Digital health literacy and careers (2 Sep 2026)

SPEAKER_04 0:11

My name is Dr. Emma Spencer, and I am a member of the Trainees and Members Committee at the Royal College of Physicians of Edinburgh. And today joining us is Prof. Mahmood Adil. He's worked as a medical director and worked for Public Health Scotland and clinically as a pediatric diabetologist. He's a clinical informatician appointed by the college as the first ever clinical, data and digital health lead. Today we'll be talking a little bit about what that role might entail, his career to date, and how he feels these areas might be relevant to the general medical training. So welcome, Prof.

SPEAKER_00 0:48

Thank you, Emma, and I'm grateful for having me on on this podcast.

SPEAKER_04 0:52

Matter of fact, no, we're really interested to delve a little deeper into what exactly your role entails. So, first of all, your career path has been quite different to many of the clinicians that our trainees and members may come across in their everyday lives in hospitals. And it'd be really interesting to know a little bit about your career trajectory to date and how you got into this area of data and digital health.

SPEAKER_00 1:17

Well, I think I need to go back to the memory lane, Emma. Let me start what career trajectory for all of us is, because it's very important, and how it gets shaped. In my view, our career trajectory gets shaped by three main factors. First one is aptitude and guidance, that what's your aptitude and who has guided you. And second, your skills and knowledge you gain in order to achieve that particular career. And the third one, the opportunities. I think with that background, I of course came out of the medical school. And while in the medical school, I realized that I'm very keen looking at the bigger picture, thinking about the health system. But it was too early for me to think about a career. So I finished my so-called house job or foundation year one or two. And then I thought, what is the best way? Then I was very lucky that my professor of community medicine at that point in time, we call community medicine, now it's public health medicine. And she said to me, Why don't I try a year of Master's of Public Health? And I said it's a very good idea. So I took a break. I went to the University of Glasgow, I did my master's. And then I realized, oh my God, this is interesting. But then the professor who was Jim McCune over there, he said to me, Manud, look, you need to go back to clinical medicine. Because if you want to make your career, which is the leadership role, the management, population health, or you call it data, I didn't have a clue about data at that point in time. So I went back, I did my training in pediatric and pediatric diabetology because there was no distinction between general medicine, general physician, and pediatrics, because we all came under the Royal College. And then later on, the Royal College of Pediatrics and Child Health came into place. I was about to finish, and then I was going to get my first consultant post. And then I thought, no, I need to stick to my purpose or my aptitude. So I then started my training in public health medicine in North Wales. And that took me about five years or so in clinical medicine. And then I restarted and did my public health medicine. And then I got appointed my first consultant post in 2000 in the Department of Health for England. Don't ask me how come I ended up a young consultant in the Department of Health, but sometime the opportunity comes across and you seize it. But then a very interesting thing happened, a little story. So the department organized a trip to take a few CEOs from our hospitals from northwest of England. I was based in Manchester to Finland. And I was asked to organize the trip. So the trip was we need to look at the Finnish healthcare system and we need to learn what we can do in the NHS in northwest of England. So I was there and I was very lucky to have the opportunity to meet with the CMO of Finland. His name was Kamalopo, and he said to me and to the delegation, one thing, he said, if any death happened with myocardial infarction in any part of Finland, I can see it on my map the same very minute. That was striking. I said, how come? Then I had a visit of Nokia. You know, nowadays the iPhone is very popular, Samsung. At my time, Nokia was very popular. So we visited Nokia and Nokia said another thing. They said we are working with our bigger hospitals, and we are working on something. If someone has got diabetes and the person can send the reading through Nokia phone, which automatically goes to the consultant, and the consultant dashboard can, and by the way, remember this is year 2000. Right. At that point, I said, My goodness, data is very powerful. So that was my first exposure at a service level to see the impact of data and digital on the lives of the patients. Because I trained in diabetes and paediatrics, said, My God, if this could happen, I think we can change the lives of people, we can make their lives easy. So then I came back and I said to the department, I need to do masters and clinical informatics. And they were very kind to allow me to use my evenings and weekends. And then I never looked back. So this was my first expo year. And then, of course, as time went by, I got more responsibility on cancer registries, I got responsibilities on data and public health observatories. And then it means I was translating my knowledge into service. So it means I was gaining experience. And then my advice and feedback to our audience is that whatever you wanted to do, try to use your knowledge and change into experience by doing things on the ground. And this is what happened to me that more responsibilities I got on the data and digital front, the more I was able to use my knowledge, and the more I was able to influence the policies. So this is the way I look back and I realize that I've achieved quite a few things. But having said that, in America, it is a separate specialty. So it means you can get board certified in clinical informatics, and you will get the roles like we have started in England called CCIOs and CMIOs, chief medical informatic officers or chief clinical informatic officers. And we learn it from USA. So this is a wonderful thing happening in UK, at least in England, and maybe some part of Wales. Hopefully, Scotland will follow the suit. Having those leadership roles in that speciality is useful. I was also lucky that I was asked at some point that I need to be helping to establish care quality commission, which you know the regulator in England. And I was the first medical director when it was established in a shadow form. And we use a lot of data to look at the quality of our health services. This is again another thing we need to remember that the data by itself is nothing unless you can change into health intelligence. And I think you as a frontline clinician understand that if someone tells you that how many patients of diabetes you have, it might not make much sense to you. But if someone tells you that how many of your patients are going to get diabetes, you might start getting interested. And then, very important, if data can tell you which one of your patients can get benefit from which of the medication to control your HPA1C, then this is the real use of data. So, in summary, that is my brief career trajectory. I also spent some time in USA at the Institute of Healthcare Improvement. Again, I learned a lot on quality, but also understood both qualitative data and quantitative data does make a huge difference.

