Q&A with Dr. Sarvi Eastell, Surgeon, Entrepreneur, and Digital Health Advisor

Dr. Sarvi Eastell is a surgeon, entrepreneur, and digital health advisor. She is the founder and CEO of Holding Your Hand, a company that helps patients navigate the healthcare system by connecting them with expert impartial advocates. She is an Honorary Colorectal Surgeon at St Mark’s Hospital Foundation Trust and Chief Medical Officer at Thriva Ltd, a company that produces at-home diagnostic kits to enable personalized health monitoring. In her spare time, she is passionate about mentoring doctors who want to innovate and/or diversify their careers. She speaks on leadership and personal development and provides workshops on the anatomy of mindfulness. Her mentees have approached her via channels such as Medic Footprints, Women Like Us, Google’s London Campus, Surgify.co and LinkedIn.

Dr. Eastell obtained her medical degree from King’s College London (2001). During medical school, she also intercalated and obtained a dual bachelor’s degree in Molecular Biology and Genetic Engineering and Mathematics (1998).

For the past 16 years, she has worked as a surgeon at various teaching hospitals in London, including Great Ormond Street Hospital for Children, The Royal Marsden Hospital, University College Hospital and King’s College Hospital. More recently she has been an advisor for NightGlass Medical Rostering and Psychiatry UK, a service for online psychiatry consultations.

Dr. Eastell has been published in several journals, including International Journal of Surgery,Annals of the Royal College of Surgeons of England, Journal of Pediatric Urology, Hospital Medicine, and European Urology. She has blogged for various other forums, including The Highgate Society, Keats Group Practice and the Health Service Journal on behalf of the NHS Women Leaders Network.

When did you first decide to become a physician? Why?
Interestingly, I first wanted to do mathematics, but at age 15, I found myself spending my week of A-level work experience in the operating room and got hooked. Medicine was also one of those careers we were encouraged to consider as science students, and being in an all-girls’ school, I was not allowed to study A-level physics because the demand wasn’t there. Although I’m talking about 25 years ago, the same thing still happens today with girls being pushed into vocations over pure STEM subjects.
In my case, my best friend’s cousin was an ENT surgeon at the Royal Free Hospital. He in turn asked his boss if I could join them for work experience for a week. On my very first day I was invited into the operating room. As soon as I enter, I faint, as many women do at least once. Of course I had no idea this sort of thing could happen, but I learnt several life-changing lessons in one go. Firstly the faint itself made me think: “Wow! The body can do this to you? Flatten you out of the blue!” My vision went, my balance started to go, I was flat on the floor, and I couldn’t move, until I regained my sense of hearing. The fact that walking into an operating room could flatten me and that my senses could leave and return at different speeds in different stages amazed me.

Then I learnt my second lesson. As the surgeon said to the nurse: “Please make sure she has a glass of orange juice and then please bring her back in” I realised how many important life-changing decisions the surgeon can make as a good leader. So I wanted to learn to impart that capacity which I believed would be acquired through surgical training.

The most profound thing to me was that a surgeon was operating and still had the compassion to understand that “if this young girl doesn’t come back to the operating room, she might exclude the option to become a surgeon”. From that point on, I didn’t want to be anything other than a surgeon.

I still love mathematics and intercalation is such a privilege for UK medical students, so I took that opportunity to combine mathematics with genetic engineering, which I now build into my work through technology and data science.

How/why did you choose the medical school you attended?
I chose the top five in the country at the time but learnt very quickly that the place had to suit my personality. Being at King’s meant I was exposed to opportunity and innovation right from the start. My contemporaries were a real melting pot from all walks of life and that really shaped the attitude I hold to this day with regard to successful teams and collaboration. Halls of residence and lectures were all mixed. This was in Central London, 1995, on The Strand. The eleventh floor had the cadavers we dissected, the basement was where classics and philosophy were being taught. In the middle you found War Studies students, and reading week could be spent in the Law Library. Students from all programmes could easily mix. That’s why, when the time came to intercalate, I could easily knock on the door of the mathematics department. Going to King’s College also meant I was to join the new training programme that was designed to ensure we were readily able to deliver holistic care. I still have strong friendships with people I met from completely different courses.

What surprised you the most about your medical studies?
I guess how much of an art it actually is. Over time, I realised that I was much more interested in subjects that had definite answers, theories that could be proven on paper, like chemistry, mathematics, physics. I missed things that were absolute. Medicine was very far from that, and a lot was terribly vague. I liked biochemistry – the closest I could get to the concrete – but when it came to things like psychology or neuroscience, there was no real theory or formula behind it. Similarly, I found psychiatry really difficult. When it came to thinking about specialties I liked the most, surgery made sense to me. With orthopaedics, you had angles, straight lines. I found colorectal surgery, along with the science behind bowel disease, really interesting.

In your position now, knowing what you do, what would you say to yourself back when you started your medical school?

Travel as much as you possibly can. It is a true privilege to travel through healthcare. You learn so much about cultures, people, variations in care, and about yourself.

Has being a surgeon met your expectations? Please explain.

