Dr Shahed Yousaf (MBCHB Medicine and Surgery, 2006) began his writing career with fiction. His new book, Stitched Up, follows his ten year career as a GP working with patients on the edge of society. Here, he talks to Claire McDonald, Warwick Medical School's Head of Marketing and Communications, about his experiences of Warwick, work, and the conversations he hopes his book will start.

What can you remember about your time at Warwick Medical School?

Studying medicine is not easy due to the volume of work that you need to incorporate and understand as well as the clinical skills aspect. One of the most important things from that time is the friendships I made. They continue to be amongst my closest friends.

My time at Warwick was bittersweet however because the night before my finals my father died suddenly. I spent that evening grieving and then travelled in to sit my finals the next morning. The staff were very kind to me and gave me a separate room to do my exams, but I haven’t been back since and remember very little about graduation.

One of the reasons for writing the book was to process and come to terms with what had happened.

How did you get into working as a GP in prisons?

Following the bereavement, I decided I wanted to do something worthwhile and became a GP, helping homeless people. Because of their circumstances they are often the people that need care most and struggle to access it.

It is an example of the inverse care law which is the principle that the availability of good medical care tends to vary inversely with the need for it in the population served. (First described by British GP Julian Tutor Hart in the Lancet in 1971).

Whilst working there, a GP colleague said that there were some shifts available within prisons and as some of the community that I was serving ended up in prison in the winter months, committing petty crime to stay off the streets, I decided to do that.

Over the last 10 years, I have worked in over a dozen men’s and women's prisons and youth offenders’ institutions.

When did you get into writing?

I have always been a writer. Before this book, it was always fiction: novels, articles, and short stories. I have had some success being published and shortlisted for national prizes. I remember writing for the Medical School magazine whilst I was at Warwick. I received commendations for my writing at Warwick; I was glad I went there as it helped me with my writing as well as medicine.

What are the challenges for you as a GP in a prison?

One of the greatest challenges is trying to be professional when you are faced with a prisoner when you know that what they have done is morally abhorrent. I avoid finding out what they have been convicted of but sometimes you do know, and you must separate your feelings from the job. It can be a challenge to have empathy, sympathy, and unconditional positive regard. All you can do is be professional and do your best medically remembering that you are not there to judge or punish them.

Do you fear working with prisoners?

There is a difference between fear and danger. Danger is a situation you find yourself in and fear is your response to it. When you stop recognising that there are dangers around you that’s something to be concerned about. Some prisoners come across very well, but you can never normalise working in that environment and neither should you. There are times when it is a violent environment and patients try to attack you. Before I started working in prisons, I thought there would be a big burly bodyguard in the room alongside you when you are seeing patients but that isn’t the case. You are alone with the patient and if they kick off you have to hit the panic button and get yourself out of that situation. Due to cutbacks, there may not even be a prison officer present in the whole healthcare department.

When I was studying, I didn’t know offender healthcare existed or that there are doctors, nurses, physios, psychiatrists, paramedics, healthcare assistants and entire admin departments within prisons. There are currently 88,000 people currently being looked after by healthcare teams in 120 prisons in the UK. It’s a hidden world that no one really knows about.

Sadly, the system is understaffed, under resourced and overpopulated. We imprison more people in England, Scotland, and Wales than anywhere else in Western Europe. We continue to build more prisons and political parties want to show they are tough on crime. It’s not a vote winner to say we should be sending less people to prison. There are lots of people who shouldn’t be in prison such as those who are unable to access community mental health beds as there is a shortage.

How do you cope with working in this system?

There is a real sense of camaraderie so in comparison to other hospital specialties or general practices there isn’t that sense of rigidity between groups. It’s not hierarchical at all. It is a place where people are valued for who they are and not their job title. We all care about the patients and each other and support one another and that makes it work.

Where do you see your career going in the future?

I would like to be able to look back at my career and say that I made a difference.

Often the biggest impact you can make is with people who weren’t expecting care or to be treated with respect and dignity.

In terms of writing, my book has been published by Penguin and is on the Amazon best-seller list. We are having conversations with TV and film production companies, and we will see what happens. It’s important to me that the book doesn’t come across as voyeuristic or profiting from someone else’s misery. I hope it starts a conversation about offender healthcare, about prisoner welfare and literacy rates. 50% of prisoners have a reading age below 11 years old and with prison ministers trying to ban books being sent into prisons, we aren’t going to reform people.

The majority of people sent to prison are due for release at some point and they will become part of our communities. Surely, we don’t want potential neighbours who have been brutalised by a system but people who have been rehabilitated, learned skills, got jobs, and are contributing to society. It costs £44,000 to keep someone in prison for a year. For every person we didn’t send to prison we could employ two prison officers which we don’t have enough of. We are wasting our money. I am pleased to say that it is a conversation we are starting to have despite it being low on the political agenda, and I am hopeful that there will be some positive progress.