Richard Smith: A collection of consistently hilarious (but also pointed) columns from The BMJ

Jim Drife, the singing professor of obstetrics and gynaecology from Leeds, wrote a hilarious, teasing column in The BMJ over many years. His columns have now been collected together in a book called “This Medical Life,” and which I thoroughly recommend. He asked me to write an introduction, and it’s below. It gives you a flavour of his wit, but I urge you to buy the book (I’m not getting a cut).

“Medical journals are dull; I don’t think that there is any doubt about that,” wrote Richard Asher, the doyen of medical writers of his era, in the British Medical Journal (renamed the BMJ when Britishness became suspect) in 1958. Asher condemned the wrapping, presentation, typeface, dreadful titles, lack of colour, and capacity to make the interesting boring, but he most condemned the way that doctors’ journals are filled with “pudder” and “gobbledygook” or what Michael O’Donnell, editor of the much-missed World Medicine, called “decorated municipal gothic.” Asher complained that doctors “clog their meaning with muddy words and pompous prolixity.”

What then can medical editors do to make their journals less dull? Asher, a physician, is longer on diagnosis than cure, but he does end by advising that “medical articles should, like after-dinner speeches, finish before the audience’s interest starts to wane.” His article, which I suggest is a little too long, was based on a talk, and was clearly intended to be funny. It is amusing in places, but oddly he doesn’t mention in his article the lack of humour as one of the worst failings of medical journals. A few funny articles, especially if short as Asher advised, can do marvels to lift the appeal of medical journals, which are prone to pomposity and taking themselves and the world too seriously. What’s more, humour can often address deadly serious subjects with more impact and insight than straight writing—as Juvenal, Shakespeare, and Swift have shown.

Editors of The BMJ, of whom I was one, thought that a few funny articles would make the journal more attractive, but where could we find a doctor who could write funny articles? It is much harder to write funny than straight pieces, and many attempts at being funny fall flat; and even if you can write a few funny articles it’s an art that is hard to sustain.

Some of us knew Jim Drife. I was at medical school with him, and we sat together on the Medical Students Committee in Edinburgh, insisting in seconds that Lyndon Johnson get out of Vietnam and debating for hours whether we should pay for a football for the medical school team. Jim was senior and I was junior, but I remembered his wit, beard, bounce, and bowtie.  I remembered as well that he sang comic songs with Walter Nimmo, another doctor. Jim, we thought, could be just what we needed to lift the BMJ, and so began his series of columns in 1988.

I’ve had a marvelous time reading my way through this collection of Jim’s columns. I regularly laughed out loud, which is something I rarely do. Jim manages to sustain the humour across more than 100 columns, a considerable achievement. It may seem fanciful, but his writing reminds me of P G Wodehouse: Jim has not only the humour of Wodehouse but also his gentleness, lightness of touch, readability, self-deprecation, and gallery of fearsome aunts (politicians and senior managers in Jim’s case). Jim is more Bertie Wooster than Jeeves but also with a touch of Lord Emsworth.

Some of Jim’s columns have stayed with me for decades, and it was a great pleasure to reread them.

I have never been able to see the acronym BMA without thinking that it means not only British Medical Association but, as christened by Jim, the British Misery Association. Jim mimics perfectly the tone, mixed metaphors, and clichés of a BMA letter to all doctors:

“The BMA is seriously concerned that some doctors (very few, I grant you) are happy in their work, and it is my urgent task to stamp this out….

Much as I prefer hewing at the bread and butter of clinical work, it has fallen to me to fight your corner against Whitehall mandarins, Westminster apparatchiks, and Brussels bureaucrats…

Next, a stern word to all you consultants. On the train the other day I overheard a consultant saying that life wasn’t too bad. Admittedly he had drunk half a bottle of Chateau Intercity Cote de l’Est Privee but I did have to change my seat and reason with him. Careless talk costs salary increases….

The BMA has successfully demonised every Health Secretary since Bevan and rubbished all their initiatives, well intentioned or otherwise. Nevertheless, we cannot rest on our laurels. The moment we relax our vigilance, contentment may break out and spread like some foul contagion from practice to practice. This must not happen. We at the BMA are the leaders of Britain’s GPs and your morale is in our hands. If it ever rises, it will be over our dead body.”

Jim in his satire makes a serious point also made much more ponderously by Enoch Powell, who was once minister of health—that the only way to get more money into an NHS funded through taxation is to complain to the government that everything is dreadful.

Humour can, of course, get you into trouble, and another column of Jim’s I have remembered for decades was entitled “Are breasts redundant organs?” It was a column where the seriousness was dialed up and the humour down, although comedy is always there with Jim:

“Sometimes when I’m lecturing I point out how easy it would be to abolish breast cancer. My suggestion tends to outrage the men in the audience and I have to reassure them that my proposition is philosophical, not practical. Women listeners, however, usually react more thoughtfully.

