrub them with a kitchen scourer. I knew something was wrong beyond the verrucas. She had a rare immune deficiency and had to have a bone marrow transplant at Great Ormond Street children’s hospital.
What makes a good doctor?
Communication and empathy. Eighty per cent is communication. You don’t need a brilliant brain, especially given that information is now available online within seconds.
Is it wise for people to self-diagnose online?
Not to self-diagnose, though I don’t mind people looking things up – it keeps me on my toes. People need to consult a doctor because doctors have learned how to identify good sources. A doctor who pretends to know everything and never looks anything up is a dangerous doctor.
Are you the only doctor who gives medical advice on Twitter?
When I started, I got grief from other doctors who thought it totally inappropriate. But people are cottoning on. I’ll answer any questions on Twitter, no matter how trivial.
There is no issue about confidentiality because I do not tweet about my patients. And if someone on Twitter asks an open public question and I answer in an open public way, they have waived the right to confidentiality.
What do you think of people using gadgets to monitor health, exercise etc?
It can be a wonderful excuse to do nothing. But get the balance right and it can be useful. It is great that people can check high blood pressure for instance. The technology is great. Some patients could helpfully be seen on Skype. But the medical profession is reluctant, incredibly slow, will say: this is not cricket. They’re incredibly conservative – [laughs] that’s why I never fitted in.
Should smoking be banned in public places?
It should. Smoking kills most smokers, but you can’t enforce something when your laws on alcohol and other drugs are so hypocritical. There is an endorsement of alcohol by the government, yet liver disease is increasing exponentially.
Should the price of alcohol be increased and people who turn up drunk in A&E be fined?
We know that hiking up prices works. But you can’t fine people; again, because alcohol is endorsed by government.
Have you met Jeremy Hunt and is he to be trusted?
He is in a horrendously difficult position and will never get everything right. I would not want his job. The NHS is seen as this sacred cow that must not change. But it needs to move on, it cannot continue as it is. Medicine is becoming more and more expensive. When I suggested on Twitter that patients should pay £10 to see a doctor, it polarised people. There have got to be reforms. Obesity will cripple the NHS in 10 years’ time.
What would you suggest to fix the obesity crisis?
The only thing to do is to become even more of a nanny state. You need to legislate against manufacturers of food designed to make us eat more. We need to reduce our salt and sugar content, we need better education at school. Evolution has designed us to be fat because, as cave dwellers, food was not common.
What does the Ebola crisis show us about our attitude towards disease? And should returning health workers be quarantined?
From the first few cases, I was saying we needed to be far more worried than we were. Ebola is a terrible disease and the World Health Organisation’s response has been negligent. It is really worrying. Our attitude to the disease is a bit superior, as if we were in control. But nature is usually the winner. We should fear and respect it.
By the way, I can’t believe this nurse threatening to sue [US nurse Kaci Hickox over her enforced quarantine in Maine]. Anyone who has been nursing and is in contact with Ebola knows they are at risk. A tiny bit of tiredness while taking off an isolation suit could be enough to be exposed.
When I was studying infectious diseases at the London School of Hygiene and Tropical Medicine – 10 years ago now – our professor asked us what we would do in an Ebola outbreak. We said we would set up isolation units and so forth. He said: “No. You’d leave.”
It was his way of spelling out that this is a serious disease, that you cannot be gung-ho about it, that there was little you could do.
Is the scheme to give doctors £55 for each Alzheimer’s diagnosis ethical?
No, it is a terrible thing. They are being paid extra to do their jobs.
Is Nick Clegg right to argue that psychiatric illness is a taboo that needs to be overcome?
We could do much better over how we deal with mental illness. It is difficult to treat as it’s chronic, but so are eczema and diabetes. It has never been covered on television. It is tricky because you can’t get the consent of the patients – that is why we cannot do it. We did educate people about HIV to some extent, but mental health is not so cool or trendy and hasn’t got Elton John behind it.
Why do members of the public frightened of going to the doctor with their medical problems feel willing to consult you on TV?
If you watch a soap often enough, you feel you know the characters. People will familiarly chat with me in the street. I don’t know them, but they feel they know me.
You’ve talked about body dysmorphia and of having experienced it yourself. What causes it? And do you still wrestle with it or is it something you grow out of?
We don’t know. Genetics? Self-doubt? A bigger percentage of gay men suffer from it. Is it to do with feelings of inadequacy, comparing yourself with your father, self-loathing? I still wrestle with it, but have learned to manage it. On a bad day, the shadow of it is just over my shoulder. It is like the old adage: once an alcoholic, always an alcoholic. Once dsymorphic …
You once described love as a “trick of your genes”. Explain.
We think we are higher beings in control but are slaves to genetics. Love is to get us to come together, have sex, reproduce. We are designed to do it. The romantic poets wrote nonsense!
Do you feel like the nation’s GP?
Sometimes, though I wouldn’t if social media did not exist. It is a huge honour. I love the fact that the show has been embraced, and that there is a hunger for knowledge and for answers people can trust. And I think GPs should have open days where people could ask questions.
Who do you turn to when you need answers?
[Laughs] I look things up.
Christian Jessen will present Fatonomics on Channel 4 in the new year
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