the patient doctor book review

The Patient Doctor: How one man's cancer diagnosis led to a quest to put the heart back into healthcare

Ben bravery.

310 pages, Kindle Edition

Published June 29, 2022

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Ben Bravery

The patient doctor: how one man's cancer diagnosis led to a quest to put the heart back into healthcare.

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New South Wales , Autobiography: science, technology & medicine , Memoirs

• Trade Paperback Jun 29, 2022 | 9780733647444 | RRP $34.99 Buy Now
• e-Book Jun 29, 2022 | 9780733647451 | RRP $16.99 Buy Now
• Audiobook Jun 29, 2022 | 9780733647468 | RRP $34.99 Buy Now

A powerful and inspiring memoir about how one man's cancer diagnosis led to him become a doctor and advocate for change in the healthcare system.

At the age of twenty-eight, with his Beijing-based science communications business doing well and a new relationship blossoming, Ben Bravery woke from a colonoscopy to be told he had stage 3 colorectal cancer.

As a scientist, Ben understood the seriousness of his condition. Cancer had quite literally whacked him in the guts, after all. But what he didn't expect was how being a patient, and a young one at that, would make him feel. Why hadn't he been better prepared for the embarrassment and vulnerability of lying naked on the radiation table? Why wasn't he warned about the sheer number of tubes he would discover coming out of his body after surgery? Why did it feel like an imposition to ask doctors about his pain on their ward rounds? And why did he have to repeat the same information to them over and over again? During eighteen long months of treatment, including aggressive chemotherapy, Ben felt scared, overwhelmed, sometimes invisible and often alone. As he recovered, it struck Ben that after everything he'd been through he couldn't go back to his former career. He needed a change - and he wanted to make change. He wanted to become a doctor. He passed the entrance exam and dived headfirst into the challenges of medical school - including an unrelenting timetable, terrifying ward rounds and the difficulty of maintaining compassion under pressure. Now, driven by his experience on both sides of the healthcare system, this patient-turned-doctor gives a no-holds-barred account of how he overcame the trauma of his illness to study medicine and shares what he believes student doctors, doctors, patients and their families need to do to ensure that the medical system puts the patient at the very heart of healthcare every day.

Honest, powerful, eye-opening and sometimes heart-wrenchingly funny, this is an inspiring memoir that shows that no matter our situation we all need to be treated with care and compassion, right until the very end.

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Originally a zoologist and science communicator, Ben Bravery worked for the Australian and Chinese governments before being diagnosed with stage 3 colorectal cancer at age twenty-eight. After undergoing eighteen months of cancer treatment, Ben decided on a career change. He became a doctor in 2018 and is now undertaking speciality training in psychiatry. Ben volunteers, advocates, writes and speaks about colorectal cancer, living with cancer, cancer in young adults, medicine and medical education, and is committed to advocating for change in Australia's healthcare system.

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Book Review - The Patient Doctor

The Patient Doctor

Dr Ben Bravery

Hachette Australia 332pp

Book Review by Robin Osborne

At the time of publishing the author of this wonderful memoir of medicine from both sides of the treatment fence – hence the cleverly apt title – was in his final stages of psychiatric training, having completed hospital rotations in the usual fields, including surgery, emergency care, oncology and geriatrics.

As he explains, ‘When it came to taking medical histories from patients, I was always most interested in what we call the ‘social history’. This is the part that allows us to learn more about the patient as a person. 

‘Sadly, many doctors tend to reduce this to asking about exercise and whether a patient smokes cigarettes. It can be so much more than this. What about the patient’s home life? Did they live pay cheque to pay cheque? Had they any prior bad experiences in hospital?’

In regard to the last question the author unequivocally responds in the affirmative, having experienced a range of unsatisfactory experiences as a patient as well as many disillusioning ones as a medical intern, bullying by senior doctors being at the top of the list. 

What Bravery describes as ‘not your typical cancer memoir’ begins in Beijing where he worked as a zoologist on projects for the Australian and Chinese governments and became ‘something of an expert’ on topics such as what types of male panda urine was most likely to attract females.

One day, at age 28, he noticed blood in the toilet bowl but, unwisely of course, ignored it. Not long afterwards, on a short visit home, he underwent a colonoscopy at the insistence of his feisty, Ballina-born mother, and received a diagnosis of advanced bowel cancer. To put it mildly, his life changed dramatically.

