Gyorgy Lovasz is Practice Plus Group’s national head of orthopaedics. After gaining a specialist qualification in orthopaedics at the University of Pecs, Hungary, he took on a two-year fellowship at the Orthopaedic Hospital, Los Angeles, followed by three years working as an orthopaedic consultant in Al Ain in the United Arab Emirates.
He then joined Practice Plus Group, formerly Care UK, working in the Barlborough and Shepton Mallet NHS Treatment Centres. It was as the orthopaedic lead at Practice Plus Group Hospital, Barlborough that, together with medical director Marco La Malfa, he pioneered joint replacement as day surgery, using regional block anaesthetics and an enhanced recovery pathway that sees patients working with a physiotherapist two hours after returning to the ward.
OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?
GL: I have always had a kind of mechanical mindset in life, I always liked fixing broken items at home. It may have started with my grandfather who was a joiner and I spent a lot of time with him around his workshop when I was a child. At the very beginning of my career in medicine, I worked at a musculoskeletal rehabilitation unit where I treated a lot of patients who had undergone orthopaedic operations. I think this was the first time that it occurred to me that actually doing these operations would be a career to pursue for me in medicine.
OPN: Could you tell us more about your pioneering day surgery and how it has benefited patient experience?
GL: Before starting this project, we noticed that many patients were going home the day after surgery and actually were having only routine observations during the night, with nothing happening that could not be managed easily at home. Initially, our patients were a bit apprehensive when offered same-day discharge after a hip or knee replacement. Now more and more come to us requesting to have their joints done this way. We have performed more than 180 procedures now at our hospital in Barlborough and the overwhelming majority of patients are very happy with it and would do it again. Actually, many of them come back for the other side, to have it done the same way. Most patients do not like to be in hospital unless really necessary and they like to sleep in their own bed if possible, providing they feel it is safe. Our results convincingly show that with proper patient selection it is safe.
OPN: As we head in 2021, it is clear that the healthcare industry has been greatly impacted by this year’s events. What has been the greatest impact within the orthopaedic industry?
GL: The pandemic has had a devastating impact on elective orthopaedic care. Initially our elective activity was shut down completely and the waiting lists have grown so long that it will take a considerable time to catch up with the demand. Theatre time and space for our care is greatly reduced, even now. Some of our theatres are utilised by other specialties which cannot operate at their trusts due to the consequences of the pandemic. The other consequence I see every day is that patients are more keen to go home earlier due to the fear of incidentally getting infected with the virus.
OPN: What’s the best part of your job?
GL: The best time is the time I spend in theatres operating. I have been in this profession for decades and operating rooms are my favourite environment. I enjoy working with dedicated, professional teams where everybody knows their jobs and does the best for the patient. Working in theatres means not only operating but also taking care of the whole perioperative experience of the patient. Surgical theatres may feel pretty hostile to patients as they are not used to them but it is quite satisfying to see how quickly a professional, organised, dedicated team can relieve their initial high stress level.
OPN: … and the worst?
GL: There have been so many improvements and innovations in how we, as surgeons, can help improve a patient’s quality of life. Sadly, even so, there are times when we have to deliver bad news to patients. Fortunately, this happens rarely but it is always a very unpleasant experience.
OPN: What has been the highlight of your career so far?
GL: I think the biggest achievement in my career is establishing day case arthroplasty at our hospital, which is now common practice. Roughly 10 per cent of our joint replacements are done this way. This is a major paradigm change in how we carry out joint replacements. I am aware that not everybody agrees with this model in our profession but the number of centres doing it is growing in Europe and in the UK as well. Though inpatient arthroplasty will remain the gold standard for a long time, when I see the happy patients and successful outcomes at our follow up clinics, I am convinced that this is the way forward for a selected, relatively healthy and motivated patient population.
OPN: If you weren’t an orthopaedic surgeon what would you be?
GL: I cannot imagine myself elsewhere than in medicine. As a doctor, I would do any other specialty, as medicine, as a whole, is amazing. It is a wonderful feeling to be able to help people by utilising science to the benefit of mankind. However, if it was not possible for any reason, something like a pilot, car mechanic or anything related to cars, airplanes, transportation or travelling would be the most satisfying.
OPN: What would you tell your 21-year-old self ?
GL: Study, study and study – invest in your future. This is the age to accumulate knowledge you can rely on in the future. Do not waste this never-returning opportunity! I think I was able to successfully spread this message in my family as both of my sons followed suit and became doctors.
OPN: If you were Health Minister for the day what changes would you implement?
GL: Reduce administrative burden and allow doctors to spend more time with patients. Involve the private sector more in elective operations as they are efficient and can provide good quality – and better patient experience – because they are focused on elective work. They are smaller, more comforting units compared to large NHS hospitals and they do not have to share attention between emergency and elective care.
OPN: Away from the clinic and operating theatre – what do you do to relax?
GL: I spend a lot of my free time catching up with the latest developments in my profession. In medicine, you have to learn as long as you practise! I have lived in different continents, but still love travelling, seeing different countries, cultures, natural beauty around the world. I like to keep fit and go to the gym, listen to the country music I fell in love with during my years in the US. On weekends, it is relaxing to go out to nature, have a nice long walk and breathe fresh air.
OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2021?
GL: Digital technology will play much more of a role in patient care. This is not only because of the pandemic: it started much earlier. Face to face contact is very important but many parts of the treatment pathway can be managed much more efficiently using digital technology. Remote monitoring of patients via (for instance) smartphone apps is quickly developing and even elderly patients are using them. Rapid development of artificial intelligence will also help to find the best diagnosis and treatment with the lowest risk for patients. In daily orthopaedic joint replacement practice, I am convinced that hospital stays will further shorten everywhere.