The Benevolent Leader

Yes, certainly. I went to Nottingham Medical School back in 1980 — long before you were born — as the first person in my family able to go to university. So I've got that standard moniker that lots of people have. I went to do medicine largely because my father died when I was young, and there was that sense of wanting to make a difference, to help people who were in the situation I was in when my father passed away.

I worked hard at medical school, was a junior doctor in Nottingham and then went to Birmingham. I was an SHO — a senior house officer — in Birmingham for two years, then a registrar for two years, and then moved to Cambridge in 1990 to do a PhD as an MRC Training Fellow. I planned to stay three years and ended up staying 22. My PhD went well, I was awarded an MRC Industrial Scientist Fellowship, was made a university lecturer — which is a tenured post in Cambridge — with an honorary consultant position, and then in 1998, eight years after starting my PhD, I was made a full professor.

I did that for 14 years in Cambridge. I got to 50 and thought, "Gosh, the next 20 years look just the same — it's probably time to go and do something different." So I took a deep breath, resigned my chair, resigned my fellowship, left Cambridge and moved to London to be Dean of the Faculty of Medical Sciences at UCL. A couple of years later I was promoted to Vice Provost (Health).

Just to give you some context — because the academic titles are all bizarre — what this one means is that I'm in charge of all of the biomedicine at the university. That's half of UCL, which is the largest grouping of biomedical scientists in Europe. I'm also head of the medical school, and academic director of UCL Partners Academic Health Science Centre. So lots of titles that come with the job.

Oh, if only, if only I was that powerful. Sadly not — although pathology is very important, I'd like to say, for the pathologists listening. We are highly regulated in medicine by the General Medical Council. We have to teach a core curriculum, and a lot of that is specified, so we have actually very little leeway in what we teach medical students.

My influence is more to put some flavour on the way the medical school runs. What's most important to me is that we turn out doctors who are scientifically literate — people who in the future may want to pursue some aspect of science. I don't mind whether that's molecular biology, stem cells, AI, data science or general practice — I mind that they have a curiosity to ask the questions that underpin a research career. And if I give you some description of the school I oversee: it's got 22 divisions and institutes, of which the medical school is one. There's neuroscience, bioscience and life sciences, ecology, population health — all of it sits in the school.

My role is to provide an environment for the students to play. And it's not just the medical students — we have undergraduates in biosciences, neurosciences, population health, and many postgraduates. UCL has over 40,000 students; we have about 11,000 in our school across all sorts of disciplines. Our job is to provide a creative environment for students to learn — to give them the opportunity to fulfil their potential. If you take the brightest and best students in the country, and I'm going to say that because they're at UCL, and say, "Here's a playground with fabulous research, a fabulous environment, and you happen to be in London where there's superb med tech and investors — get on with it," then all of a sudden they do fabulous things. For me it's about empowering people to make a difference. I never believe my job is to tell people what to do — in academia you can never tell an academic what to do, that's just heresy. But you can provide an environment, and some nudges and some carrots, and watch them do it. And that's exactly what's happened.

The pandemic has been fascinating. Like everyone else, we accelerated the graduation of our students. We had a fascinating graduation, overseen by Mark Emberton, Dean of the medical school, which was all done online — our students dressed up in fancy hats and gowns for an online graduation. It was absolutely terrific and truly innovative, and it allowed the students to be released to go and serve in our local hospitals. We also let medical students volunteer to do back-office work, released our scientists to help in labs, and some of our secretaries went to help with the Nightingale hospital in London. We were very keen to help that national effort.

You might remember at the start, the modelling from Imperial said 500,000 people would die, and even with all the interventions, over 200,000. So when we started looking at this, it was terrible — we were looking at a true disaster. Every medical school and nursing school in the country did the same things to get people released to help. It changed the way we interacted with our NHS colleagues, and I think we did the right things. There will be a huge public inquiry and lots of criticism, but the NHS did well — we didn't fall over, we stood up, we dealt with the challenge and came out the other end.

