Medspire team interview
How did you get to where you are today?
I see myself as a global citizen, having spent the first half of my life in India where I was born and brought up, and the second half in the UK. Although my job has offered me boundless opportunities to travel the globe.
I am the King's Health Partners’ foundation professor of surgery. King's Health Partners is a collaboration between King's College London as the university, and hospitals which include Guy's, St Thomas', South London, Maudsley, and King's College Hospital.
It's a privilege to be the surgical chair for such a large organisation and to be in a position to try and be the best - my three catchwords are: ‘be the best’ in surgical science and education. The journey has been a long one. I was inspired by my grandfather who was himself a doctor.
What attracted you to urology as a specialty?
I went to Medical College Kolkata, which is the oldest medical college in the East. It was built by the British and I was there from having done my schooling in St. Paul's School, Rourkela, and then my college at St. Xavier's College, Kolkata.
I was educated by Jesuits, and then ended up in the oldest medical college in the East. We used to have the surgical block there which was called the David Hare Block at that time. I was a house surgeon - now known as FY1 and FY2. At the time, we were doing everything by open surgery.
Endoscopy had just about arrived, so we had started doing cystoscopies, but most of it was open surgery. Kidney stone surgery, for example, was open. Prostate surgery for benign enlargement was open - this was called the ‘Freyer's prostatectomy’ through the bladder. Then there was the ‘Millin's prostatectomy’ where you went in front of the bladder in the space of Retzius.
We used to make large cuts to take out kidney stones. We used to do everything. Gallbladder, duodenal ulcer surgery, complex bowel surgery - I did it all.
Then, in the late 1980s, Dr Shivaji Basu - who was an inspiration, and working in the UK at the time - returned to Kolkata and brought with him a Dornier lithotripter - a stone-breaking machine. That really changed everything for me, because suddenly we went from large cuts to no cuts.
I thought: ‘I have to understand how this works’. I ended up joining him, and I remember distinctly the first day that he arrived. He drove into work in his red Volkswagen Golf, which he had brought back from the UK.
Then there was this amazing lithotripter. Some of my own family were treated for this, having had open stone surgery before. When this happens, you can’t not love urology, and you can’t not want to become a urologist.
What are the biggest advancements you have witnessed within urology during your career?
Many. I think urology is the most technologically-driven surgical specialty. It has adopted surgical technology, and technology in general, much earlier than other surgical specialties. TURP (transurethral resection of the prostate) was the bread and butter procedure when I started training.
Everyone who had benign enlargement of the prostate got a TURP. Now, all these years later, we have realised that many of them did not need it - that in itself was a major shift from the open operations I’ve described.
We used to do open surgery for stone disease. Now we can do everything through tiny holes, or without any holes. These operations are called PCNL or ‘percutaneous nephrolithotomy’, or putting a telescope up the urethra called ‘ureteroscopy’. They have completely changed things, and I have seen these changes myself.
The other changes have been drug therapy for benign enlargement of the prostate, so TURP went away to a large extent because tablets came in, and particularly two kinds of tablets, to relax the muscle at the neck of the bladder and shrink the prostate. That took away many patients, especially those who didn't need a TURP from that operation.
In my own specialty, which is prostate cancer, when I started, the majority of patients in the UK were either being monitored or receiving radiotherapy. Dr Patrick Walsh had revolutionised ‘nerve-sparing radical prostatectomy’ - an open operation with a cut in the lower part of the belly. From there, we moved to laparoscopic for a brief period, and now there’s robotic surgery.
When I started doing robotic surgery about 18 years ago, only 1% of radical prostatectomies were being done robotically in the UK. Today, it’s 92%. This is a complete shift in the way we practice this operation. Kidney surgery used to be mainly an open operation. Now the majority are laparoscopic or keyhole.
So much has changed in urology. The fundamentals of being a good doctor have remained the same, but the way we manage our patients has become less invasive, and often more driven by medications rather than operations. On the whole, it is better to be a urological patient now than it was 20 years ago.
Tell us about the ‘Dasgupta Technique’ - the surgical management of overactive bladder which involves the injection of Botulinum toxin - which you pioneered.
First, I’d like to say I did not add the Dasgupta name to the technique. In fact, I am very averse to such things. That naming happened in 2005/2006. I remember this clearly.
My PhD student at the time, Arun Sahai, was running the world's first randomised control trial of the substance, in a particular kind of overactivity called ‘idiopathic detrusor overactivity’, where you don't have a cause for the overactivity.