SPEAKER_04 8:47

Yeah, that's such an interesting career trajectory. And sounds like you spotted something on that trip to Finland, kind of ahead of its time, really, in 2000. And now, obviously, clinical informatics is integral to lots of, you know, it's its own specialty in America and definitely integral to the way we work here in the UK now. With your role with the RCP College Lead for Clinical Data and Digital Health and your roles you've done in other organizations, can you tell us a little bit about what those roles might entail?

SPEAKER_00 9:20

Well, I think it depends on the role. For example, when I was medical director for Public Health Scotland, Public Health Scotland is the organization which collects all the health and care data in Scotland. So it means that it has got a huge advantage of having a data of 5.4 million people. And it means anyone who is working in Public Health Scotland, in particular in professional leadership role, you're keen to use that data and change into health intelligence to give insight. And that was my role while I was at Public Health Scotland that how best we can change this data for our clinicians, for our policymakers, for our managers, and for our patients so that they can use it and make their health better, or we can deliver better services. But then I remember I had a good conversation then with the president of the Royal College, Direct, and I said to him, Look, so many people are coming to Public Health Scotland, my colleagues, the clinicians, that they're saying how best we can use this data for clinical purposes in a more effective manner. Why don't we create a role within the college which could be much closer to our fellows and members? And that's the reason this role was created. But what does this role entail from a college perspective? The first thing I was very keen and still very keen to do is to raise the awareness of data in digital. Because our clinicians need to be very clear what is meant by health data and what is meant by digital health. And just to recap, and I'm sure if you go on the website of the college, we have done two wonderful videos which explain what is health data and what is digital health. And I would encourage that anyone who's listening, they should go, it is only seven minutes, a bite-sized video. But let me recap that what we are very keen to do in the college to be very clear that when we say health data, it is not the clinical data you collect through your patient interaction in the hospital. So health data falls into four groups. First is clinical data, of course, the lab data and everything else. Second is the lifestyle data, which now we started collecting. So many countries, in particular, the Nordic countries, they're very, very good. And the third one is the omics data, the genomics, protonics, and so many omics data. And this omics data is becoming almost routine. And the fourth one, which is, in my view, is the most important, is the social determinants of health data. Because 70% of the outcome of the disease or outcome of the health of the person or health of a nation is dependent on the social determinants of health. And in Scotland, we divided the country into almost 10,000 data zones, and we collect data in each and every data zone. And this is the same state of play in England as well. So I think this is the data side. For digital health side, I want to be very honest that people use the digital health terms in a very, very different way. But the question comes: what is digital health? If someone asks, and what would be my answer or your answer? It is the use of information and communication technology in sport of health and health-related fields. And of course, as time went by, artificial intelligence came on board, big data, blockchain, so many other new technologies, they all come under the remit of information and communication technology. And with that clarity, I would say that digital health is the field of knowledge and practice associated with the development and use of digital technologies to improve health and healthcare delivery. So it is a field of knowledge and practice. And this is the way my colleagues from USS haunted, because they wanted to make it a separate specialty. And there is a number of reasons that before we start thinking, can we make it a separate specialty in UK? But the point is that this is a very important field. And now raising awareness is first the most important thing, what we did in the last few years within the college. As you might have seen, as I said, those videos were created, conferences, the evening updates. Wherever I got the opportunities, I did my best to raise the awareness. And the second thing about the data and digital literacy, because this is again a key thing that yes, you can raise the awareness, but what is the purpose? So that brings me to the question that when we say the digital literacy, what does it mean? It means your ability to access, understand, and use the digital tools. Let me repeat it. Your ability to access, understand, and use. So we are very lucky in the NHS. A lot of things have been done, for example, by NICE, they say these are the digital tools which have been could be used safely and effectively. FDA in the past, in America, they have approved a number of digital tools. But the question is have you got the ability to access them? Second, to understand them, and the third to use them. And I think this is something the college and we within the college are very, very keen to do. And the third thing which is important in this role is show the example of best practice. Because to make things tangible, that's how it is going to make a difference for my patient, it is very important. The clinician needs to know. I should show them the example. College and other organizations should show them the example, how the things can be done in reality.

