“…and listen to those who speak up.”
The year is 1828. Anaesthesia is yet to be invented and tethered to an operating table in the centre of a crowded, putrid theatre at Guy’s Hospital, a patient screams at his surgeon to stop the procedure. An hour into a lithotomy—which should have been over within minutes—the flustered surgeon, determined to retrieve the stone, refuses to stop, until he can hold the stone aloft in front of his audience. His patient endured over an hour of excruciating pain to stoke this surgeon’s ego and died days later.
One of the spectators in the onlooking crowd is “The honourable doctor,” our protagonist James Lambert, a doctor who is appalled by what he is watching. From his early training, he has recognised that corruption and malpractice is rife within the medical profession. He joins forces with a group of reformers to challenge the establishment and stand up for what is right.
Nick Black, public health physician and author, brings the true story of James Lambert to life in his book, The Honourable Doctor, weaving a readable tale of his life and love, alongside factual historic detail, taken from contemporaneous medical papers. We follow Lambert through his early apprenticeship as an apothecary-surgeon and bear witness to his unease at some of the dubious practices taking place in the grand teaching hospitals of the day. From body snatching to medical blunders, alongside a large helping of nepotism, Lambert shows how even as a young doctor, he wishes to avoid being drawn into any corruption. Fired by his passion for science, accountability, and ultimately his patients, he is recruited by The Lancet, to write candidly about his misgivings.
He courageously documents in detail the botched lithotomy case, writing it with the Lancet team, and linking this untimely death to the surgeon’s gross incompetence. The establishment responds vehemently, banning Lambert from London’s prestigious medical institutions, and pursuing a libel case through the courts. Lambert risks his career to expose this poor practice, with the mantra “Things can’t improve if we don’t question and challenge.” Sadly, he pays the ultimate price for his courage with his own health.
Fast forward to the present day, and the struggles Lambert faced as a whistleblower have changed very little in the intervening years. Despite the introduction of “Freedom to speak up” policies introduced in 2015 in the wake of the Mid-Staffordshire scandal, the NHS continues to have a disappointing track record in supporting whistleblowers, who are often faced with disciplinary action, ostracism, and regulatory referral.
Despite the potential adverse consequences, many brave clinicians continue to speak truth to power to this day and speak up for what they believe is right.
More recently, Ravi Jayaram was one of the paediatricians who, along with other consultants, voiced his concerns about the nurse Lucy Letby, who was found guilty of murdering seven babies and attempting to kill seven others under her care. Jayaram was silenced when he spoke out, accused of bullying, and threatened with referral to the General Medical Council (GMC).1,2
The late neurologist Jenny Vaughan, who co-founded the “Learn not blame” arm of the Doctor’s Association UK, was a vocal defender of the doctors Hadiza Bawa-Garba and David Sellu, among others, and tirelessly campaigned for a just culture in healthcare for patient safety.3
Nick Black’s book captures the story of an ordinary doctor, who the history books may not have painted across the front covers, but whose actions made waves and real changes to the practice of medicine—at great personal expense. This is a book which serves as a reminder, that good people do speak up all the time—and within the fraught system of the NHS, we continue to have clinicians just like Lambert who choose to take a stand for what is right. Let us learn from these stories, and listen to those who speak up, to strive for what is right.
References
1.Dyer C. Lucy Letby inquiry: Consultant says he wishes he had reported concerns sooner. BMJ2024;387:q2540. doi:10.1136/bmj.q2540. pmid:39547700
2.Dyer C. Lucy Letby inquiry: Former hospital boss denies claims he targeted doctors who raised concerns. BMJ2024;387:q2689. doi:10.1136/bmj.q2689. pmid:39613
3.Illman J. Jenny Vaughan: neurologist and medical law campaigner. BMJ2024;385:q1005. doi:10.1136/bmj.q1005.
BMJ 2025; 389 doi: https://doi.org/10.1136/bmj.r696
I would love to see The Honourable Doctor made into a film. I studied for a while at Guy’s Hospital and this book forced me to change my mind about who my heroes should be. James Lambert is now top of the list.
Of course, I couldn’t agree more!
Thanks
Nick
This all sound like something written early in the last century by AJ Cronin. It sounds as though nothing very much has changed within the medical profession with malpractice hidden by the powers that be just to maintain a favourable image with their political overlords.
Thanks Paul. Back in Regency times it wasn’t so much malpractice as incompetence and ineffectiveness. Scientific medicine (as we know it) was just starting to emerge but few doctors tried basing their practice on scientific knowledge, preferring to stick with their beliefs and opinions. Of course there was also corruption and nepotism in the way hospitals were run! As a great admirer of AJ Cronin’s The Citadel, I’m delighted to have my novel compared favourably with his!