He had written this article with a number of colleagues. He called me up and said: 'We'd very much like to name this after you, because this is a pioneering contribution and people should know this. I'll be sending you the paper to review and then if you agree, add your name to it’. I said: 'Arun, it's very kind of you, but please don't send me this paper and please don't add my name to it’.
So if you actually look at this article in the BJUI, I am not an author. In subsequent book chapters on this, for example, in Arthur Smith's Textbook of Endourology, those chapters are written by other people. I never named it after myself. I'm slightly embarrassed that's what's happened.
But the story goes back over 25 years, when I was working as a junior doctor in the Institute of Urology which had moved from what was called the ‘Three P's’ - Peter's, Paul's, and Philip's, into St Peter's Hospital at the Middlesex Hospital site. Middlesex Hospital does not exist anymore. It's a bunch of very fashionable buildings.
The only part of it that exists is this old chapel because they couldn't remove it.
I was training to be a urologist having come over from India, and then I really wanted to do some research. I was looking for someone who had a position. One came up which was funded by the Medical Research Council - it was very prestigious even then, as it is now, to have a Medical Research Council fellowship.
I met Professor Clare Fowler who was a neuro-urologist or, as she called it, a ‘uro-neurologist’ - a specialty she's credited for developing. She was looking for someone who would be able to study a particular kind of nerve fibres in the bladder called ‘C fibres’ and the effect that a semi-synthetic solution of chilli peppers had on these fibres, called ‘capsaicin’.
I remember, I sent her a handwritten note, and when I went to see her, she said: 'Such beautiful handwriting’. I'm not sure I agree, but that's what she thought. Subsequently, I applied, interviewed, and got the job.
These fibres were not first described by us, but by de Groat from Pittsburgh in spinalised cats, whereby these bladders become overactive, and the major signalling - which is normally from a kind of nerve fibre called ‘A Delta’ - is replaced by C fibres. We started looking for these fibres as part of an MRC grant in human bladders - so these were human bladder biopsies.
We found them, and also found them exquisitely sensitive to capsaicin, which was given as a solution into the bladder - so, intravesical capsaicin. The majority of these patients had ‘neurogenic detrusor overactivity’, so their overactivity was because of an interruption in the nerve signalling from the brain down the spinal cord to the bladder.
The majority of these were neurogenic patients and the majority had multiple sclerosis. Capsaicin was a semi-synthetic solution, and it was never commercialised because it was already available. Then it was replaced by a substance called ‘resiniferatoxin’, which comes from a cactus and is 9000 times more potent than capsaicin from chillies.
But that never took off, and the company which started doing the trials folded, because we found that the resiniferatoxin was sticking to the plastic containers in which the solution was given.
Essentially, we were giving the patients an installation of saline, not resiniferatoxin. So these are things you learn from. No one ever realised that this substance would stick to the plastic containers, or plastic bags, like saline bags.
Then came Botulinum toxin. A group from Switzerland had already tried it in spinal-cord injured patients, but this needed a general anaesthetic, so it was tedious. The first report had appeared. Then, in 2002, we started looking at whether we could deliver this as an outpatient procedure under local anaesthetic, without giving a general anaesthetic to these patients with neurological disease. The answer was ‘yes’.
We first did the experiments on oranges in a water bath, because the peel of an orange has a similar thickness to the wall of a bladder. It's about four-millimetres thick. We had a sheath from Olympus. We had an ultrafine 27-gauge needle which went down the sheath.
If you don't have the sheath, if you just put the needle down the cystoscope, it will go through the side of the cystoscope, and suddenly your theatre sister will start shouting at you saying: 'You have destroyed £15,000 worth of cystoscope’. So never do that. This was all designed in the early phases.
The first patient was a taxi driver from Luton. I told him I'd never done this before. He was so miserable he was willing to accept anything - and the rest is history. We did the first trials. Trials also came out from Brigitte Schurch, who was another pioneer in this space, from Switzerland.
Then we did international trials, and by the time we had studied its mechanism of action, and the science behind it with the receptor biology, we then got it licensed. Now it is part of NICE guidance, guidance from the European Association of Urology, American Association, and other gynaecological societies worldwide.
It has been a game-changer, because eight-million people in the UK alone have overactive bladders, so it's more common than diabetes and heart disease combined. You don't hear about it because people suffer in silence. I think it will probably remain my most significant contribution, or a translational contribution over a 25-year period.