SPEAKER_04 15:25

That was, yeah, that was a perfect answer and leads so nicely on to our next questions. Because I was going to ask you exactly what you'd want that term digital health literacy to mean to a resident doctor. And it sounds like, you know, you've already summarized that, and there's some amazing videos online that people could go to if they wanted to watch an explanation again. Maybe you could also give us a bit of an idea of how a clinician could enhance their digital health literacy or get better at using, understanding, and accessing those tools.

SPEAKER_00 15:56

You know, if I go back to my clinical days and I'm sitting an outpatient or I'm doing a hospital wardround, what are the things expected from me as a physician, both from my colleagues as well as from my patients? I think it is expected I should be delivering effective care, safe care, patient-friendly care, and efficient care. So if these are the four purposes of my day, I've been trained over the years, then the question comes: what knowledge and experience I need to gain for digital health to make myself an effective doctor, a safe doctor, a patient-friendly doctor, and an efficient doctor. So I always say that there are two ways to deal with this challenge. First, you need to be motivated. You need to be very clear that yes, really, I want to do it. And the reason you need to be motivated, whether we like it or not, digital health is the future. You can see that in your trust, they're using APEC and the many other organizations, they're bringing very, very potent EMRs, but they are only potent as long as you can choose them effectively. Coming back, that's how you could be effective. It means you can deliver care which can improve the patient outcomes. Let me start. There are many different tools available. First are the clinical decision sport tools. Have you heard of open evidence?

SPEAKER_04 17:34

Yes, I actually downloaded the app this week because someone told me about it at work. Yeah.

