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Surgeon In Brief With James Bidwell Consultant Trauma & Orthopaedic Surgeon, NHS Grampian OPN: What made you choose Orthopaedics? ST: I always knew I wanted to do surgery of some sort- as a JHO somebody commented that I must be a surgeon as I walked down the middle of the corridor, quickly (probably late as usual), white coat open. Presumably physicians skulk in the corners with coat buttons done up to their necks. My experience as an undergraduate had put me off orthopaedics and I had intended to do neurosurgery. However during basic surgical training I grew to enjoy T&O and at the same time was put off neuro. This biases me against the proposed “run-through”system of training because it forces juniors to make career choices at too early a stage when they haven’t had any meaningful experience of the specialty.OPN: Where did you train? ST: My undergraduate studies and basic surgical raining were in and around Glasgow, and I am currently a 4th year SpR in Tayside (Dundee and Perth), although posted in Inverness right now.OPN: What are your specialist areas? ST: I am hoping to develop an interest in upper limb.OPN: What are the best and worst aspects of your job? ST: The best- making a difference to patients, and seeing a problem solved. The worst- those periods where there is a constant demand for your time and you haven’t got space to think because someone else needs you to do the next thingOPN: Are there any developments in orthopaedics that excite you? ST: I think some of the work being done with chondrocytes, either ACI/MACI, or stem cells, could really change the way that orthopaedics is practiced in the future, although I suspect it will still be some time before a successful technique can be used widely.OPN: What are your thoughts on surgeons who receive financial benefits for using a company’s products? ST: The main benefit of the NHS, other than the fact it is free to patients, is that there is no financial inducement towards any type of treatment or investigation, which makes clinical decisions more likely to be taken on the basis of clinical need. There is no product that is appropriate in all clinical situations, and financial benefits make it more likely that they will be used in scenarios where another option might otherwise have been taken. Perhaps patients should be told if their surgeon receives any benefits.OPN: Are patients becoming too knowledgeable on joint replacement and the implants that are used? ST: I have no problem with patients knowing as much as possible. But the decision as to which implant to use must ultimately rest with the surgeon, on the basis that a) they should be recognised as the more knowledgeable, b) it is their skill with that implant which will have the greatest effect on the success or otherwise of the surgery and c) it is the surgeon who will take responsibility in the event of any complications. If a patient disagrees they are free to find a surgeon who uses whatever implant they are seeking, and that should be their course of action, rather than to go with a surgeon’s decision, only to raise it as an issue in the event of complications. OPN: Is it right that surgeons are rated and reviewed by patients on the website www.iwantgreatcare.org? ST: I think there was a recent Scrubs episode about a similar website! The problem is obviously that patients’ criteria for what makes a good doctor are different from ours, and will likely reflect communication skills more than anything else. There is also the danger that it becomes a ranting forum, with a bias to negative experiences. However, I think this kind of feedback can be very useful, and I would prefer it to be given confidentially to the surgeon in question rather than an open website. I note that it is another step towards the Americanisation of the NHS, with the idea that the customer (patient) always knows best and that referrals are made more on the basis of patient-to-patient recommendations rather than clinical ability.OPN: What aspect of the industry would you change, if you could? ST: A higher level of evidence required before products are released on the market, or perhaps a greater emphasis on the fact that some products are still experimental and need to be treated as such.
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