Consultant urologist Mr Ben Challacombe says you were his role model, and you're credited as being the UK's first modern robotic surgeon. Talk us through that journey, and the challenges.
I'm really pleased to hear that Ben feels I was a role model. It's very generous of him, because he was my first fellow. I'd arrived at Guy's in the late 1990s - towards the end of my senior registrar training.
We were just evolving into specialist registrars, so we were in transition. I arrived at Guy’s from the Institute of Urology training rotation. Then having trained with Richard Tiptaft, who was the head of department at Guy's, I was appointed to a consultant post.
Ben turned up saying he wanted to do some research. I said: 'Look, very nice of you, but I have no money’. One message that's very important: yes, you can dream of doing whatever research you want, but you at least need some money to kick it off, and at that time I had none.
But Ben, to give him credit, got all the funding himself, worked hard, worked out-of-hours, and we did the first randomised control trial, not just of telerobotics, but robotics. This was a robot which could drive a needle into a kidney.
We did this on a kidney model, because there were over 300 procedures - half done the traditional way, the other half done with a robotic arm. The robotic arm was controlled either locally or by a surgeon from Johns Hopkins.
I had by this time set up a collaboration with Louis Kavoussi, who was, and remains, a great friend. This robotic insertion of the needle to take out stones was compared to being done manually, with a human hand, which is how it is usually done.
This procedure is called PCNL or ‘percutaneous nephrolithotomy’. Essentially, it involves putting a needle, making a channel from the skin to the kidney, and taking out stones - completely avoiding open surgery. We almost killed that.
That trial showed that the robotic arm was more accurate than a human hand, but was slightly slower. That really is credit to Ben for doing that as part of his master's thesis, which he subsequently published. We had a system called the AESOP, which was a camera-holder you could guide with your voice - I had learned about the AESOP from Kavoussi while I was in Hopkins.
During the late 1990s I was in Hopkins for a short stint. During this time I learned how to do keyhole kidney surgery from a very good friend from the All India Institute of Medical Sciences. Most surgery at this time was ‘open’ surgery. So these were big leaps.
When our da Vinci System arrived, supported by a £1.1 million grant from the Guy's and St Thomas' Charity - competitive funding - we were very pleased, because at the time there were only two robots in the country - two da Vinci robots. One was ours, the other was with Lord Ara Darzi - again, a very good friend and a legendary surgeon at St Mary's. So that's how the journey started.
The first operation was a robotic prostatectomy, which has become the most popular, common robotic procedure in the world, along with hysterectomy, which came much later. We then, curiously enough, did the most complex surgery. The next two operations are the most complex operation that we do, which is a cystectomy.
People have often asked me: 'Here's a robotic surgeon who has never done any robotics, how the hell did you take on the most complex thing?' Well, we were experienced open and laparoscopic surgeons, so we made the shift, and yes, it was a leap of faith.
Then we did ‘colposuspension’, which you do for incontinence. It then ‘died’ and then, 17 years later, it returned. That is because the way to treat that kind of stress incontinence with meshes has ‘died’ because of the mesh controversy. So that was the robotic journey.
We have gone through every possible version of the da Vinci robot. We went from the standard da Vinci - the console was like the bottom of an elephant, very big, but with 3D HD vision and tiny little wrists. From that we went on to da Vinci S, da Vinci SI, XI, and currently X.
Hopefully soon, we will have a single port model which is not yet licensed in the EU, so it doesn't have a Kitemark. It is licensed already in the United States. So it's been a very exciting journey. I think the future will involve three things.
The first thing is that costs will go down. Second, connectivity will be better through 5G and 6G. And third will be the role of artificial intelligence.
The other people I must mention in this journey are my colleagues who were amazingly supportive, and someone who again, is a great friend, David Probert who was the chief executive of Moorfields Eye Hospital and has gone on to become the chief executive of UCLH.
David was the manager with me at the time, so we remember struggling to convince people, when this really was a completely revolutionary move from open to robotic surgery.
What makes a great surgeon?
That's something you cannot answer with a single statement. I think one of the most important attributes of a surgeon is to be decisive. The one attribute a surgeon should not have is to be indecisive.
I would rather have someone who stood there, cut a tissue, knowing that they were doing the right thing, and if it bled, fixed it, or made a judgement call and walked away from it. The surgeon that I don't want is someone who stands there dithering and can't make a decision. Being decisive is a very important attribute of a good surgeon.
