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We tend to imagine the next war using the language of the last one. Frontlines. Forward operating bases. Evacuation corridors. Protected rear areas. Helicopters lifting casualties within the golden hour. Surgical units working with some degree of distance from direct threat. That mental model is increasingly outdated. Future conflict will not present itself as a … Read more

There is a particular confidence that comes from having done the thing yourself. Not read about it. Not watched someone else do it. Not quoted a paper that quotes another paper. But actually stood there, hands involved, making decisions in real time, feeling the resistance of tissue, the unpredictability of physiology, and the weight of consequence … Read more

There is a great deal of conversation at the moment about prolonged field care, about evacuation denial, about scarce skill sets, high-value clinicians, and the limits of logistics in modern warfare. These are serious discussions, and they deserve to be had. But as I listen to them, I am struck by a recurring omission, one … Read more

For decades, military medicine has been built around a comforting assumption: that there will always be a place behind the fight where casualties can be evacuated, stabilised, and treated in relative safety. That assumption no longer holds. Modern near-peer warfare has erased the idea of a predictable frontline and replaced it with something far more … Read more

There are few sights in medicine that still silence a room. A patient vomiting blood is one of them. Bright red or coffee-ground, slow or torrential, it transforms vague symptoms into undeniable urgency. This is no longer discomfort or indigestion. This is acute gastrointestinal haemorrhage, and it demands immediate attention, calm thinking, and disciplined action. The … Read more

There are few sights in medicine that still silence a room. A patient vomiting blood is one of them. Bright red or coffee-ground, slow or torrential, it transforms vague symptoms into undeniable urgency. This is no longer discomfort or indigestion. This is acute gastrointestinal haemorrhage, and it demands immediate attention, calm thinking, and disciplined action. The … Read more

Few symptoms unsettle patients more than a change in bowel habit or the sight of blood where none should be. Stools, after all, are deeply personal. People know their own rhythms, patterns, and tolerances, and when those patterns change, instinct tells them something is wrong. More often than not, that instinct is correct. For the … Read more

Abdominal swelling is one of those presentations that looks deceptively simple. The patient points to their abdomen and says, “Doctor, it’s getting bigger.” What they are really saying is, something inside me has changed, and I need you to work out what. The swollen abdomen is not a diagnosis. It is a sign, and like all good … Read more

My balanced perspective for prospective applicants This is a question I get asked more and more: “Would you recommend medicine as a career today?” It’s a fair question. Medicine has changed enormously over the last few decades, financially, structurally, and culturally. The government contribution to medical education has decreased significantly, tuition fees are high, and some … Read more

Every year I meet anxious applicants who cling to a single number or achievement as if it were their entire destiny. “I’ve got a Band 1 SJT, so I’m safe.”  Or, “My UCAT is high, surely that guarantees me an interview.”  Or even, “My GCSEs are flawless, they can’t turn me down.” Let’s set the record straight. The … Read more

We tend to imagine the next war using the language of the last one. Frontlines. Forward operating bases. Evacuation corridors. Protected rear areas. Helicopters lifting casualties within the golden hour. Surgical units working with some degree of distance from direct threat. That mental model is increasingly outdated. Future conflict will not present itself as a … Read more

There is a particular confidence that comes from having done the thing yourself. Not read about it. Not watched someone else do it. Not quoted a paper that quotes another paper. But actually stood there, hands involved, making decisions in real time, feeling the resistance of tissue, the unpredictability of physiology, and the weight of consequence … Read more

For decades, military medicine has been built around a comforting assumption: that there will always be a place behind the fight where casualties can be evacuated, stabilised, and treated in relative safety. That assumption no longer holds. Modern near-peer warfare has erased the idea of a predictable frontline and replaced it with something far more … Read more

In trauma, unpredictability is not an anomaly, it is the environment. You can be as prepared as any human being possibly can be: your drills rehearsed, your team aligned, your mental model sharp. And then a case arrives that does not behave the way you expected. A physiology that collapses sideways. A wound that hides … Read more

There is a quiet truth that every experienced deployable clinician eventually comes to understand: we do not train for one type of world, but for three. Contingency deployments, humanitarian missions, and kinetic operations each demand something entirely different from us, yet they all sit squarely within the same professional identity. You cannot choose which world … Read more

The groin: small region, big problems Few areas of the body punch above their weight like the groin. It’s a crossroad of vessels, nerves, muscles, and just enough anatomical compromise to let abdominal contents slip through when the stars misalign. This is where inguinal, femoral, and obturator hernias live, argue, and confuse medical students. It’s also where surgeons … Read more

The great escape… The abdominal wall is a masterpiece of engineering, layers of muscle, fascia, and peritoneum that hold back the constant pressure of life: breathing, coughing, eating, lifting, laughing, and occasionally regretting. But even the best architecture has weak points. And when the inner contents, usually omentum or bowel, find one, they make a … Read more

The day the colon stops cooperating If small bowel obstruction is the frantic traffic jam of the gut, large bowel obstruction is the motorway shutdown, slower to declare itself, but far more catastrophic when it does. The colon, proud custodian of our digestive leftovers, is designed to move content calmly toward the exit. But when something blocks … Read more

It always starts with a sound… A low, hollow gurgling echo drifting across the ward. If you’ve been a surgeon long enough, you learn to recognise that sound, the one that tells you a bowel somewhere deep inside someone is unhappy. Distended. Struggling. On this particular night, the call came just after midnight. “Professor, could … Read more

A small sore with big ambitions The stomach, that muscular bag of acid and appetite, is built for abuse. It churns, digests, and disinfects, bathing itself daily in a cauldron of hydrochloric acid strong enough to dissolve a nail. Yet, occasionally, its defences falter. The mucosal barrier thins, the acid seeps in, and an ulcer … Read more

We tend to imagine the next war using the language of the last one. Frontlines. Forward operating bases. Evacuation corridors. Protected rear areas. Helicopters lifting casualties within the golden hour. Surgical units working with some degree of distance from direct threat. That mental model is increasingly outdated. Future conflict will not present itself as a … Read more

There is a particular confidence that comes from having done the thing yourself. Not read about it. Not watched someone else do it. Not quoted a paper that quotes another paper. But actually stood there, hands involved, making decisions in real time, feeling the resistance of tissue, the unpredictability of physiology, and the weight of consequence … Read more

There is a great deal of conversation at the moment about prolonged field care, about evacuation denial, about scarce skill sets, high-value clinicians, and the limits of logistics in modern warfare. These are serious discussions, and they deserve to be had. But as I listen to them, I am struck by a recurring omission, one … Read more

For decades, military medicine has been built around a comforting assumption: that there will always be a place behind the fight where casualties can be evacuated, stabilised, and treated in relative safety. That assumption no longer holds. Modern near-peer warfare has erased the idea of a predictable frontline and replaced it with something far more … Read more

There is a particular kind of behaviour that appears after every conflict, every kinetic deployment, every traumatic event where clinicians and medics have intervened under fire. It creeps into conversations, audits, social media commentary, and even formal reviews. It is the phenomenon of the Monday morning quarterback, the individual who analyses events from a place of … Read more