Looking back and looking forward
By Simon Hodkinson
BOA Vice President
When you get to the final chapter of your career as I have, it is interesting to look back because soon that’s all you can do and the rose-tinted spectacles have yet to replace the conventional ones!
My time in medicine started in the NHS as a house officer in London, but then continued in the Royal Navy (RN) until I accredited, all be it with spells of higher training in the NHS. I left the RN for the NHS in 1999.
Looking back, I have spent 41 years in practice in two different systems, but all trying to do the same thing – that was and is, to do your best for your patient, no matter what you have at your disposal nor where you are.
I can’t remember when or why I decided I wanted to be an Orthopaedic surgeon, but I suspect the two months exposure to T&O as a medical student did spark an interest. I wonder how we can encourage our current generation to consider a career in T&O, with so little undergraduate exposure to a speciality that has been my whole professional life and will remain with me for what remains of my life.
Times were different in the 1980s and 1990s; the hours we worked were ridiculous and thankfully gone for good. However, as ever with the ‘law of unintended consequences’, our junior colleagues have never been as unhappy as they are now.
One wonders why, with hours reduced, the quality of life should also have improved. The last 25 years have seen a complete rethinking and restructuring of the curriculum, to the envy of many other specialities. It may not be perfect in some eyes, but it is a hell of a lot better than it was!
Is it the loss of the firm structure and ‘ownership’ of our patients, which we did have in those days as we were virtually omnipresent? Maybe. However, we cannot go back to those days, as there was no life outside of medicine, and the demographics of our workforce and their respective aspirations have changed – for the better in my humble opinion.
We need to find out why there is so much unhappiness and correct it as a matter of urgency in the future. Our young colleagues are our future and it must be in all our interests to develop a happy satisfied workforce that sees T&O as a career to aspire to.
The last 40 years have seen massive changes in medicine in general and our lives outside of the profession, not just in T&O. I can remember young patients with severe osteoarthritis of the hip being considered for hip fusion – unthinkable nowadays. We take for granted that a well-done hip replacement will last 20+ years and provide patients with a complete transformation in quality of their lives .
Is there a better compliment than to be told that you have given someone their life back –literally in some cases?
At home we have the now ubiquitous mobile phone , cursed on some occasions, addictive to others; but my generation remembers being tied to the handset at home on call or desperately searching for the un-vandalised red box (white ones in Hull), when you dared venture out of the house and the air call went off.
And what of the future? Things look grim at the moment, waiting lists through the roof, no beds and a level of disgruntlement amongst medical staff on a scale unparalleled in my time in medicine.
But we will get through it. The NHS is too precious a resource to go under, and we owe it to the people we care for and the next generation.
The future will be transformational in how we investigate and treat our patient. We already have robotic-assisted surgery, and we now have the capability to assess patients’ pain and disability in ways unthinkable 40 years ago. Our understanding of the mechanics of humans and how we can replicate those mechanics is moving at a huge pace.
In my own speciality of foot and ankle surgery, the scope of practice has completely changed in the last 25 years and it will go on evolving in so many ways, one hopes, for the benefit of patients.
AI has hit us in the last 12 months with the potential for much good, but also the potential for serious harm. As ever we need to be careful how we tread.
GIRFT and the use of ‘Big Data' will drive forward constant improvements in what we offer our patients, but the challenge will be to take the workforce with you. Going over the top without the troops is a lonely place to be!
Regrets: a few. It was all too easy to neglect my family when there was a case to do or a patient to see. Precious time lost forever and a hard lesson learnt.
But overall, a challenging and amazing journey – one I will be sad to get off when the time comes.