The other attributes are very different to the caricatures of surgeons that you may have seen on TV. I think surgeons need to be humble. The instrument they have in their hands, whether it's a scalpel, a laparoscope or a robot, has the ability to change lives.
Knowing that, and knowing that the patient has put their faith in you, should build not arrogance, but a deep-seated sense of humility whereby you need to understand the responsibility that comes from becoming a surgeon. A good surgeon is willing to accept their shortcomings and train to get better.
These are people who have to learn something. As a surgeon, or as a doctor, I always learn something from everyone I meet. Do not be worried about learning from others and be aware of your own shortcomings so that you can continuously improve, because that is a lifelong process. It doesn't start and end on the day you become a consultant.
What are your current research interests?
There are a number of these, and what excites me the most is the partnership between King's Health Partners Academic Surgery and the new department of Surgical and Interventional Engineering, which is led by my college, Professor Sebastien Ourselin who is the head of biomedical engineering, at the School of Biomedical Engineering at King's.
We are putting in a state-of-the-art lab space at the centre of this, which will be a cadaveric facility with every possible computing power that you can think of. In fact, some of the world's most powerful computers will come in.
There will be every possible new technology, including hyperspectral imaging, next-generation ultrasound scan. There will be robotics - new robots, with a view to doing what we call ‘surgical data science’ - integrating all these superb videos that we take with sensing.
That sensing could be speech, the sense of touch, our great interest in the science behind haptics - which is currently lacking in robotic surgery - and vision. And trying to use AI to see if we can understand surgical performance better, improve patient outcomes, and better train the next generation of surgeons.
For example, I am one of the principal investigators in a trial called the ‘MASTERY’ study through the Royal College of Surgeons of England, where we are looking at ‘automated performance metrics’. We are going to attach a 'black-box' to the back of the da Vinci robot, which will collect this data, and then match this with patient outcomes and performance.
This is a national study on all 500 patients, which I think will be very exciting. I'm very grateful to Prostate Cancer Research for funding us as a centre of excellence. We have a number of different arms to it.
We are interested in the repurposing of common drugs, such as drugs for blood pressure, to treat prostate cancer, then trying to halt metastases by blocking semaphores. And finally, immunotherapy of prostate cancer. We have just received a patent for fusion peptides.
As an example, interleukin-15, if injected directly into prostate cancer, can be very toxic, but it can be toxic to the rest of the body. So we have attached a tail to it, which makes this agent stick to the lining of prostate cancer cells and kills the cells directly, rather than causing any collateral damage or reducing collateral damage.
The lab experiments on these have been completed. We have received a patent, and are very much looking forward to doing ‘first-in-man’ studies. My other research interest is in surgical simulation, which I have co-led with Professor Shamim Khan who is the Professor of Surgical Education at King's Health Partners.
Tell us about running the first ever multi-centre trial looking at the effect and transferability of simulation-based training on operating performance and patient outcomes.
The trial is called ‘SIMULATE’, and it is important for medical students, many of whom have done a BSc in surgical science, which is part of anatomy at KCL. Students have come into my lab, which is on the fourth floor of Guy's at the Sherman Education Centre, and have learnt how to operate, not on patients, but by simulation.
There are three main parts to it. The first is technical skills. The second is non-technical skills, which in the wider context is called ‘human factors training’. The third, which is a relatively new concept, is called ‘cognitive training’ or training the brain.
Brain training is very common in athletes - they do it all the time - so why not in surgeons? Why do we think that we are just doing things with our hands and not using our brain? There's a fallacy of thought, and can we somehow improve it by training our brains? The answer is: yes, we can.
The trial is called the ‘SIMULATE trial’. It started as a trial within the UK, and was supported by the British Association of Urological Surgeons to see if randomisation between simulation versus standard of training, which is no simulation - i.e. learning from your boss - can lead to better patient outcomes and create better surgeons. This is called ‘predictive validity’.
It hasn't really been shown in large-scale trials before. It certainly has not been shown in a large-scale randomised and international trial. We quickly realised with the trial, which started about eight years ago, that we were unable to recruit just within the UK.
So we had to expand it to Europe and then realised that even that was not enough. Then we expanded the trial to China, Japan, Canada and the United States. This is 15 centres from different parts of the world, involving 1140 cases.
The PhD student who did this as a labour of love was Abdullatif Aydın, who is now an academic clinical fellow with us. The trial protocol was published in the British Journal of Urology International. In fact, this was the last edition of the British Journal of Urology International of which I was the editor.