‘The leap from zoologist to cancer patient was not my choice,’ he writes, ‘but the leap from cancer patient to doctor was. That decision – what it’s like on both sides of the hospital curtain, and how medicine can be made better for patients and doctors – is the point of this book.’ 

It is an exhausting journey through surgery, radiotherapy and chemotherapy, to the logistics of stoma bags and the awkwardness of managing post-operative demands – not least when one decides to continue jogging! Then there was the long slog through med school, bullying again being common, and clinical placements as a mature age student.

Throughout seemingly endless appointments and admissions Bravery is ably support by Sana, a TV presenter he met in China and almost instantly fell in love with. Their relationship is central to the story, as is their (spoiler alert) ultimately successful attempt to fall pregnant through IVF after wisely freezing his eggs eight years prior to the radiation that would render him infertile. The difficult birth of their son is the final breathtaking hospital event in the story.

Damning the much-vaunted concept of patient-centred care as ‘great marketing’, he says that as a patient he rarely felt at the centre, and ‘For a great deal of my care, I felt like a bystander watching things happen around me… I felt like a passenger in someone else’s people mover, a bit closer to the action and moving along with everyone else, but with no idea of where we were going or how long it was going to take.’ 

He found things were similar on the other side of curtain, too, although he feels there is hope if the system can prioritise the values that make us human – ‘communication, respect, empathy, compassion, kindness and balance.’

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The Patient review – Steve Carell is absolutely faultless in this intense kidnap thriller

The Office star plays a kidnapped therapist in this claustrophobic two-hander with Domhnall Gleeson. It might be slow going, but the performances are utterly stellar

Y ears ago, any foray by a comedian into drama was greeted with anything from horror to mockery. Who was this dog, was the general feeling, attempting to walk on its hind legs? Fortunately, we’ve passed a lot of water since then. We generally understand now that if you can act funny you can probably, you know, just act, in much the same way as Ginger Rogers could dance forwards too and in flat shoes.

No one has demonstrated this more clearly over the last few years than Steve Carell, who first made his mark in comedies like Anchorman and The 40-Year-Old Virgin before coming to small-screen prominence as Michael Scott in the US version of The Office. Even if the latter didn’t quite plumb the heartbreaking depths of the original, it still gave its lead plenty of chances to show himself in the round. Since then, he’s taken on more and more “straight” roles, including a high-wire act in The Morning Show as the nice-guy presenter, family man and beloved colleague accused of predatory behaviour by credible witnesses.

Now he is one half of The Patient (Disney+), an intense two-hander (for the bulk of the 10 episodes) with Domhnall Gleeson containing little margin for error. And neither man puts a foot wrong in his performance. Carell plays Dr Alan Strauss, a well-regarded therapist who is nevertheless becoming frustrated by his lack of progress with one of his clients, Gene (Gleeson). When the good doctor is knocked unconscious outside his home one evening and wakes up the next morning shackled in a shabby basement bedroom, he learns why. Gene’s name is really Sam, and Sam is a serial killer. He did not feel able to confide in Alan when they were in his office – but here, now, at his isolated home in the woods, he can relax and speak freely. He wants to be counselled free of the compulsion to kill.

“Serial killer kidnaps therapist” was obviously the elevator pitch from creators Joe Weisberg (the man behind the multilayered brilliance of The Americans) and Joel Fields (executive producer on that show and many others), and you suspect it attracted many parties who were keen to make a tense, claustrophobic thriller out of it, with a different escape attempt every episode and a terrifying showdown at the end. What The Patient actually aims to do is produce an essentially cerebral show, a portrait of an evolving (if forcibly so) relationship, that probes the limits of empathy, the different types of complicity, culpability and guilt, and the meaning of responsibility – as a father, as a therapist, as a creature moving through the world.

To that end, Alan is given a loaded backstory (in flashback) and a rich – and richly troubled, even before he became a killer’s captive – inner life. His adored wife Beth (Laura Niemi) – a formidable woman and cantor in their synagogue – recently died of cancer and they were both estranged from their son Ezra (Andrew Leeds) because of his conversion to orthodox Judaism. He is haunted by memories of them and increasingly by questions of how the victims of the Holocaust resigned themselves to their fate.