SPEAKER_00 17:39

Oh, wonderful. Okay. So let me use that example. So there is another app which is called medwise.ai. Exactly, work on the similar premises. You get a question, or you have a patient, and it's complex. You cannot go back to so many nice guidelines, or you cannot go back to many things you need to look at. You put the information in and it can give you the answer if you have tried open evidence in such a way so that it is going to make your life and the interaction with the patient very easy and very effective. So, this is what I learned that if my clinical colleagues started using those tools in their day in and day out, it means they can save time and their health outcomes would be better. If I had the opportunity to present, which I think I presented a couple of years back at the Royal College Conference, then I usually showcase it. Let's say there is a patient with these sort of comorbidities, these are the medications the person is on, and all the social parameters, and then see what results you can get. And then you will see, it will give you the answers, much easier you can digest it and it's evidence-based. Then the second thing, thinking about how you can learn. Either you can go by knowledge-based approach or experience-based approach. It depends on which organization you are working in. Let me give you one example. My understanding is Great Ormond Street in London, they have started ambient speech in the whole trust. It means when you're having interaction with your patient, everything is getting recorded and it goes into the patient record directly, it will save you a lot of time. So it means if these tools are available, you need to have the courage to start using them. So this is one way of how you can learn with experience. Other is the knowledge base. Now, if you go on Moodle, if you go to other platforms, there are very 15 to 20 minutes programs which you can go, not the AI programs, it's just a program which has been created so that you can learn the ABC of the digital health tools. So I would say first you need to have the motivation. Second, you need to think where you are based. Uh, then you can ask your hospital and trust that you are very, very keen. And then third thing is that do it by experience. And the fourth one, if you have time, it's better to have the basics sorted and go on those Moodle course.

SPEAKER_04 20:20

Absolutely. I'm sure there's lots of our listeners that know that this will be a part of our future in healthcare and want to get more knowledge. So that's some great sign posting to where they can. And my homework is to start using open evidence now, which will be exciting. I wanted to maybe ask you to give one example of how you can see improved digital health literacy impact directly on patient care. I know you've talked about a few throughout your chat there, but just maybe a specific one you'd want to raise to people.

SPEAKER_00 20:48

Okay. If you're happy, I can use diabetes as an example. Always, yeah. Right? Because we have about 5.4% prevalence of patients with diabetes in Scotland. So what you need for a patient who has got diabetes, you want that the patients. Nowadays, diabetes is not a disease. It means that if you have a disciplined patient, you can treat the patient in the right way. Patient live as healthy life as any other individual, and the complications of diabetes can get delayed, or even chances are they may not get those complications. But the question comes that what are the tools we have in hand, the digital health tools, which can help us to achieve that goal. So in Scotland, we have got the data called Sky Diabetes. It's all the data with patients with diabetes in one place. Then they have developed the tool called My Diabetes My Way. This is the app which any patient with diabetes can download and can see that what control he or she has on diabetes. It can guide the patient that how best you can improve your own outcomes. So there are a number of tools being approved by FDA, and these apps are available because we need to remember that with chronic diseases, we try to co-create health. It is not like surgery that being a surgeon, I can do the appendixctomy, and 90% onus is on me because I and my team need to do the right surgery to take the acute appendicitis out. In chronic disease management, it is a multifactorial, and we need to make the patient our partner, and we need to empower the patient. And digital health does empower patients. The role for our clinical colleagues are when you do your consultation, you need to ask the patient, do you use any digital health tools? Are you wearing any Apple Watch or any other thing which is collecting a lot of parameters? By asking that question. You remember when I was trained, I was told that in history you need to take these pieces of information from the patient, including social history. Now the time has come that we need to tell our front and future graduates that they need to ask about the digital health history.

SPEAKER_01 23:20

Yeah.

SPEAKER_00 23:21

That what tools you are using or you are keen to use because you can check the aptitude of the patient. So coming back to diabetes. So in this way, this is one way. Now, on the other side, if you go by the type 1 diabetes where your patient is on insulin, and I dealt many of those in my career over the years, is that we need to use the monitors because we are giving them insulin through monitors. And now the algorithm of using the giving them the right combination of insulin at the right time is becoming much easier because the computer and those algorithms can be calculated in the background. And you do not need to be doing it as a physician spending a lot of time. And the third thing is that, which I feel which is the public health and prevention side, we need to be thinking in terms of diabetes, what are the things we can do and we can help the patient or the people who are going to be the patient, how best we can improve the health outcome of the nation. And this is what we have done. Many countries have done. For example, in England, we they developed the atlas of variation. So when I was in Scotland, we learned a lot. I mean, I'm still using Scotland, England, but it means our difference in healthcare system is wonderful because we learn from each other. So in England, they developed atlas of variation on the complication of the diabetes. And we learned that how best we can do these things in Scotland. So it means we can think at the population level why, when we have got standardized data, some part of the country is not getting a standardized care and they're having more amputation because the diabetes is not well controlled. And then, of course, you need to work with the diabetologists and the clinicians that what are the things they are not doing in order to improve patient outcome. So again, I use the diabetes as an example where you can use the data and digital health in order to improve the patient outcomes and make your services more effective.