I have been told that it is winning one of the top abstract prizes in the European Association of Urology meeting. We are very proud of this. The full paper is currently under review with a major journal.
Tell us about your time as Editor-in-Chief of the British Journal for Urology International.
I used to be a trustee of the British Journal of Urology International, because it is run by a charity called the BJUI Company. The journal is published by Wiley and is run by the trustees - I was one of the trustees.
The editor at the time was the late Professor John Fitzpatrick. I was inspired by the British Journal of Urology International. I really love the publishing scene, and the creativity that it brought. This was creation at its best.
This was one of the top-three jobs in the world in my specialty, and you can really make a difference to the education of the next generation of surgeons, and also to patient care, by publishing material that can change the way we practice as surgeons. So that was the inspiration behind it. John Fitzpatrick's time as editor was coming to an end, so the job was advertised.
I was one of 12 people who applied, four were shortlisted, and I got the job. John Fitzpatrick's vision in a single word was ‘colour’. He asked me: ‘What would I bring to the journal?’, and I said: 'The web’.
My vision was very much web-based and I wanted it to become the most read surgical journal on the web. We have various different metrics to show three-million downloads plus - a doubling of the impact factor - but we also achieved the highest Altmetric. It's called a ‘1469’, and it was the only surgical journal in the Altmetric Top 100.
In fact, it was the only surgical journal in the Altmetric Top 50. The top journal was Nature and the paper in Nature was about an antibiotic that had been developed at the time with no known resistance. Obviously, these things evolve. But we achieved the Altmetric score of 1469 which I am very proud of.
I also owe a lot to the editorial board, and the editorial team. Scott Millar was my managing editor. I had amazing people like Declan Murphy, who was the social media editor. At that time, no one had even heard of a social media editor.
We put him in. I brought in Tet Yap who's a urologist who runs Glass Magazine - from the fashion industry - to do new bold designs. No one had ever dreamt of this before. I brought in Matthew Bultitude, who is currently our clinical director - again, someone who had trained with me, like Ben, to do the web.
So we brought in things that no one else had done before, not even The Lancet. And boy, what a journey it was as the tenth Editor-in-Chief of the BJUI. It really was the most fantastic time of my life.
The creativity, the joy. Towards the end, we had to embrace open access, so we brought in the BJUI Compass. Then during my time, BJUI Knowledge, a web-based learning platform came in. It expanded from being just the BJUI to BJUI Knowledge and BJUI Compass - a tripartite offering from that journal.
So I'm immensely proud of the journal, and to hand it over to my friend, Freddie Hamdy from Oxford. It was a tricky handover because it happened right in the middle of the pandemic, so we couldn't meet face-to-face - everything was done electronically.
But thank God for that, because the journal had gone completely from being a paper version by then, to everything being electronic. There was no paper at all, so that helped in hindsight with the handover and the seamless progression to the next editorial team during Covid.
What advice can you offer to medical students and doctors about how to excel as a researcher?
First, do not be afraid to dream big. My first foray into science was the immunology of a parasitic infection called ‘leishmaniasis’. Everyone thought I was a complete lunatic at the time, but it was a big dream with a clinical end - an unmet need to save the lives of patients who had failed all drug treatments.
It was based not just on removing their spleens, but also altering their immunology. So it was a big dream, and it came true. Try to be inspired and find someone whose work you really like. If you are thrust into a piece of research because it's convenient and it's there, then it won't work. It is something that has to come from within.
You have to love that piece, and you really have to think: ‘I want to make a difference - I really am curious to know what this piece of science will lead to’.
Do not be afraid of failures. While at the National Hospital and the Institute of Neurology in Queen's Square, I would often, and even now, turn up to the lab and find the cells are all dead, or infected with bacteria, or the experiments have gone wrong.
This is normal in the lab setting. So you have to be willing to take those hits, and smile and rise again like the phoenix. You have to be resilient.
Early on, you have to learn how to write. This is something that we teach well now. In my time, there was no such opportunity. But the ability to write is important, because if you can't communicate then no one knows that you're doing good work.
Finally, as you go further in your career, you need the ability to generate grant money, because if you have no money, you can't do anything. You have to find grant money to support what you're trying to do. Those are my key messages to young people who want to chase a career in surgical science.
What advice would you give to medical students and doctors about how to excel in their career?
