Dr Keith Grimes FFPM
An FPM Voices Q&A

FPM Voices is a Q&A interview series that shines a spotlight on the careers and insights of senior and influential pharmaceutical physicians. Through these conversations, we aim to provide colleagues with a deeper understanding of the opportunities, challenges, and rewards of pharmaceutical medicine.

Each interview explores personal career journeys, key lessons learned, and the role that the Faculty of Pharmaceutical Medicine (FPM) has played in shaping professional growth.

What first sparked your interest in pharmaceutical medicine, and what has kept you passionate about the field?

The technology came first, if I am honest. I have been a geek all my life, with memories going back to the 1970s, and it was a passion long before it was a job. Throughout my clinical career I kept dragging that interest into the work. What eventually occurred to me was that what I was doing had become a specialist form of clinical practice in its own right, and the closest match I could see anywhere in medicine was pharmaceutical medicine. But I was not working in it, so it did not seem like a route open to me.

Then I left clinical practice to focus on digital health and AI, and the problem sharpened. I was still practising medicine, but through technology rather than through patients, and my professional development had no natural home at all. I said as much on stage at the Royal Society of Medicine in December 2024. Sheuli Porkess, FPM’s President, was in the audience and came to find me afterwards. She drew the parallel I had missed: pharmaceutical medicine itself emerged as a response to exactly this problem, specialist expertise that needed a discipline and a route to develop it. She also pointed out that the Faculty’s work has never been only about drugs, but about devices and technology too. Conversations with Sheuli and with Marcia Philbin, FPM’s CEO, took it from there.

What keeps me in it is the tension rather than the technology: a lifelong love of the stuff, held against a duty not to do harm. Technology has an enormous part to play in fixing the problems patients and the people caring for them actually have, and it has been slowed by too little understanding, too little creativity, and too little rigour about how to make it safe. The last is the one I work on. In a national cross-sectional study published in the Journal of Medical Internet Research in 2025, colleagues and I found that around 70% of digital health technologies influencing patient care in the NHS in England carry no documented clinical safety assurance at all, and fewer than one in five were fully assured against both DCB0129 and DCB0160. The follow-up in BMJ Innovations this year found the cause is not indifference but capacity: mean clinical safety officer capacity was 1.1 whole-time equivalent, and 0.4 in integrated care boards.

My own response was to build an instrument for assessing the quality of a clinical safety case, the Clinical Safety Case Quality Tool, and release it openly under a Creative Commons licence, with the method published in BMJ Innovations. Anyone can use it and change it without asking me, which is the point.

What does FPM represent to you, both professionally and personally?

Professionally, FPM is the best worked example I know of a profession responding properly to an emerging problem.

When I spoke to Sheuli, what came up was the thalidomide moment. Doctors and drug companies were working together in good faith, and something still got through. What followed was not a quick fix but a long journey: the drug withdrawn in December 1961, Sir Derrick Dunlop’s Committee on Safety of Drugs in 1963, which gave us the Yellow Card scheme, the Medicines Act in 1968, the Faculty founded in 1989, and Parliament recognising pharmaceutical medicine as a specialty in 2002. Four decades to build a discipline. It did not happen by itself.

That is almost entirely absent for technology in healthcare. There is informatics, and good people scattered across it, but no clear home. I received no training at medical school in computer science, digital health or artificial intelligence, and when I make that point in talks, which I do often, the only pushback I get is that some schools now offer optional courses. Optional is not the same as core. Meanwhile FPM is beginning to inject the rigour that is missing, particularly for clinicians who have finished basic training and want to specialise. A great many of them want a career in digital health and AI, and at present they stumble their way into it or not at all.

Personally it matters more than that. I still consider myself a doctor. I am simply a doctor who practises medicine through the products I build, rather than through the patients I see. That framing softened a hard decision when I stopped clinical practice. But without a formal home, I was left working out my own development and appraisal alone. Everything I had learned told me how to do that. Nothing told me where.

I am fifty-three. It took me a long time to get here. And I now watch medical students, junior doctors, mid-career and even late-career colleagues with no clear idea how to get in at all. I will be damned if I am going to let them wander in the wilderness when they could be doing work that is professionally satisfying and directly useful to patients and to the people looking after them.

In what ways have you helped champion FPM’s mission for the next generation of pharmaceutical physicians?

Mostly by teaching, and by trying to build the thing whose absence I keep complaining about.

I teach at UCL, Bayes Business School and Warwick, and run a lot of webinars. I also spend a good deal of my own time with medical students, newly qualified doctors and mid-career colleagues, walking them through my own route and through how to work in digital health, AI and clinical safety. That is not a formal programme. It is what you do when there is not one.

I have deliberately worked in a narrow area, mainly because clinical safety is one of the more poorly covered parts of this field and one of the things that will most directly unlock our ability to deploy technology at all. The pattern there is instructive: clinical safety officers receive training, and are then largely left to themselves, with no agreed core competencies and no development pathway.