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It’s an admirable attempt to use the trappings of a thriller to lure the audience into something cleverer and more challenging. As the series wears on, though, and despite each episode bar the finale being kept to a tight half hour (or in the case of the pilot, just 21 minutes), it feels a bit too slow and repetitive. The tension dissipates, past the point of no return for many, I suspect, hindered by a script that is rarely more than top-tier serviceable. Those who remain will be watching for the performances. Gleeson makes Sam genuinely odd and unpredictable, with his coldness shot through with sparks of … something, even if we cannot call it true human feeling or compassion. The desire to ape them, perhaps – to fit in with society even if he doesn’t understand it, and the hope that connection will grow thereafter. And Carell evokes all of Strauss’s fear (he’s an excellent controlled-panicker) and frustration, his irrepressible professional interest working both with and against his desire to escape, and his enduring grief about his various losses. If you can be patient, The Patient will yield its rewards.

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The Patient Is All Killer, No Filler

The Patient is not epic. Unlike several of the major shows arriving on TV as summer turns to fall — HBO’s House of the Dragon , the Disney+ comedy She-Hulk: Attorney at Law , Amazon’s forthcoming Lord of the Rings: The Rings of Power — it does not contain dizzying visual effects, take place in a fictional realm, or have any connections to a larger cinematic universe.

In almost every way, The Patient does the opposite of what its blockbuster-level television counterparts are attempting. While they go big, The Patient remains appropriately, suspensefully intimate and contained. For long stretches, it functions as a two-hander, with scenes that involve a pair of actors doing exceptional work opposite each other: Steve Carell as therapist Dr. Alan Strauss and Domhnall Gleeson as Sam, a patient with homicidal tendencies. Much of the ten-episode FX-produced limited series is set in a single room: the spare finished basement of Sam’s isolated home in the woods. The majority of episodes have tight run times of 30 minutes or less. The first , which debuts today on Hulu alongside episode two, lasts for a mere 20 minutes, which is precisely how much time is required to set up the show’s central premise and conflict. It is, pardon the pun, all killer, no filler.

But it’s not “all killer” in the ways you may imagine. As established early on, Sam is a serial murderer who kidnaps Alan, chains him up in the basement of his home, and insists that Alan cure him of his desire to take the lives of people he deems offensive. Minor spoiler alert: Yes, we see Sam engage in some rather violent behavior. But The Patient is not a “murder show.” It does not fixate on the grisly nature of Sam’s crimes or a police investigation into those crimes or, refreshingly, any sexual compulsions that may be driving Sam’s tendencies. Creators Joel Fields and Joe Weisberg, who gave us the masterpiece that was The Americans , steer all the way around serial-killer tropes to create a limited series that offers surprising twists and thoughtful nuance in equal measure.

Written entirely by Fields and Weisberg and co-directed by Americans veterans Chris Long, Gwyneth Horder-Payton, and Kevin Bray, The Patient emphasizes a sense of claustrophobia and isolation in every artistic choice. Carell and Gleeson are often framed in tight close-ups. When Sam returns home from work or an errand, the headlights from his car illuminate the basement as though someone has finally come to Alan’s rescue, a hope extinguished each time Sam walks through the sliding glass doors. Even the scenes that take place outside Sam’s basement, which include flashbacks to moments in Alan’s life pre-kidnapping, are often set in compact interior spaces: a crowded dinner table, the deathbed of a loved one, a small office. The Patient does everything it can to put us in a headspace that is isolated and reflective of the private, sometimes uncomfortable process of seeking therapy.

Sam initially starts sessions in Alan’s office, where Sam uses an alias and is not completely forthcoming about the depth of his problem. He kidnaps Alan on the assumption that more regular therapy in his home, where he can speak freely, will finally enable him to make a breakthrough. If Sam doesn’t reach that point, it seems very likely that Alan will become his next victim, a possibility that hangs over the series like the unspoken diagnosis of a terminal disease.

Much of the tension in The Patient naturally derives from whether Alan can make it out of that basement alive, an emergency situation at odds with the calm compassion he exudes while counseling Sam. Several episodes end cliffhanger style, including the second installment, when Alan hears movement upstairs in the house but we don’t get to see who’s there until episode three. Because the show is rolling out weekly — after the first two episodes, one will drop on Hulu each Tuesday — watching isn’t quite the nonstop heart attack it would be if The Patient were instantly bingeable. But at the very least, it definitely causes bouts of A-fib.