SPEAKER_04 25:24

Yeah, I think that's really interesting. I think those tools on an individual level are amazing to empower patients in chronic diseases, as you talked about, but maybe I don't think as much about how, from a bigger picture public health perspective, you could look at what's different in different areas and how you can intervene there. Wanted to ask you a bit about maybe what's the thing you're most excited about in the future of the NHS with digital health literacy, and maybe what you see is the biggest challenge for the NHS, because there are undoubtedly challenges in using these kind of tools.

SPEAKER_00 25:58

I think we first of all, uh we all should be proud of the National Health Service. It was, of course, established in 1948 on 5th of July. Every year we celebrate the birthday of the NHS. But the system is wonderful on many fronts. First, it is clinical based, so you are treated on the basis of your clinical need. It is a free at the point of delivery, and it is outcome-driven, it is keen to improve the patient outcomes. And now we do collect a lot of data in the NHS. So NHS does collect a lot of data. At one point there was a cliche we use, it is data rich, intelligence poor, that we collect a lot of data, but we don't use it effectively. So the opportunity NHS has created is that it is collecting a lot of data on individual patients and on populations. But now we need to find the ways to change it into health intelligence, which we can provide to our frontline clinicians, we can provide to policymakers, and we can provide to patients and populations so that we can improve the health of the nation. And I think this is what I see the biggest opportunity. Now, having data itself is not good enough. Now, AI is coming. There was a time when we say, okay, I can collect a lot of data, and then my data analysts could change and help me to change into intelligence. Now, with the availability of most of the AI tools which you and I have got access to from ChatGPT and a number of others, we can ourselves change that data into very much applied intelligence relevant to my patient and to your patient. Then the challenge comes, patient confidentiality. What data I can use in order to improve my patient outcomes into those AI tools. And this means we need to raise the awareness of the information governance, patient confidentiality. You know, there are two main big concepts in information governance. First one is primary use of data, and second is secondary use of data. Primary use of data means that your data is used for providing you direct care. It means no one needs to have your permission to use that data. Otherwise, you and I and any other doctor who's providing services wouldn't be able to provide any services. So by law, it means, but secondary use of data means that the data is going to be used for research, for innovation, for policy, other things. And this is where we need to be very, very clear. So I feel that my clinical colleagues and the new graduates, they need to have a good understanding about the information governance so that we can use patient data in the right way to achieve the right outcome. And the challenge, I mean, this is the opportunity, we have a lot of data, and we can use it to improve our patient outcome and population health outcome. The challenge comes that, first of all, you need to have the understanding going back to the data and digital literacy. If we don't include in our curriculums in the medical schools, in the postgraduate curriculums, the competencies, if I use the word, then the chances are that we will have a lot of data and we our clinicians won't be using them effectively because they are not data and digital literate. And we can only make them and we can improve their competencies if we can include it in the undergraduate and postgraduate curriculum. So this is you are in part of education and training within the Royal College. This is very important. We need to be looking from that perspective. Second, people are very concerned about AI. So AI is being used everywhere. And there are two schools of thoughts that I can use the AI and I can trust it. And the second school of thought is no, I do not want to use AI because I don't trust it. And I think I personally feel that we as clinicians need to work together to identify the reasons why we don't trust the AI use in healthcare. And we need to overcome those challenges. Because at this point in time, the Academy of Medical Royal College is now making an effort that how best we can have a unanimous voice and to understand to explore the trust issue and all other issues, because data leads to AI, and AI will lead to improve health outcomes. And I think we need to be making sure that as professionals, we understand it and then we do our best to contribute it accordingly.