Breast cancer becomes more common with age and will eventually affect at least one in 17 women in Britain. Screening may improve survival rates but does not aim at abolishing the disease altogether. The way to eradicate breast cancer is to remove the breasts before the cancer develops…

The audience eyes me warily, no doubt feeling there is something weird about a man who talks about removing normal breasts. They may be right. Perhaps all this is a distorted grief reaction to the deaths, over the years, of relatives, friends, and colleagues, killed painfully by glands they didn’t need.”

Jim advanced this idea years before the discovery of the BRCA genes, which mark an increased risk of breast cancer and have led some women—like actor Angelina Jolie—to have both breasts prophylactically removed. The column created a media storm and provided material for a later column, in which Jim described touring media outlets and how “a tabloid carried my sinister picture – lip curled, eyes shifty” and another paper “made me ‘Wally of the Week.’”

And on the rare occasions that I’ve worn a bowtie I always think of Jim’s observation that “Bowtie wearers are never left alone with other men’s wives.” What, I always wondered, did that say about Jim, a man famous for his bowties? The same column on how doctors should dress advised on the tricky subject of blood stains:

“Next, a word about bloodstains. It is all too easy to overdo these. The aim is to show that you still carry out practical procedures, but you don’t want people to think that you are clumsy. Bloodstains should therefore not be seen on the body area, collar, or spectacles and should never be more than 2 mm in diameter. The cuff is the ideal place for most doctors, though for obstetricians the socks are a possible alternative.”

A true satirist, Drife mocks widely—not only the BMA but the Committee on Safety of Medicines, the General Medical Council, royal colleges, NHS managers, evidence based medicine (using Animal Farm as his model), conference organisers, public relations companies, and, of course, editors (“I don’t mean grandees like ED, BMJ, who I imagine spends most of his time in full evening dress being chauffeured from embassy cocktail party to college power dinner”), and journals.

He satirises the questionnaires used in newspapers and increasingly medical journals to try and brighten them up:

“How do you relax? I swim with a friend who happens to be a dolphin [that line makes me laugh every time]

What is your greatest fear? Losing my humility.

What are you currently reading? Nietzsche’s Die Geburt der Tragödie, Unzeitgemässe Betrachtungen and Menschliches, Allzumenschliches.

What is your greatest regret? Not learning German.”

Or the award schemes that are money-spinners for journals:

Hospital cyclist of the year—Because cycling is healthy, exponents feel empowered to walk around the hospital dressed like extras from Star Trek, glaring at people they suspect of being motorists. The prize will go to the cycle parked in the most outrageous place within the hospital grounds. (Last year’s winner: inside the MRI scanner.)”

And inevitably obituaries, which were the bane of my life as editor of The BMJ in that they were the only submissions we couldn’t reject, were written in code (“he was a bon viveur” meaning he was a drunk, and “he was a true Celt” meaning he was a Scottish drunk), and whereas all doctors had faults while alive they became saints at the moment of death:

“For the first two decades, Drife’s career was that of a conventional medical academic. At 48, however, he published the first of his racy Euronovels under his anagrammatic pseudonym, Jason de Merwife. His style, aimed unashamedly at the translators, was described by one critic as “like a dubbed film without the pictures.” With plots drawn from his experience on the editorial board of the European Journal of Obstetrics and Gynecology, Drife pioneered the “shopping and refereeing” style of fiction now familiar on bahnhofbucherstanden throughout the continent.”

If only any of our obituaries had had such swagger.

Jim touches on many serious subjects in his columns—maternal mortality, teenage pregnancies, pill scares, poverty, sectarianism, inequalities, complaints, the agony of phoning hospitals, and the tax on sanitary towels—but all are done with a light touch and humour, which you might think impossible if you have not read the columns.

Many of the subjects he touches on are bugbears of doctors, particularly hospital doctors, and the comedy lightens their load and—importantly for editors—makes the journals seem less remote and arrogant and more in touch with the concerns of their readers.

One subject guaranteed to irk many doctors is managers and their instructions, guidance, and pathways. 

“A colleague recently calculated that, as lead for obstetrics in his hospital, he had received 3825 pages of advice, guidelines, and reports about maternity care from various bodies. I should point out, in case anyone from top management is listening, that “recently” means a year or two ago. Rest assured that he is on target, and his total must be well over 5000 by now.”

“Comedians mocked the news that it took 247 steps to change a light bulb in an NHS hospital, but I felt cheered. In these difficult times, the fact that somewhere in the NHS a light bulb has been successfully replaced is surely a cause for celebration. Doctors involved in management, however, were gobsmacked that this change was achieved in only 247 steps. We need to know more about this thrusting, no-nonsense hospital.”

This collection of columns might perhaps appeal most to doctors and others who work in healthcare, but I think that anybody will be able to find much that will bring them a smile and even, as with me, a belly laugh. I hope that Jim feels proud of what is not only funny, but a magnificent body of work.

Richard Smith, Assistant editor at The BMJ from 1979 to 1991 and editor in chief from 1991 to 2004.