Andrew Lees’ Neurological Birdsong emerges from an intersection of social media, medicine and poetry. Lees is an acclaimed neurologist, researcher, author and – in recent years – prolific tweeter. Embracing the immediacy of Twitter, Lees crystallised his ideas into 140 characters. Lees describes himself as being in the ‘autumn’ of his career, and Twitter offered him a way to interact with a new generation of doctors and those living with chronic neurological conditions. Neurological Birdsong gathers 300 of his tweets into print, with the text re-set in poetic form. This transformation takes the messages out of the frenetic Twittersphere, reframing them as brief poetic reflections and aphorisms. In doing so, Lees invites the reader to engage with these short pieces in a slower, more considered way, much as one would approach a collection of poetry.

The themes are kaleidoscopic, ranging across clinical wisdom and ageing, critiques of hospital management and telemedicine, and reflections on his mentors and his self-experimentation with medication (‘I've always tried the drugs I prescribe’).

Lees writes frankly – bluntly even – and isn't afraid to take a position. ‘We need to stop hiding behind bullshit protocols,’ he declares in an angry, straight-talking piece. Other tweets-turned-poems capture the reader's attention in a different, perhaps more affecting, way by applying the same scrutiny to himself. One such piece begins ‘When I'm staring down the barrel of my latest mistake [ … ]’.

A thread runs through the book to do with Lees’ observations on ageing, intertwined with his ongoing evolution as a clinician. In one passage, he covers a lot of ground in just a few haiku-like sentences:

Here is a high-flying neurologist, the most cited researcher on Parkinson's disease, letting go of his former status and discovering a deeper connection to his patients instead – perhaps allowing him to be ‘top dog’ in a different way.

Another thread is the critique of how services may be run or commissioned. Lees is most persuasive when he blends the intimate with the polemic, as in this piece where he contrasts face-to-face patient interactions with the limitations of online consultations:

Whether or not one agrees with Lees’ opinions, he writes so clearly that you know where you stand. He notes that he used to enjoy ‘rough and tumble debates’ with colleagues earlier in his career, and this comes through in his writing. His opinion pieces evoked in me a desire to enter the debate, and I can see how these pieces would have been effective on Twitter.

Elsewhere in the book, Lees references the controversial figure of William Burroughs, author of The Naked Lunch, who was an ‘invisible mentor’ throughout his career. In the context of the present book, this influence seems a surprising one. Burroughs was a Beat Generation writer known for a stream-of-consciousness style, dependence on heroin, and intoxicated, intoxicating prose. To understand this influence more fully, readers could explore Lees’ earlier work, Mentored by a Madman: The William Burroughs Experiment. On closer reading, some passages in Neurological Birdsong have a certain light (‘Hospitals are like coral reefs’) that is reminiscent of the vivid, poetic energy of the Beats. And as with the Beats, there is an underbelly of disaffection. I could hear echoes of Allen Ginsberg's ‘Howl’ (‘I saw the best minds of my generation destroyed by madness [ … ]’) in Lees’ polemical writing on the subject of ‘Bad Medicine’: ‘I sat on the front row / of the vast theatres, / packed with doctors / during the latest silly season of jamborees [ … ]’.

It is worth noting that Burroughs’ life was also marked by more disturbing events. He was convicted in absentia of the culpable homicide of his common-law wife, Joan Vollmer – a fact sometimes glossed over by Burroughs’ admirers. It is unclear how, or if, Lees has grappled with this aspect of his ‘mentor's’ legacy, but it adds a layer of complexity to the influences on his work.

I found many pieces in Neurological Birdsong alluring. A few carried a more provocative, ‘grumbling’ quality (to borrow one of Lees’ own self-descriptors), which at times seemed to narrow the focus, such as when referring to those who commission services as ‘payers’, or describing doctors he perceives as mechanistic and poor listeners as ‘hyposkilliacs’. This may be a function of the necessary contraction and provocation required to get one's point across amidst the noisy birdsong of social media.

This somewhat enigmatic book stopped me in my tracks several times and made me reflect on aspects of my clinical and teaching practices. Not everyone will appreciate the emphatic confidence and directness – but for those that do, this will make a compelling read. Lees’ commitment to careful observation of his patients and treating each as an individual – along with his intolerance of unnecessary bureaucracy or anything that hinders good care – lingers in the mind.