How did you get into medicine?
Medicine wasn't an intentional choice I must say but I have never regretted it. I grew up in Khartoum, Sudan, where I studied medicine at the Faculty of Medicine, University of Khartoum. I went to a missionary school where the first language was English; it was the expectation that if you did well in school, there were two career options – medicine or engineering. I did well so I was destined to become a doctor. Medicine suited me and I was fortunate to study at a very good medical school with an excellent undergraduate medical education; it was one of the oldest medical schools in Africa, established by the British when Sudan was a British colony.
I did well in medical school and qualified with the Lord Kitchener Prize, which was later renamed the Faculty of Medicine Prize for Best Performance in the Final Year of Medical School.
Who inspired you to follow a career in medicine?
My parents were bankers so there wasn't an immediate role model in the family to inspire me to go into medicine, but I had a very supportive group of friends from school and we all did medicine together in Khartoum. I was fortunate to have been taught by eminent clinicians across all specialties in medicine, especially the Professor of Neurology, Professor Daoud Mustafa. He was an amazing role model and teacher, with a holistic approach; he focused on how the social determinants of health influence the disease presentation and response to treatment, and the long-term patient outcomes, by taking a comprehensive history and formulating a patient-centred management plan.
Professor Mustafa had a popular weekly lecture, where he, his colleagues and students would present complicated neurological cases. He had very high standards so you had to be up to scratch! It was the highlight of our week and he was a great inspiration in my career; he was dedicated to free hospital care which was accessible to all. I definitely learned the essential qualities of what it means to be a doctor from him – beyond the diagnosis and treatment – knowing the patient as a human being with their specific social circumstances and the impact their disease has on both them and their family.
What impact did the legacy of British rule in Sudan have on your early career?
When I qualified and came to the UK to start my postgraduate studies I learned the British NHS way of medicine; the interactions between different specialties here is a different model of medicine to how I trained in Khartoum.
Sudan became independent in 1956 and when I was growing up Arabic was marginalised. In school and college we spoke English but I was lucky to have fantastic teachers who introduced me to Arabic literature. The positive influence of British power meant we had the British Council which provided a cultural centre in Khartoum; growing up I would go there to read and continue developing my skills in English and there was an annual festival of European cinema.
During my medical training, we really felt the legacy of the British dominance of how to do things; there was a sense of dominance of British culture and language in the hospital setting and the British way of teaching medicine. I trained at Khartoum teaching hospital which was a state hospital and the primary language of the majority of patients was Arabic; very few would be able to communicate in English. When I qualified back in 1994 ward rounds were still conducted in English, with patients and their families unable to understand the discussion. After the ward round, we would have to go back to the patient and explain things and answer any questions in Arabic. It was a definite barrier and lessened the focus on person-centred care; how do you express the real lived experience of patients using a different language?
What research interests have you had?
My research has evolved over time. My Masters at Keele looked at the impact of oxygen supplementation on functional outcomes in acute stroke patients and I had another great mentor, Professor Christine Roffe, with whom I published papers. Then I moved to BSMS and my research interests began to change. I look after the Stroke Rehabilitation unit at Princess Royal Hospital and my patient-centred research focuses on Medication Related Harm in Older People. For the last decade, we have been working alongside health professionals and patients and their carers/families to develop a risk prediction tool. The immediate eight weeks after leaving the hospital is quite a challenging period where a lot of medication-related problems occur due to various factors; patients not taking medication, being ill-informed or unsupported if an adverse event happens and knowing what to expect and where to seek help.
We are now working on using the risk-prediction tool to identify high-risk patients at hospital discharge and offering them an intervention. This will be a nationally adopted initiative called the DMS – the Discharge Medicine Service.
My other research focuses on the narrative of illness; recording terminally ill patients’ autobiographies and assessing how that affects their well-being and that of their family members/carers. It is a holistic approach; looking at how the social determinants and psychosocial dimensions of health, not just the clinical or medical aspects, impact and influence people staying longer in the hospital.
What has been your biggest achievement?