SPEAKER_04 31:04

Yeah, I think the development of AI in healthcare will be fascinating and is just undoubtedly already in our, you know, already existing in our day-to-day lives and will be more so. So it'll be really interesting to think more about how we incorporate it and yeah, how we get trusting and use it well. Just two more questions for you. So when I was preparing for this, I was having a read about you online, and I just noticed one other really interesting thing you've done with your career, which was from a public health point of view, be involved in Olympic Games and Commonwealth Games. I wondered if you'd talk very briefly about what you did there. I just thought that might be of interest to some of our listeners.

SPEAKER_00 31:41

Well, it says that sometime opportunity knock on your door and you need to grab it. And this is what happened 2002 Commonwealth Games in Manchester. I was head of health protection and clinical services for Northwest of England, working with the Department of Health. And when Manchester won the bid to have the Manchester 2002 Commonwealth Games, I was given the responsibility to look at the emergency planning and look at whether we are clinically prepared. Because we're having 100,000 visitors, and we are having 56 countries' Commonwealth teams were coming, and they were coming with their own doctors, with their own rules and regulations. And that was my job that to work in collaboration with those 56 countries and to make sure that we our emergency planning services are up to scratch and sitting on the gold command, working with the all blue light services to ensure that we are ready to deal with any incidents and thank God there was no big incidents happen.

SPEAKER_04 32:45

Yeah, that's so interesting. It sounds like a massive job to me. I wouldn't know where to start with that, but so interesting to prepare for an event like that.

SPEAKER_00 32:53

But interestingly, then uh we competed against many other countries for 2012 London Olympics, and I vividly remember that two countries went into the final International Olympic Committee have got rigid criteria against which they can judge the city which is going to host the Olympics, and one of the chapters within those criteria is held. So we were against France, right? Paris. Against Paris. Of course, Paris subsequently won it for 2024. And at that point, the Department of Health and my colleagues in London, they were very keen to use our experience from Commonwealth Games. So I was very lucky in a way that I was able to offer my knowledge and experience from Commonwealth Games, and that went into our bit. And I can't claim that because of that input, we won it, but at least I can probably say that me and many other colleagues played a part. And we delivered an excellence 2012. And I think on concluding remark on this question, crowd medicine has become a now a big specialty or big discipline now. Because I remember we were dealing, working very closely with police on the Manchester United games. And the same in London football. But then with Commonwealth Games, we started in before that we had the Jorpen football in 1996, then Commonwealth Games, and then globally, the big Hajj event happening in Mecca. We learned a lot that they are doing a big crowd medicine because they're having millions of people within five square miles, and they deal with all the health needs of those millions of four to five million people. And this is now a speciality in many countries, the crowd medicine. So I had already got a glimpse of it while doing the Commonwealth games because you're dealing with the crowd medicine, you're dealing with many other things. But crowd medicine is something we need to be considering now in the future.

SPEAKER_04 35:02

Yeah, I think actually this discussion with you has been a really good example of public health medicine being an incredibly broad specialty from crowd medicine to the digital health side of things. You're really interesting. With my final question, I just wanted to say there'll probably be listeners today that would like their career to involve some kind of leadership role in a way that yours has for many years. I just wondered if you had any advice for people who aspired to have that as part of their career.

SPEAKER_00 35:32

Okay. Let me start where we started. I said when I wanted to get into and where I am now, I looked at three factors your aptitude and guidance, your knowledge and experience. And the third one is uh remind me now. What was the third one?

SPEAKER_04 35:54

Maybe opportunities as well.

SPEAKER_00 35:56

Excellent. It was a test on you.

SPEAKER_04 35:58

I've been looking forward to it.

