Download - Society for Cardiothoracic Surgery

July 2010 41
President’s Address continued from page 39
they will not take on high risk cases. It is also clear that we need
to provide some more positive support, both for surgeons and for
Medical Directors. In the few cases in which further investigation
was apparently needed, we have used the Royal College of
Surgeons “Invited Review Mechanism” – the Society does not get
involved in any formal local review.
One of the most important things that this highlighted for me was
that we need to support each other. Much of how we function as
surgeons is based on our own in-built confidence in our ability.
You will be aware of the experience of Professor Marc de Leval
when he went through the difficult period of having a run of
deaths with the arterial switch operation in babies. To his huge
credit he analysed this issue in detail and has written a number of
important publications. In the Lancet in 1997, he said “What I
have learned most from my re-training is to re-gain confidence and
also that one should never give up”.
Performance
The Psychologists have a model which aids understanding of the
relationship between performance and
stress. We all understand that some stress
is good - as the stress/arousal level
increases your performance increases.
However there is a peak performance after
which further stress causes a decline. A
group called “My Peak Potential Limited”
has done some work with Leeds
Metropolitan University looking at
impaired performance. They highlighted
the fact that this relates to lack of
confidence, lack of motivation, inability to
deal with stress and a negative mental
attitude.
The writer of Ecclesiastes says:
“Two are better than one because if one
falls down his friend can help him up” .
We should take this to heart – we will
probably all go through periods of doubt
and lack of confidence during our career. I
know that I have. As colleagues we need to recognise that and
support each other through that process.
No Presidential Address would be complete without a look to the
future. Need to remember though the words of Niels Bohr
(Physicist 1885-1962) who said “Prediction is very difficult,
especially about the future”.
This is well illustrated in a clip from the BBC News
www.news.bbc.co.uk/2008. A 58 year old man was given the
diagnosis of mesothelioma with a prognosis of 9 months survival.
He was feeling very positive and optimistic and so went to the
“bookies” – William Hill gave him a 50/1 odds for a 2 year survival.
In June 2008 he collected £5000.
“Sometimes I believe
people are perceived as
a problem, a medical
problem, a physical
problem. Some
hospitals see patients
as no more than a set of
medical problems.”
Archbishop Vincent Nicholls
So what of the future? We know our patients are getting older –
this was clear in the analysis in the national database report. A
recent article in the BMJ showed the predicted number of people
over the age of 80 in countries around the world. The UK is
somewhere in the middle of the range but the number over 80
predicted to double by 2030 and treble by 2050. Again we know
from the database that older patients stay longer and will
consume more resources.
This prompts me to reflect that our society (in general, not the
SCTS) seems to have lost sight of the fact that death is a certain
outcome of life. It seems that we don’t talk about death and that
death should occur in hospital rather than at home in family
surroundings. This begs the question of what are we trying to
achieve with our high tech medical care. Oscar Wilde’s Dorian
Gray tried to maintain his eternal youth with disastrous
consequences. The recently appointed Roman Catholic
Archbishop, Vincent Nichols, has attacked the NHS over lack of
compassion. He said “sometimes I believe people are perceived
as a problem, a medical problem, a physical problem. Some
hospitals see patients as no more than a
set of medical problems.” He argued that
calls for assisted suicide and euthanasia
reflected a society that did not know how to
deal with death.
Training
Enough of death. So what of training in the
future? We as a specialty, began discussing
the impact of the European Working Time
Directive back in 2002. A Working Group
Report at that stage recommended that we
move towards provision of service with
surgeons’ assistants and nurse
practitioners as there would be fewer
trainees. Some units began to do that and
more are now following suit. I have been
very frustrated to hear discussions on the
European Working Time Directive from
sources which should be better informed.
There seems to be a belief that trainees
have to leave on the dot of 48 hours in the
week – in fact under the European Working Time Directive you can
work up to 76 hours in one week. The whole focus of the directive
is to ensure appropriate rest – it states that you should not work
more than 13 hours at a stretch without a rest period. Personally I
do not have a problem with that. The older generation here will
remember going in to hospital on a Friday morning and coming
home on Monday evening. Things were generally quieter in those
days and we did get some sleep but that duty period was surely
unacceptable and nobody could justify that. The other irony in the
discussions is that current UK legislation (in the form of the “New
Deal” which was implemented in 1991 under the previous
Conservative Government) is more restrictive of working hours
than the European Working Time Directive.