Download - Society for Cardiothoracic Surgery

July 2010 3
President’s Address
Leslie Hamilton
Annual Meeting SCTS March 2010
“There is a time for everything…
And a season for every activity under heaven”
Ecclesiastes 3: 1
Members of the Society and
Guests...
One of the most challenging aspects of
preparing one’s Presidential Address is
choosing a topic or theme - and then
having done that, to choose a title.
Having looked in many places for
inspiration, I came across Ecclesiastes,
the 21st book of the Old Testament in the
Bible. Written by King Solomon, the son
of King David, towards the end of his
career, he was reflecting on events and
considering things which were important.
As the Bible has always been an
important point of reference in my life it
seemed appropriate that I used
quotations from Ecclesiastes as the
structure for my address.
It is with both pride and humility that I
come to give my Presidential Address. Noone
works in isolation and I could not have
undertaken the role of President without
the support of a number of people. First
and foremost: my colleagues at the
Freeman, who through their support and
by working as a team have allowed me to
be away from the Trust to undertake the
duties of President. In particular I want to
thank Asif Hasan who, first as my senior
registrar and then colleague in paediatric
cardiac surgery, shared the workload of a
1:2 rota. By allowing me to go to Society
meetings he accepted that he himself
could not be involved in Society business.
It is a source of great pride to me that he,
in a seamless manner, took over the
management of our paediatric work and
allowed me, in view of my advancing years,
to go back to full time adult practice. My
thanks also to Krys Tocewicz with whom I
“buddy up” on the adult side – we do joint
ward rounds and look after each other’s
patients when we are away.
It is too easy to take the support of your
family for granted and so I am delighted to
have my wife Joy and our four “children”
(Stuart, Suzanne, Carolyn and Fiona) here
at this meeting so that I can express my
thanks publicly to them.
One of the joys of being President is
working with the superb Executive
Committee – a wide range of personalities
and views but all working together for the
common goal of enhancing the Society.
Inevitably you work closer with some than
others and I think Graham Cooper (in his
role as Honorary Secretary) and I have
spoken more to each other over the past 2
years than we have to our wives! With a 5
year term for Secretary and 2 year for
President there is usually an overlap but
Graham and I started our terms of office
together - as a “virgin” Hon Sec he has
shown great wisdom. His support has been
invaluable. Many of the events at the
Society meeting get credited to the
President but of course this is all the work
of Simon Kendall (and now Ian Wilson) and
our meeting team and so a special thanks
to them. The issue of monitoring
outcomes has always been a source of
pride for the Society but it has inevitably
had its sensitivities. Publication of the
“Blue Book” last July was a major event
and I am very grateful to Ben Bridgewater
as Chairman of the Database Committee
for seeing that through and for
(repeatedly) explaining the statistical
analysis to me. Thanks too, to Isabelle as
our senior administrator for putting up
with all my e-mails and telephone calls.
At the beginning of each Presidential term
the President and Executive set a series of
objectives. I would like to take a moment
to review these briefly and report on the
progress we have made:
1. Quality of care: we wanted to get
beyond using mortality as the only
outcome measure and look to using
aspects of morbidity. The various
chapters in the Blue Book attest to what
we have achieved. A recent paper in the
New England Journal of Medicine from
the USA looking at general surgical
specialties, ranked hospitals by
mortality and looked at the incidence of
complications. The authors showed
that the incidence of major
complications was similar across the
hospitals. The difference came when
they looked at the incidence of death
after major complications – the best
hospitals with the lowest mortality dealt
with the major complications better. The
Database Committee: members were
appointed following open
advertisement and interview and they
have taken this work forward. It
culminated in the publication of the
Blue Book and I have already
acknowledged Ben Bridgewater’s role
as Editor. We realised that as a result of
the analysis we would have, by
definition, statistical outliers. We
needed to develop a policy of how we
would deal with that issue. Graham
Cooper led the work and developed the
policy document “Explaining
Divergence” – this was implemented
when the results of the data analysis
were available. This was the most
challenging and difficult task I had as
President and I am grateful to all of you
with whom I had contact for being so
understanding and positive. I am
pleased to report that other specialties
have approached us for permission to
use our policy in dealing with outliers as
they begin to analyse their own
outcomes.
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