Yes, definitely; certainly from what I wanted it to be as a student. It’s been a phenomenal experience. There came a point when I thought: If I really want a family, will I be able to juggle all of this with that? The other thing is, as female surgeons, we tend to match with husbands of similar work ethics and drives, which seemingly leaves little room for family. At some point, I thought to myself: “Let me find a family-oriented specialty, something easier to deal with”. I considered office urology, but realised quite quickly that choosing something I wasn’t passionate about was going to harm me. At the point of choosing a registrar number, I switched across and moved to general surgery.

What do you like most about being a surgeon?
The thing I love the most is the learning journey, to see a whole spectrum of pathology in a vast spectrum of patients presenting in so many unpredictable ways. I’m not operating at the moment but when I did it was colorectal surgery that I loved for the mixture of overlapping pathologies and the link with genetics.
Another thing that’s really incredible is the peace that comes with an operation that goes perfectly to plan, without surprises or anatomical deviations. It’s a strangely meditative experience. You get taken away to this space where you hyper-focus, you have this strong, wonderful relationship with a patient who trusts you, and you will soon give them and their loved ones the great news of how everything went to plan. It’s very humbling on so many levels.
What do you like least about being a surgeon?
The politics and times where good leadership is undervalued; people’s lives and agendas can come into the workplace. I think it’s important that you have a collaborative, cohesive department. I think that diversity is the key to success, but a surgical department can’t be all that neuro-typically diverse in a sense, as we all want to be surgeons. I think that was ultimately why I needed to see the world as a much bigger place, and to be in touch with the outside world through medical technology and innovation.
What do you like most about being in health entrepreneurship and med-tech?
We are in a tech revolution which is opening so many doors. It is a very unique privilege to be part of this movement. At the same time there’s a significant responsibility to make sure that the contributions that we make are thoughtful and considered. We need to have a voice that stands for patient rights and protects core values in healthcare that have stood the test of time.
What do you like least about being in health entrepreneurship and med-tech?
Well, what we create today could go horribly wrong in the future in unpredictable ways. What happens as a result of automation? What outliers will we see being harmed and how can we repair the damage done if the systems have created monumental shifts that cannot be undone? For example, digitizing everything might make patients lose trust in the confidentiality of their records. What if they stop seeking health care because of such a concern, because of an impact on their health insurance, say? So the unintended consequences worry me. But that’s also why we have to participate in innovation, to be proactive and have a voice.
Describe a typical day as a doctor—walk me through a day in your shoes.
I would go to a morning grand round which starts at 7:30, where an interesting topic is discussed. An example that springs to mind is the study that assessed the significant impact of stress on the GI tract of students with Crohn’s disease during exams. After that the multi-disciplinary meeting is a great place for collaboration and productivity as the entire team focuses on doing what’s best for the patient. And then there’s the complex cancer clinic – I cannot begin to explain what a humbling experience that is. At St. Marks, we see a lot of patients with rare genetic conditions, e.g. familial adenomatous polyposis. St. Marks is world-renowned for being a centre of excellence for colorectal and GI care, so it’s a privilege to have an honorary surgeon contract there while making room for my additional med-tech and innovation work.
Describe a typical day of working on entrepreneurship and med-tech —walk me through a day in your shoes.
Ah! Dramatically varied! One day, I could be in meetings with my colleagues, discussing the cases that we’ve had come through to Holding Your Hand. I might also have governance meetings with Thriva. I might be invited to a conference to speak about patient health. For instance, as part of Google Campus London, there was a showcase with various start-ups at The House of Commons in Westminster. Through making the business case for Holding Your Hand, I spoke to MPs about the importance of making the most of the NHS. There are carers across the country are incredibly able patient advocates; they’ve been accustomed to NHS values which are quite uniquely focused on patient empowerment and patient choice. This is a skill to be valued, and could be utilised via Holding Your Hand.
On a separate occasion, I had to talk to The Business and Innovation and Skills Committee about the future of technology. I shared my thoughts on health innovation with reference to intellectual property, a very important topical ethical discussion because of how IP contrasts with the idea of advancing health as a human right.
On average, how many hours a week do you work? How many hours of sleep do you get per night?
At the moment, I probably work too many hours, and don’t get enough sleep, which is why I’ve cut back on operating hours. You have to make a decision to prioritise your own personal health. I don’t know if having weird sleep patterns draws you to surgery, or if you learn to cope with such little sleep because you become a surgeon. Either way, I just seem to be one of those people that feel like they never need sleep, but I try not to ignore the science!
How do you balance your various professional roles?
My life is quite unusual at the moment. When I stopped working full time as a general surgeon, I went full time into med-tech and then I started to feel a void; I really wanted to be back in the healthcare setting, which is why I asked to stay on as an honorary general surgeon.
With the start-up world, you just don’t know whether something will go crazy or go quiet, you don’t know whether you have to change angles or stick at something tentatively with a patient pace. With technology, you need to dial back and reassess if the things you are doing simply aren’t working.
There’s also an element of my job that’s starting to grow, that of leadership and academia. Although running a start-up is a bit of a roller-coaster, the amount that you learn from it takes you to areas that you didn’t expect. Coaching, mentoring and leadership are such areas for me.