Let me be clear. Not everyone wants to be me. I worked all the hours that God gave me, because that's who I was. I was always trying to put in as much hard work as I could, but work-life balance is also important and I have learned that myself. It's not always about hard work, it's often about smart work.
Keep time for yourself. Have time to do other things. I took up marathon running at a relatively older age. Most people who run marathons are much younger than I, but it's something I enjoy. I’m a tennis fan. I’m addicted to tennis, in particular, Roger Federer, so I’ve been seated court side at most tournaments. Have a life outside work, otherwise you will go crazy.
Be honest with yourself and enjoy what you do. Not everyone will want to do what I do. I'm a clinician/scientist - I spend half my time doing science and the other half looking after patients. Most surgeons just want to be clinicians.
They love operating, they love the tech, they want to serve their patients, they want to do that well and go home and enjoy time with their families away from work.
I don't want to give the impression that you have to be a clinician/scientist all the time. The majority of people are not clinician/scientists, so they just have to be true to themselves. They have to do what they love doing the most and do it well. So my message is exactly that - be happy, be focused, work hard, and enjoy yourself.
Have you any habits that have helped you along the way?
I sleep an average of four hours, so I have a bit more time on my hands than most people. It is a strange habit. Most people say to me that this is very surprising. It's not surprising, I've always been like that.
It's not a habit I would recommend. In fact, there are many books which say this is exactly not the right thing to do. So it’s not recommended, but it is a habit I've had for a long time - knowingly or unknowingly - which helps.
I think time management is vital - whether you keep an electronic diary or a paper diary. Otherwise, if you're double booked, people don't like you, and your life goes all over the place. So have some organisation in life.
Surround yourself with the best people. My success story is not about me, it is about other people. I've had fantastic personal assistants, friends, and colleagues. Whether it be the BJUI team, my science team, education team, engineering team, clinical colleagues, and personal assistants - these people have been outstanding.
So if you surround yourself with outstanding people and look after their careers and their growth, then that is a habit worth having, because their success reflects well on you.
My most significant contribution to anything is looking selflessly after the careers of others and supporting them to do well. That is also the most significant thing that I have enjoyed.
Who have been some of your key role models?
My grandfather was a doctor, so when I was growing up in India, you either studied engineering or medicine. For me, it was easy, so I was inspired by my grandad. Then there’s Dr Shivaji Basu, the man with the lithotripter and still a great friend - he's now in his early 70s.
Professor Pravat Choudhury, who was a great surgeon, old-fashioned style, but a very kind man. He actually changed my mindset and said: 'Ask yourself, I've taught you how to save leishmaniasis patients by removing their giant spleens’, because that's what the parasite used to do.
These patients would have giant spleens and would not respond to any drugs. He said: 'You need to not just learn how to operate, but find out why these patients are alive. What is happening to their immune system?' This was a switch in the lymphocyte count between helper and suppressor lymphocytes - the terminology has now changed. So that was my first foray into science.
He was a huge role model. Then in the UK, people like Professor Fowler who is Emeritus Professor now and retired. And Richard Tiptaft, after whom our visiting professorship at Guy's is named. He was the man who brought Guy's and Thomas' urology together.
I am inspired by my students, because I learn as much from them as they learn from me. On the science side, people like Professor Fiona Watt who leads the Medical Research Council. I found Sir Ed Byrne, our just retired principal, an immense inspiration. When I received my fellowship of King's College from him, it was amazing.
I met him for 20 minutes and at the end of it, he gave me one of his poetry books. I learnt all I needed to learn about what to do next in those 20 minutes. He showed me how to focus. The principal before him, Sir Rick Trainor, was a huge inspiration and role model.
There are various people who have inspired me throughout my career. Within urology, I have taken inspiration from Professor Muhammad Shamim Khan. He and I arrived at Guy's on the same day and he's been fantastic.
From the younger generation, Pankaj Chandak is very inspirational. And I hope one of the big names in the future will be Kamran Ahmed and Nick Raison - Kamran is my senior lecturer and Nick is about to come as the academic clinical fellow. So these are the people who at all levels have inspired me to do well.
What's your favourite book?
I have two favourite books. The first is David Copperfield by Charles Dickens, which I've read many times. The second is a series of books by Satyajit Ray, the famous Indian filmmaker of Oscar fame, who wrote The Adventures of Feluda - a fictional detective, a bit like Holmes and Poirot.
That series, much like the Holmes series which appeared in the Strand magazine, appeared in various magazines and was then compiled as a book set - and I love that.