What I would like from the Faculty is broader. Not a clinical safety officer pathway specifically, but a route for the digital health and AI clinician generally. Within FPM I sit on the New Technologies Expert Group and on its sub-groups covering standards in pharmaceutical medicine and the responsible use of AI. It is early, and I would rather say that plainly than claim more than has been done.

What’s a recent innovation or lesson – whether from colleagues, patients, or scientific advancements – that has inspired or changed your perspective?

Something I have been hearing from the front line, and it changed my mind. When you do clinical safety work on something like an ambient scribe, you make assumptions in advance about how it can go wrong. The real interest starts when unusual things come back from people actually using it. That is one of the great joys of this work. It is detective work.

Clinicians using ambient scribes have told me, separately and independently, three things. That they recall the consultation less well afterwards. That they have lost the chance to structure their own thinking during the consultation, because the writing that used to do that work is now done for them. And, most interesting, that in group practices the notes were carrying a subtle conversation between colleagues, in their length, their emphasis and what was left out, and that this has gone.

That changed my view. An ambient scribe is not a transcription tool with a few risks attached. Writing the note was never simply the recording of what happened; it was doing work of its own. And the consultation itself is only a small part of medicine. Automate the artefact and you can quietly remove the function it was serving.

I hear this from a range of places, including the AI in the NHS WhatsApp community, where I am one of the admins. My own use of these tools has taught me the same lesson: you still need to keep your hands on the wheel and do the human part of the task yourself.

What is one of the biggest misconceptions about pharmaceutical medicine, and how do you think we can change that perception?

I am a UK doctor, which is to say an NHS doctor, and there is a powerful sense of us and them. I spent four and a half years at Babylon Health, and when I left the NHS to do it I received a good deal of unpleasant correspondence from colleagues. The misconception, put plainly, is that working with industry means you have gone over to the other side, and that your motives should be assumed accordingly.

What I found instead was intense professionalism, real discipline, and a seriousness about regulatory standards I had not expected. Babylon was working with technology genuinely advanced for its time, in a space with very little guidance, asking people to change ways of working they were quite happy with. It was an object lesson in identifying the right way forward and then standing up to challenge over it.

The point I would make to colleagues is that you have to understand how the sausage is made. It is easy to expect the sausage to arrive safe and good. How it is made safe is not obvious unless you have spent time inside it, and pharmaceutical medicine has done a good job of building that bridge.

How do we change the perception? By talking about it, particularly to new and upcoming doctors, and by being clear about where the parallels with clinical practice lie and where they do not. Here is the asymmetry that strikes me most. Frontline clinicians accept without a second thought that the drugs they prescribe had to be made safe, and that there are people whose professional job that is. They have a blind spot about technology. They assume it simply works.

What is one key change or advancement you hope to see in pharmaceutical medicine in the coming years, and why?

This one is simple. I want the Faculty of Pharmaceutical Medicine to be the home for doctors like me. I want it to take everything it has built across pharmaceutical medicine and devices and become the home for doctors who are builders: doctors who want to take these fast-changing technologies and work with industry, in healthcare settings, with patients, in discovery and in research, and who want to build the evidence base. And I want to reach a point where somebody chooses to go to medical school because they want to be a doctor like me, and the route is clear, through specialist training and under the guidance of a body like this one.

If we do that, then technology and AI can be brought into medicine the way drugs were. Which is to say with evidence, with rigour, with surveillance when things go wrong, and with somebody accountable, rather than on the cheerful assumption that it simply works.

Throughout your career, what has been your greatest challenge, and how do you stay resilient in the face of setbacks?

Running a business is no small thing. But the honest answer is my burnout.

I became very ill in 2017. I was increasingly dissatisfied with the pressures of general practice and increasingly aware of the work I actually wanted to be doing, and my first instinct was to do all of it at once. That was a bad idea. I burnt out, and spent five months off with depression and anxiety.

Recovery taught me to focus on the things I love and that give me a proper sense of purpose and agency, and I got there with the support of my wife, my family and friends, and my medical team. Staying well, and resisting the urge to do more, is the ongoing discipline rather than a problem I solved once.

It might sound as though I resent having had no obvious route in sooner. I do not. I am grateful for the years in clinical practice, not least because I do not think I could have arrived where I am by a shortcut. When I joined Babylon there was an induction standup where you introduced yourself to the room. I had gone to medical school in 1990, and I told them that for the first time in twenty-eight years I felt I had met my tribe. I meant it.

I talk about the burnout openly, and deliberately. When I was unwell I went looking for accounts from people who had come through it and could not find them, because nobody was saying anything. That was hard. So I decided I would be open about it.

And finally, if you had to describe your job using only a movie title, what would it be?

I am going to cheat and use a television series, on the grounds that it fits better.

Altered Carbon, from Richard K. Morgan’s novel. It is set in a future where human consciousness can be backed up, and the lead character is essentially working a case inside a world whose rules have quietly changed. That is what this feels like. You are discovering things for the first time, but from first principles and recognised practice rather than making it up. Principled discovery, and it is the most thrilling part of the job.

I am an intensely curious person, and my career has been at its best when I have been given hints about what I am supposed to do and then had to find my own way forward, and share what I found.