So, back to your question — the future is challenging. There's a lot more online. Medical students clearly need hands-on teaching; that's essential, so we need to get them back into the hospitals. And this is with us for the next few years — it's not going to go away. I'd love to say a vaccine is going to work, but if you listen to Chris Whitty and Patrick Vallance, they're cautious, and I'm following their lead. 95% of all vaccine trials fail. So we have to learn to live with this for some time — in the way our students learn, the way we deal with patients, the way we practise medicine, and the way we work from home.

I'd expect nothing less.

I think this will change the whole way we teach students. You can say — why can't we do exams in the future as open-book exercises? Why do we expect people to learn vast amounts of information and then test them on what they recall? That's fine for GCSEs and sixth form, but it's probably not appropriate for many university courses.

But for medical students, remember, we have a curriculum to deliver — we have to engage with what the GMC wants us to teach. And I don't just want you to be an empty vessel into which we pour information. I want you to think. I want to take the brightest people in the country and get them to think — about science, about challenging the norms, about asking questions, about designing studies. Because only if you do that will our profession advance. You can't learn that online, you can't learn it on YouTube — it has to be interactions between students and academics, students who say, "Why do you say that? What does that mean?" And then when you get to the clinical years, you're on the wards. I still do bedside teaching — I've been doing it for 20-odd years, teaching clinical skills — and you can only learn that with patients. You have to make mistakes, get it wrong, be corrected, and slowly you build up the pictures that come to a diagnosis, and from that an action plan and some therapy.

When I went to Cambridge in 1990 to do my PhD, I went to work on neutrophils, and six years later we published an important paper on that in the Journal of Biological Chemistry. I'm very proud of that. But so much of science is chance, and the best work we did was in the second year of my PhD, where we stumbled on something important. What we described was a genetic disease — alpha-1 antitrypsin deficiency. I was purifying the antitrypsin protein for other experiments, and from a series of discussions in the lab, we realised there's a common mutation that leads to the protein getting stuck in the liver, causing liver disease, and the lack of a circulating protein leading to emphysema. We thought, perhaps we can explain what the mutation is doing — how it's causing the protein to misfold and stick together, to accumulate in the liver and hence cause the circulating deficiency.

And we gave it a name, because the beauty of science is you get to name things. We called it loop-sheet polymerisation, because it's the loop of one protein inserting into the beta-sheet of another so the molecules stick together. Can I explain it to a five-year-old? Yes — the first thing I taught my son to say, now 29, was "loop-sheet polymerisation." "What does Daddy work on, Timmy?" "Daddy works on loop-sheet polymerisation." He couldn't get "sheet," he kept saying "sheep," as in the fluffy things — but it didn't matter. It was the first words I taught him, being a rather bonkers scientist.

The beauty of that discovery is I've now worked on it for 30 years — crystal structures, NMR, small molecules, antibodies, cell models, fly models, worm models. In understanding one disease, we've described a series of other diseases that occur by the same protein-protein linkage. And I'm still going at it 40 years later — it's probably the most exciting thing I do. When I'm dead and buried, the tombstone needs to say: he did lots of things, but what he really did was describe the mechanism underlying antitrypsin deficiency. That's the legacy that goes on forever. I like to describe it as: in the big tapestry of science, this enormous carpet, I have two stitches in the bottom right-hand corner that are mine and will always be mine. And they'll outlive me.

Everyone can do it. My challenge to everybody is: do a period of research. You don't know whether you want to be an academic until you've done it. It doesn't have to be in a lab — it can be a clinical trials unit, epidemiology, whatever you like — as long as you do a period of time in research. It's deeply frustrating, because you do lots of things that don't work. But it's also jolly exciting — this protein-protein linkage we uncovered had been a problem since the 1960s, and suddenly we knew something no one else knew. It's a truly fabulous sensation.

The way you do it is you throw yourself into it. You join a lab where lots of people know far more than you do, and you build up your skill set. All science is, is asking questions — it's no more than that. But you need the tools and the resources to answer them. And it's important to choose your lab, your supervisor and your projects very carefully. When I got the MRC fellowship to move to Cambridge, I was married, we had quite a big house — and Cambridge was the best place in the world to do what I wanted to do. We had to sell the house, and my wife's and my salary went down to a third of its value. My wife sat on the sofa saying, "What are you doing to us? We have no money." But it was the right thing. Everything worked out, and the science flew. So the key message is: follow the science — go to the best place in the world to do the work you want to do, and you'll benefit from that environment.