The key is to keep doing it all so that you learn how to prioritise, learn what’s important, learn what you’re good at. You also need to be honest and have humility, otherwise you’ll create a whirlwind that’s going nowhere. You owe it to your colleagues and your family and your patients to do what’s right by them. Most of all you need to look at yourself with self-respect. Career happiness is key, because without that it’s impossible to balance the roles.
How do you maintain a work-life balance?
I’ve always had the attitude that there is no divide between work and life outside of work. The division has never worked for me. Looking at the academic angle of leadership is my current hobby. Talking to medical students, public speaking, mentoring and coaching – these are all my passions. I enjoy AI-related articles and technology podcasts for pleasure. Family and friends are a constant, of course, but I still end up talking about these things! And the passion can be contagious.
Most important is juggling work with family and motherhood. I’d say it’s very hard to do; progression can be hindered, but the gains from parenting can be rather surprising. It improves ones abilities in ways you’d never expect. You learn patience and leadership. You learn to recognise other traits you have, and you get comfortable using them in the outside world. I’m talking about transparency and humility. Raising a child is a big project; you’re shaping the personality of someone you hope will add to society. I also waited a long time to have a child, which many do nowadays, but I had to have IVF which is a difficult experience.
In leading workshops on the anatomy of mindfulness, I’m reminded of how life stresses can be overcome with simple techniques like taking deep breaths. The balancing act is a challenge, but it’s a good challenge to rise to.
What types of outreach/volunteer work do you do, if any?
The mentoring and coaching I do is all pro bono and I run anatomy of mindfulness workshops. I feel like I’m best at supporting doctors who want to diversify their career. I think that it’s very hard to leave the doctoring identity, so I find it quite a privilege to be able to encourage people to diversify their careers while maintaining patient contact.
With Holding Your Hand, we offer a lot of people pro bono support. It’s something that we’re taking on a paid basis only as a corporate well-being benefit, mainly because we want to prove the point that having an unbiased impartial advocacy role would strengthen patient empowerment.
Patients are by definition vulnerable because of the loss of normal health, but that’s just the start. They then have to step out of that place and seek out the help they need, a journey which I believe needs an advocate. We know the best health care is delivered when you’ve got empowered patients who are contributing to shared decision-making. Patient involvement increases, satisfaction improves, litigation drops, outcomes are better all round.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
Follow your heart, keep your gaze outward but don’t forget to have humility. Ego is definitely a waste of time and work every day with passion! Definitely make decisions with passion; being purely strategic rarely leads to happiness.
What part of medical training itself prepared you best for health-tech involvement?
I think it’s the duration, because you immerse yourself so fully into it. There is also a reciprocal relationship in that medical school gave me various opportunities to do other subjects, to participate in other activities, to actually go and do my elective year abroad. There are a lot of concerns about progression and specialisation in medicine, but there is also the nurturing of a particular persona that’s very important to becoming a good doctor. It fosters innovation and being able to think outside the box, because you have to as a doctor; if faced with atypical presentations, you need to be able to call ideas together. For me, being able to study mathematics and genetics as part of my BSc is something that lent itself fully to the current state of med-tech. I’ve, in a sense, been trained to be comfortable with engaging in innovation.
From your perspective, what is the biggest problem in healthcare today? Please explain.
We need to think about how we can deliver care with empathy and holistic understanding. We know that everything gets squeezed so doctors have less time but that’s mainly because of the efficiency drivers that come into play. The more technology you have, the more efficient you become, but it’s at the cost of the human touch. You’ll have a specialist who can see a lot of patients in their niche speciality, but how much compassion can they deliver? It’s a huge problem, and the reason I set up Holding Your Hand.
As a doctor, you need to realise that a patient could be coming with a whole host of health problems and personal problems. You need to understand that you’re facing a human being with a whole spectrum of considerations besides your one niche specialty area.
I was among the first cohort of King’s College London medical students sent out into the world with a holistic care agenda. As someone who believes in this approach, I’m certain this is an area that will evolve as we understand more about the mind and I think Big Data will contribute massively to our understanding of patient psychology.
Where do you see surgery, and medicine at large, in five years?
In parts of the UK, medical schools are increasingly introducing empathy education, which may come with virtual reality use. Surgical innovation has been going on for ages, particularly with laparoscopic training, and will continue. Increased Big Data use will deepen our understanding of outcomes data, and machine learning will deliver some interesting insights and tools. We all need to be comfortable with the amount of big changes coming our way. Most importantly, we will see patients who are more empowered, better educated, more comfortable with technology, and hopefully safer as they feel able to be more involved.
What’s your final piece of advice for students interested in pursuing a career in surgery?
Always do it with passion, as with anything else. It will help you choose the right specialty of surgery for you, the right department, the right colleagues. If you don’t have that, you can’t get on with the team. If you at some point feel you’re losing your passion, question it. It might be a case of being frustrated by the less-than-altruistic nature of the politics.
Life is just too short to be doing things with a calculated agenda. Every time I’ve planned, it has gone wrong, and every time I’ve followed my heart, things have gone right. The happiest people are the ones wholeheartedly following their passion.