SPEAKER_00 35:59

Opportunities. Okay. Right, good. So I think the advice, the first and the foremost, most of us who went into medicine, we were keen to help other human beings, right? So I start, we need to be go back to our purpose. Purpose needs to be very, very clear that why I am doing what I'm doing. And different stages of life or in in training, we think maybe when I was at your stage, I was thinking, when I'm going to get my first consultant post, right? Because this is logical. But I did ask the question what I would do with my first consultant post. And then that's where the question came or answer came in my head: leadership. And my mentors, I'm very grateful. I had mentors at every stage. It doesn't mean you need to be formal, but I'm grateful to them. So leadership in my head is when your actions inspire others to dream more, learn more, do more, and become more, you are a leader. So I started thinking that wherever I am, my leadership shouldn't be linked with my title. Because this is the first thing I would say our audience needs to be thinking. Doesn't matter what stage of career we are, the leadership and title shouldn't be anonymized or synonymized with each other. And the second thing which I always say that if you are in the leadership role, think about your aptitude first. Because I was told at very early on, maybe from my childhood, I'm grateful to my parents, emotional intelligence. And I realized that when we are in clinical medicine, yes, your IQ becomes pertinent. But there is now with EQ does play a role. But in leadership role, which is sometimes, of course, get mixed up with the management role, your EQ becomes the most important thing. And I worked very closely over the years with General Medical Counsel, dealing with poorly performing healthcare professionals. And when we looked at those cases years back, we realized that they were very competent healthcare professionals, but at times their EQ wasn't as good as it should be. So the communication became a challenge. So this brings me the question about the skills. One of the things which is very important is the communication skills. And communication skills is half of the success in any role you are delivering, whether you're dealing with the patients or you're dealing with population, policymakers, or with the media. And you need to be very clear: communication is not what you say. Communication is that what you listen. That's the reason we have two years and one time. That we need to be listening more. And this is something we need to be thinking in your one-to-one context with the patient. And if we can create more time with the digital health tools, with ambient speech, if we can create another five minutes in your interaction with patient, you need to be listening to the patient. And by listening to patients, it means that we can understand them better. And half of their stress goes away when the doctor is listening. And the third thing, you need to AMI. I don't want to say that, but I always felt what next? I'm very, very privileged, lucky. I was visiting faculty at Yale School of Public Health. I went to Harvard, I went to IHI. But my motivation and my being inquisitive to learn more, the learning and leadership are indispensable to each other. And learned it from going to John F. Kennedy Library in Boston when I was at Harvard, and it is written over there, and it was part of his speech. But we need to be learning all the time. And this is part of the leadership mantra. And if I have to use the example, which motivated me, as you said, Commonwealth Games, I never thought that I would be able to do something, but I seized the opportunity. This brings the third element, which is the opportunity. I think we need to be thinking laterally. For example, what was the biggest news in the last one week, apart from those many sad news which are coming from different directions? But one was the biggest exciting news a week ago. I don't want to quiz you, but let me say this was the Artemis II came back from the lunar lab very successfully. And I remember, I'd read, of course, I wasn't there, when the Apollo 11 landed on the moon. Neil Armstrong said, one small step for man, one giant leaf for mankind. And we learned a lot by thinking laterally from the airline industry. In this case, when RTMS II was coming back and I was watching, and I was saying, my God, what is the moment for the health system in the world when we can do something like the RTMS II? And I think this is something in the leadership role that within the healthcare system, sometimes we don't learn the things within our system. The solution is outside. But we need to be thinking laterally. For example, we learn checklists. You know, the pilot used checklists, now we're using the surgical checklist. So we learned a lot from airline industry, from nuclear industry, which are the safest industries in the world. And I think we need to get motivated as well by aiming high, that thinking that what is beyond the moon and the moon is my health system. If I am the NHS, this is my moon. If I am in the USA, then the US health system is my moon. But as a humanity, the 7 billion or 8 billion people, that is my moon. And I think we as the physician working in the NHS, and by the way, Royal College has got its footprint in 100 countries. And this is where I say that I might have influence on billions of people. And I think this should be our mantra, that wherever we are, and by the way, when we talk about leadership, leadership is in a system. And when you're working in a ward, ward is your microsystem. When you're in a hospital, it is your mesosystem. And when you are in a country, you think about macrosystem. So, in summary, we need to look at your aptitude and your emotional intelligence, your motivation to be in the leadership role and think about the knowledge and skill which you can gain. Think laterally and learn from others. And I think having a good mentor around you and listen to them. Thank you.

SPEAKER_04 42:56

No, not at all. Thank you so much for taking the time to talk to us. That was fascinating and has given me, you know, lots of food for thought. So I really appreciate it. Thanks so much, Prof.

SPEAKER_03 43:18

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