We talk to Paul Carson, an Irish doctor, former editor of Doctor magazine and the bestselling author of multiple acclaimed medical thrillers. His latest novel, Fatal Practice, is published with Whitefox.    

Q: Can you tell us a bit about your career as a doctor and a writer of medical thrillers?

My writing came from necessity. After working in hospital and family medicine in Australia, the UK and Jersey (1977 – 1983), I returned to Ireland in 1984 to set up my own practice. I wrote to newspapers and magazines offering to be a health correspondent but all I’d written until that point were prescriptions that chemists had difficulty reading! One publication wrote back saying: ‘we can do a weekly column if you’re any good.’ From then on, I wrote about heart disease, breathing difficulties, allergies – anything that filled a page and paid a fee.

Over the next ten years I published health books and children’s books. Driven by a desire to always find the next challenge, I moved to fiction. My first medical thriller, Scalpel, became an Irish bestseller and opened unexpected doors into television development.

Around the same time, I was confronted by a very different challenge, leukaemia. In 2003, I started anti-cancer therapy and was told ‘you might live four more years.’ Enter Rituximab, newly approved for specific cancers, and here I am in 2026, still in remission and very well.

Q: Why did you choose Whitefox as a publishing partner and how did you find the process of working with us to bring Fatal Practice to life?

Whitefox was one of three agencies recommended by Muswell Press on its website and I liked what I read about Whitefox. My experience has been positive from initial query to post-publication. I asked for a rigorous editorial assessment and received suggestions that were spot on and greatly improved the final product. I’m 76 years old and technophobic so having all the background work done efficiently and correctly was invaluable. The book PR campaign that Whitefox organised has also been excellent. I would (and have) recommended Whitefox to any aspiring writers having difficulty getting their work accepted by publishing houses. It might not be the cheapest option available but if you want the very best editorial expertise and can afford it, go for it!

Q: Fatal Practice looks at the abuse of power within a rural GP practice. In your experience, does family medicine provide a rich source of dramatic material?  

Write about what you know is the usual advice for writers. Doctors see drama in hospitals and family practice. We hear stories that leave us reeling and we’re sometimes exposed to extremes of human behaviour. In 1980, a dangerous psychotic patient tried to kill me by luring me into a petrol-soaked shed. It’s a long story but obviously he didn’t succeed. As I was coaxing him out, he struck a match and within seconds the wooden structure was engulfed in flames. He died; I didn’t.  A GP colleague once told how he stood for an hour in the middle of a field trying to ‘talk down’ a mentally disturbed man who had a loaded shotgun pointed at his chest. The GP’s sole protection was his doctor’s bag.

Family medicine provides most of the material for my books. Over more than forty years, I’ve dealt with a wide spectrum of human behaviour, both good and awful. Vile and saintly. Including concealed pregnancies, children put up for adoption, hidden addiction, domestic violence, financial ruin, and suicide. A phrase I once heard at an inquest stuck with me: ‘an autopsy may show the cause of death but will never reveal the thoughts coursing through a troubled mind.’

In Fatal Practice I wrote about what I know, and it was uncomfortable because I’ve seen how power can be abused behind a respectable public face. In the novel a single-handed GP becomes suddenly incapacitated, so a locum doctor is brought in to maintain patient care. He finds the practice strange with unusual prescribing, missing files, and worrying disclosures from patients. He’s tempted to walk away and leave the problem to someone else, but his conscience won’t allow it. He has to see it through.

That was me, once upon a time.

Q: There’s a huge appetite for medical thrillers, why do you think this genre is so enduringly popular?

Hospitals and surgeries are strange theatres of trust where we surrender control. We undress. We confess. We allow strangers to examine us, sedate us, cut us open and decide whether we live or die. Trust is implicit; abuse of trust is abhorrent. That trust makes medicine fertile territory for thrillers — because betrayal in such places feels uniquely terrifying. And, possibly, that’s why readers enjoy the books. Perhaps they like being terrified but at a distance!

Q: What do you love most about the process of writing, and what aspects do you find the most challenging?

I’ve retired from active medical practice. I miss the patient contact (especially with children), the challenge of diagnosis, treatment and ongoing management. The daily conversation with patients. Learning about their lives, loves, dreams and aspirations. Writing allows me to continue that medical journey but without the night calls, the emergencies, the asthma attacks, the heart attacks, the epileptic attacks. Now, in my 76^th year, I’m using fiction to explore the dark side of medicine. It’s a challenge and I always enjoy that.

I was asked once, ‘Are you trying to write your way out of medicine?’ I said no, and that was the truth. Medicine has been my life since graduation in 1975. It’s difficult to keep the reality of a medical career out of my writing. Names, dates, locations. If a scene is based on fact, then I must disguise it so the people involved are protected. Their identities, home town and general locale must not be shared. It’s crime fiction, not crime fact.

I enjoy putting characters in difficult situations where I have to decide if they sink or swim, are spared or doomed. What their final outcomes might be. Most of the time I haven’t a clue; their fictional future depends on my fertile imagination and what mood I’m in on the day! A final enjoyment is a sense of achievement at the end of a writing day. Maybe five hundred good words. A character made more believable. A story readers can now relate to.

One thing I do know is that many excellent writers have to search for storylines, characters and settings. By contrast I don’t need to look. I’ve seen it all.

In the nineties, publishers were said to be looking for someone to do for medicine what John Grisham had done for law. I never became that writer, but the territory remains rich, dark and largely unexplored. If you’re a healthcare worker and reading this, go for it.

Q: What advice would you give to anyone about to embark on their first fiction writing project?

Don’t wait for inspiration, confidence or permission. Start writing and keep writing. Accept that there will be good days and bad days, moments of elation and moments when you’re convinced the whole thing is rubbish. That’s normal.

And don’t give up the day job too soon. Very few writers make a living from their first book (or even their second or third).

Q: Do you plan to write more thrillers, and will we see more of Dr Jakob Kane?

I spoke with Dr Jakob Kane only last night. He was flustered, agitated, and complaining.

“What do you want?” he snapped.

“There’s something I want you to check out.”

“Oh, no. I’m not going through all that again.”

“I’m sorry, Jakob,” I said. “But I can’t get it out of my head.”

“What’s it about?”

“Well,” I began. “There’s something very strange going on in a practice in Wexford.”

“I’ll pack my bags.”

We’ll be back…

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