The Patient is about more than disturbing the cardiovascular system, though. Alan brings his own baggage into the sessions, and his issues figure as prominently as Sam’s. Via flashbacks and some imagined discussions with his own late therapist, Charlie (David Alan Grier), we learn that Alan’s wife, Beth (Laura Niemi), recently died of cancer and that Alan has become estranged from their son — losses that nag at his soul and become intertwined with the emotions he experiences in the basement. Alan’s feelings about Judaism, a matter directly related to the rift in his family, become more central as the episodes progress, giving the series a sense of gravity. On a surface level, The Patient is a thriller about a man being held prisoner by someone he’s expected to treat. On a deeper one, it’s about atonement and forgiveness, finding empathy and recognizing your own blind spots, seeking justice and realizing it does not always come, at least not in the form we may want.

While The Americans was a very different show, Fields and Weisberg demonstrate a similar gift here for threading multiple needles in tone and theme, then sewing all the pieces together in an impressive finale. As was the case on their Russian-spy drama, they are aided considerably by their star duo. The camera does right by both Gleeson and Carell, magnifying their subtle choices just enough to make them register. Playing a man whose life is defined by compulsions both dark (murder) and pedestrian (Dunkin’ Donuts coffee), Gleeson never fully relaxes. Through small tics — the clenching of his jaw, the plucking of loose flesh on his hand — he conveys how uncomfortable Sam is in his own skin and how happily he would shed it if he could just figure out how. Carell gives one of his strongest dramatic performances, conveying panic in moments of genuine distress and, more impressively, in the undercurrent that runs beneath his seemingly affable attempts to encourage Sam. Alan’s life preserver is his ability to maintain professionalism in an absolutely maddening situation, but that doesn’t mean it keeps him fully afloat. Carell keys us into just how hard he’s kicking beneath the water, briefly signaling desperation in his gaze or making a nerve beneath his right eye twitch when he hears news from Sam he doesn’t like.

We see those details only because The Patient is the kind of show that keeps its focus narrow and purposeful. Because this is an original piece of television — not based on a true story or existing source material, which is beginning to feel like a rarity — there are moments of genuine discovery and shock. As Alan advises Sam during a therapy session in which he keeps interrupting, “Sometimes when we wait, people don’t say what we think they are going to.” The Patient does that repeatedly throughout its economically constructed season, right up to the very end. It may not be the most uplifting series you’ll watch this year, but it’s certainly one of the most thought-provoking and absorbing.

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Gender medicine for children and young people is built on shaky foundations. Here is how we strengthen services

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Guidelines on gender related treatment flouted standards and overlooked poor evidence, finds Cass review

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“Medication is binary, but gender expressions are often not”—the Hilary Cass interview

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• Independent Review into Gender Identity Services for Children and Young People

Improving the evidence base for young people is an essential next step, writes Hilary Cass, as her independent review into gender identity services for children and young people is published

Medicine is a science of uncertainty and an art of probability

–William Osler

William Osler’s much quoted aphorism is well known to every medical student. Living with medicine’s many uncertainties would be intolerable for doctors and for patients without some coping mechanisms. In Osler’s time, doctors relied on a mix of knowledge, custom, and paternalism to hide uncertainties from patients, and provide treatments they had learnt from their mentors. Nowadays we have the three pillars of evidence based medicine to lean on: the integration of best available research evidence with clinical expertise, and patient values and preferences.

My independent review into gender identity services for children and young people is published today. 1 When conducting the review, I found that in gender medicine those pillars are built on shaky foundations.

I took on this review in full knowledge of the controversial nature of the subject, the polarisation and toxicity of the debate, and the weakness of the evidence base. Gender care for children and young people had moved from a “watchful waiting” approach to treatment with puberty blockers from Tanner stage 2 for those with early onset gender incongruence, followed by masculinising or feminising hormones from age 16. My review launched while the Divisional Court was considering the case of Bell v Tavistock, which focused on whether young people under 18 have the competence or capacity to give consent to endocrine treatments. 2 Competence or capacity is only one part of the process of informed consent. My review also had to consider the other components: the evidence underpinning the treatments, and the clinical judgements which might lead to recommending an endocrine pathway.

Since my interim report was published in March 2022, the review has commissioned the University of York to conduct a series of systematic reviews appraising the evidence on the characteristics of the population of children and young people presenting to gender services, and the outcomes of social transition, psychosocial interventions, and endocrine treatments. 3 4 5 The review also commissioned an appraisal of international guidelines and a survey of international practice.