Probably most things I say, actually — you can ignore everything you've heard on this podcast. Let me turn it around and be more positive, because that's my nature. I do think everybody should do some research. People who say, "I don't want to do research, I just want to be an NHS consultant" — that's fine, and NHS consultants are invaluable, they do a terrific job. But you're an NHS consultant for a very long time, doing the same thing day in, day out. What I'm offering you is a chance to do something different. If you do a period of research and it hooks you, and it works, and you're good at it — lots of ifs — at least you've tried, and it gives you a different career. I've got one of the best jobs in the country: I run a medical school, I have a research group, I teach on the wards, I still do my clinical work. It's varied. Whereas many of my NHS colleagues have been doing the same thing for 20 or 30 years and they're tired. So don't just follow the straight route. Do things that are different, take a gamble, find out what's right for you — and at the end of the day you'll have a far more exciting and interesting life. Don't be a sheep. That's my advice. Don't be a sheep. Just made that up.

You need to do both. You could only write that op-ed in the New York Times because you're a credible scientist. You have to do the hard yards in the early days to build up a reputation where people say, "He or she is a credible scientist, therefore I believe what they're going to tell me." And it's not the name of the journal — it doesn't have to be Nature. It's the body of work. I'd point to 30 years of work that's made a contribution to the field as being more important than any individual paper. Only when you've got that can you credibly opine in public.

People who lack that background and then opine in public — well, you see what's on Twitter. Lots of people opining in the absence of any knowledge, and that's just noise. What I want to hear are people who've done something, who are credible, and then this is their view — they're the people I want to listen to. That's the signal in a Twitter storm; the rest is the noise of people echoing who don't have the depth to comment. I realise that's probably elitist, but I'm after the expert opinion. So yes — Eric Topol's article in the New York Times comes off the back of a very long and distinguished career as a scientist.

Probably badly, is the answer. But of course you're not just pitched into it. Nobody says to a 24-year-old, "Right, now run a £670 million turnover operation, 11,000 students, the biggest medical school in the UK." It's something acquired over the years. You start off with your CV like anyone, work through the ranks, gain your clinical, research and managerial experience, and I just kept everything going — I never shed anything, I just kept gaining things.

At my level, you do two things. One, you compartmentalise. When I'm on the wards, I do blocks of two weeks, then blocks off the wards — I'm not doing it day in, day out. Two, you have to make decisions. When you're in my position, it almost doesn't matter whether decisions are right or wrong — as long as you can correct them further down the track. The key thing is making a decision, moving something on. If it's wrong, you say, "I'm really sorry," correct it and move forward in a different direction. You need momentum, and you need to unblock things. Most things get stuck in my world because the computer says no. Academics come to me and say, "David, this is madness" — and it often is — and my job is to unblock it so we can move things forward and I can help people develop their research programmes.

Oh gosh, I haven't thought about it in such a cerebral way. It's more just the reality. A problem arrives, you sort it, and once it's sorted you can forget about it. There'll be something in my inbox — you make a decision, arrange a meeting, come to a decision and move on. Once I've done that, I can forget about it and move on to the next thing, and the next. It's being decisive, quickly making decisions and then being able to move on. You dearly hope they're right. As I said, it does matter if they're wrong, but you can correct them. And as you progress to leadership positions, you're asked to make more and more decisions. The first ones are scary, frankly. But if they're right and they're rewarded, and you can unblock things and people progress, you grow in confidence. The little decisions become bigger, and then you're making big decisions based on that experience.

We in the medical profession are trained to make decisions from an early age. As a medical student you're already making them — you're sifting information and coming up with a diagnosis, an investigation plan and maybe a treatment plan. As a junior doctor you make small decisions; as a consultant you're making them all the time. When I'm on the wards, it's the same as my university job: people give me information, and what I ask my juniors to do is give it to me in a way I can assimilate. I'm looking for a pattern — because that's what it is, just patterns — and from that pattern I make a decision on the patient. But it can be wrong. If I give a therapy and two days later the patient isn't getting better, I'm wrong, so I change tack and go somewhere else.