My biggest achievement is my research so far in the Prime 3 Study: Medication Related Harm in older people at hospital discharge. It is linked to an intervention to reduce the impact of this challenge and has been nationally acknowledged; in 2020 we received the National Patient Safety Award. The work began as the Prime 1 Study and then the Prime 2 Study, funded by the British Geriatrics Society, which was essentially a consultation with patients and their families to co-develop the language of how to explain risk. What does 30% probability of harm mean? Do patients want to know this or not?
So, it's been a rewarding journey of research that is making an impact in terms of not only patient benefit but cost savings; if this intervention is able to reduce the magnitude of the problem then there are cost savings for both primary and secondary care. It is our ambition to inform policy change, both regionally and nationally.
What has been your biggest challenge?
I think for clinical academics like myself, it's juggling between the clinical workload and academic workload and the expectations that brings; you want to deliver on both fronts and it's not an easy task. It involves a lot of forward planning, having a clear demarcation of my time, and support from clinical and academic colleagues, but also being flexible. It is an art to combine the two, but my research projects are informed by clinical issues and challenges, so my research is not detached from my clinical work.
What does your interest in medical humanities entail?
Growing up in Sudan cinema was an important part of the culture. I was exposed to the best of Arab as well as international cinema and my interest in film continued when I came to the UK for my postgraduate studies. I am the Film and Media Correspondent for the British Medical Journal but I started off as an amateur in 2003, writing reviews of films with a medical, and later humanities, dimension, eventually writing reviews for the BMJ and the Medical Humanities Journal, and my book the Cinema Clinic.
In 2017 I and Dr Mina El Naggar, a medic and filmmaker in Egypt, founded the film festival MedFest Egypt which is now international. We screen films and hold workshops and exhibitions over three or four days on specific subjects – old age, women's health, children’s health. We've been very fortunate to have the support of various organizations, including the Ministry of Health in Egypt, the Cairo Opera House and the British Council in Cairo. We’ve delivered four editions so far; Covid slowed us down, but we resumed this year.
Lambert Wilson, the French musician and actor said “the world is written in an incomprehensible language, but cinema translates it for us universally”. Film is a huge learning resource for informing good practice; reflecting on the lived experience of illness and suffering portrayed in film can greatly help our practise and communication skills; condensing a patient’s case history into one paragraph whilst including the key elements which make this story unique and different from another helps the clinician make a diagnosis and formulate a management plan. Getting the story right ensures we do the right thing for the patient.
For example, the Spanish film All About My Mother starts with an organ transplant nurse teaching students via role-play how to approach a deceased patient’s family for their consent to donate an organ. It's a brilliant example of how to use the right language in a compassionate way in very traumatic situations. It requires a lot of skill and the film shows in just a few minutes the importance of good communication, or lack of communication for that matter, and the consequences.
Why is Black History Month important to you?
Black History Month is an important time to reflect on what has already been achieved and how people have challenged racist attitudes, behaviours and stereotypes and systems, but there’s still a lot of work to be done.
We can be inspired; we can learn from history. Steve McQueen’s film Mangrove is set in 1960’s Notting Hill about a West Indian restaurant which is racially targeted by the local police constable; the community comes together to challenge him and hold him accountable, rejecting and stopping his behaviour.
One of the criticisms of Black History Month is that it's one month, but it's more complicated with a diverse agenda. We assume that by highlighting it for one month, that's enough, but it's a wider conversation and needs a bigger response.
Has diversity and inclusion improved during your career? What more can/needs to be done?
I would say that we are now more vocal; we speak about it. There's still a lot to be done, but I think it doesn't always need to be institutionally led – it can be via community organisations and grassroot approaches. I think we need to be more creative in identifying other sources of help in the community as well as international organisations to challenge bias and racist systems. There are improvements but there is still a lot to be done; one discrimination is one too many and we have a collective responsibility to challenge that wherever it exists.
FIND OUT MORE ABOUT KHALID HERE >
Find out more about Medfest Egypt >
Read Khalid's film review of 'Allelujah' here >