The findings of the series of systematic reviews are disappointing. They suggest that the majority of clinical guidelines have not followed the international standards for guideline development. 6 The World Professional Association of Transgender Healthcare (WPATH) has been highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency. 6 Early versions of two international guidelines—the Endocrine Society 2009 and WPATH 7—influenced nearly all other guidelines, with the exception of recent Finnish and Swedish guidelines; the latter were the only guidelines to publish details of how developers reviewed and utilised the evidence base, and the decision making process behind their recommendations. 6 7 8

The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria and mental or psychosocial health. 9 The effect on cognitive and psychosexual development remains unknown. 9 The clearest indication is in helping a small number of birth registered males, whose gender incongruence started in early childhood, to pass in adult life by preventing the irreversible changes of male puberty.

The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. However, the lack of long term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group. 10 11 In particular, we lack follow up data on the more recent cohort of predominantly birth-registered females who frequently have a range of co-occurring conditions including adverse childhood experiences, autism, and a range of mental health challenges. Filling this knowledge gap would be of great help to the young people wanting to make informed choices about their treatment.

A key message from my review is that gender questioning children and young people seeking help from the NHS must be able to access a broad-based holistic assessment delivered by a multi-professional team. Notwithstanding the pressures on CAMHS and paediatric services, these young people should not receive a lower standard of care than other similarly distressed adolescents. This means access to a wide range of services, including autism diagnostic services, psychosocial support, and evidence based interventions for commonly co-occurring conditions such as depression, anxiety, and eating disorders. Regardless of whether or not they chose a social or medical transition in the longer term, they need support to help them thrive and fulfil their life goals.

The challenge of the assessment process is that while it may direct a broader care plan, it does not give certainty about which young people will ultimately develop a long term trans identity and which will resolve their gender-related distress in other ways. Young people are in a state of neurocognitive and psychosexual development into their mid-20s. Some mature faster than others, and we have no way of knowing when the majority will be in a settled identity. The review has spoken to young adults who are happy and empowered by their decision to medically transition and to others who have regrets.

The ethical challenges are great. Some young adults have told us that they wish they had known when they were younger that there are many more ways of being trans than following a binary medical transgender pathway. The fastest growing identity under the trans umbrella is non-binary. There is almost no research on this group, many of whom want a spectrum of treatments falling short of full medical transition. This raises questions about what medicine can do, what medicine should do, and more specifically what the NHS should do.

Improving the evidence base for this population of young people is an essential next step. Fortunately, because this review has been an iterative process with interim recommendations, the new regional services which are being established to expand provision for the population will have a research structure embedded from the outset, data collection will be integral to the service model, and a prospective puberty blocker study is already in development.

I very much hope that this strong multi disciplinary team model, with networked service delivery and embedded research, will encourage more clinicians with experience in child and adolescent health to work in this evolving area of clinical practice.

Competing interests: none declared.

Provenance and peer review: not commissioned, not peer reviewed.

• ↵ The Cass Review. Independent review of gender identity services for children and young people. April 2024 https://cass.independent-review.uk/?page_id=936
• ↵ v Tavistock B. (Divisional Court) [2020] EWHC 3274 (Admin) https://www.judiciary.uk/wp-content/uploads/2020/12/Bell-v-Tavistock-Judgment.pdf
• ↵ Archives of Disease in Childhood. Gender identity service series. https://adc.bmj.com/pages/gender-identity-service-series
• Taylor J. ,
• ↵ Council for Choices in Healthcare in Finland 2020. Medical treatment methods for dysphoria associated with variations in gender identity in minors – recommendation. https://palveluvalikoima.fi/en/recommendations#genderidentity : Council for Choices in Healthcare in Finland 2020
• ↵ The Swedish National Board of Health and Welfare 2022. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2023-1-8330.pdf
• ↵ Taylor, J., Mitchell, A., Hall, R., et al (2024). Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326669
• ↵ Taylor, J., Mitchell, A., Hall, R., et al (2024). Masculinising and feminising hormone interventions for adolescents with gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326670
• ↵ Taylor, J., Hall, R., Langton, T., et al (2024). Care pathways of children and adolescents referred to specialist gender services: a systematic review. Archives of Disease in Childhood, Published Online First: April 2024. doi: https://doi.org/10.1136/archdischild-2023-326760