And it's the same in the bigger world. If you stray from the respiratory system, where I work, into cardiology — heaven forbid — you're out of your depth, so you ask your cardiology colleagues to help. That's the answer: we've always been trained to make decisions, because that's what doctors do. And you have to recognise the limitations of your skills, and know where you need to ask someone else for help — whether that's in medicine or in a managerial position.

That's a really good question. In medicine we do try to teach leadership skills, but in reality you develop them on the wards — faced with patients, faced with colleagues, navigating difficult situations. Like many people, I do it on instinct: you've been trained to recognise patterns, that in this situation you do this and then that happens.

When I progressed to being Dean, what I really enjoyed was the recognition that leadership is all about recognising your defects — the things you don't do as well, where you need help. Leadership is about building a team. It's never about me; it's about a team of people around you who cover the bits you don't do. When I took over as Dean, what I needed to learn was to look at the details, the metrics, the movement of small indicators — and I had a brilliant faculty manager who did that beautifully. The two of us made a fabulous team because our skill sets were different but overlapped. The key thing for people stepping up to these positions is: you don't have to do everything. It isn't all about you. You're not the finished beast and you never will be. When I'm stuck, I have four fabulous deans and four brilliant directors of operations, and I'll say, "Right, what do you think?" I'll hear a series of views, and between us we decide and move forward. That team is incredibly powerful.

The training you have as a doctor is invaluable. As a 24-year-old you don't yet realise the privilege it is to be a medical student — the training you get in understanding people. People see you when they're most vulnerable and they trust you, even as a medical student; they can't distinguish between you and everybody else, they see you as a doctor. That training carries you forward.

And the thing I think is really important — and I say this rashly, knowing people will say, "Well, you didn't do that then" — is that kindness matters. In my job I talk about three things all the time. The first is excellence, because I want us to be the very best in the world; what my team hears me say is, "I don't mind where we are, as long as it's first." The second is partnership — working together and adding value with our hospital partners, across the university and across different institutions. And the third is kindness. That's not softness — it doesn't mean letting people get away with things — but taking a kind approach to how you do things. I made that triad up, by the way; everyone in my position has their own values, but those are the three I talk about a lot. When you get to do my type of job, it's a huge privilege, because you get to set the tone of part of an organisation. And of course everyone makes mistakes, including me, and everyone has to say sorry. Saying sorry is really important, because none of us is ever perfect — but that kindness, I think, is critical.

Define "dick."

So can I turn "dick" into alpha male or alpha female — the silverback gorilla approach?

Absolutely not. That is not the right style of leadership. The breast-beating — "I'm in charge, I hold all the resources, you do what I tell you" — is absolutely not the best way of getting things out of people. For me it's an anathema. Leadership is about helping other people get the best out of themselves. It's about developing a team that works together, everyone growing, supporting and enabling — because then you'll want to come to work and do your best. It's about you saying, "David, I'm stuck on this, can you help me?" I'll unblock it, give it back to you, and when the credit is apportioned, it's yours — not mine. If anyone notices that I may have helped along the way, that's all I can hope for. It cannot be about me. For me, leadership is about being a generous leader — everyone else thriving in the environment, and hopefully at some stage noticing you may have done something useful. What you can't hope to be is the alpha-male silverback, top of the pile, shouting and screaming, the Hollywood director. That's a thing of the past.

Not really, actually. Most of it I sort of made up as I went along, to be entirely honest. People can go to books, websites, endless YouTube videos — but ultimately it's about you, and about developing yourself. First of all as a scientist, because you need that base, that credibility. And then, instead of books, I'd argue: look at people you admire, and think, "I'd quite like to be a bit like that when I grow up." As I progressed through medicine, I worked with a variety of consultants and thought, "I like the way he or she does this, I don't like the way they do that." So when you get to that position, you're a fusion of the different people you've seen. And as I went through management and leadership roles, I did the same — I've worked with a variety of vice-chancellors, and there are bits I like and would adopt in the way I act. So I don't think it's about books, or YouTube. I think it's about watching people, finding role models, and saying, "Do you know what — when I grow up, I want to be like that."