Ian McDermott is a consultant knee surgeon, working in full-time private practice in Central London, within the London Sports Orthopaedics practice, which he founded more than 10 years ago. He still enjoys being active academically, as well as still being involved in medical politics.
OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?
IM: Orthopaedics is quite possibly the best job in the world! You get to work with lots of amazing people and your job is focused on helping people, every single day. Orthopaedics is a mixture of anatomy, physiology, pathology, biomechanics and psychology, combined with the practical and technical skills of surgery, with top quality tools and cutting-edge technology. And we fix people! What’s not to love about it?!
The frustration of the job is that there’s no such thing as “zero risk” or “100% effective”; however, that means that we’ve always got a strong incentive to try and build upon existing practices and improve what we do, which is a great motivator for constantly working hard and constantly trying to be better.
For me, orthopaedics is a great mix of speaking to people and getting to know them and their complaints and concerns, it’s often a complex challenge of working out exactly what their main issues are, and then it’s the science and art of helping each patient reach the right decision for them about what potential treatment(s) might be needed, if any. Only then, once it’s confirmed that someone does actually need surgery, is it my job to do the best job possible, from a ‘technical’ perspective. I think that a lot of people forget (or perhaps are ignorant to) the fact that the profession of surgery is about a lot more than just ‘cutting’!
I left the NHS over 10 years ago now because I wanted to provide each individual patient with the best possible level of care, and you can only do that in a system where quality rules over cost-cutting. In particular, I wanted to work in an environment that allows me to allocate sufficient time to each patient so that I can do things properly.
OPN: It is clear that the healthcare industry has been greatly impacted by the past year’s events, what has been the greatest impact for you within the orthopaedic industry?
IM: At the end of March last year, the private hospitals in the UK did a deal with the NHS that saw the NHS take almost the entire private sector. The NHS ended up utilising only about 1/3 of the capacity of the private sector. During this period, private doctors were shut out, dropped and simply discarded. Many of us offered our services, but were turned away, and for the following few months we simply sat around doing just the odd remote tele-consult here and there, but were, effectively, unemployed. It was a deeply unsettling and stressful time for everyone. However, we’re the lucky ones: we’re the ones who still had a job, a career and a business to go back to, and we survived. Sadly, the same can’t be said for many people out there in other industries or sectors, who are still suffering terribly.
As for healthcare, there are now reports that there are over 500,000 patients on NHS waiting lists waiting just for orthopaedic surgery alone, with over 67,000 of these already having waited over one year. A recent study showed that a significant number of these patients’ symptoms are rated as being “worse than death”. So, there is now a tsunami of patients in need of orthopaedic care who have been neglected and whose issues will only ever have been getting worse with time. There is no way on Earth that the NHS will be able to cope with this. So, the private sector can only ever get busier, as it tries to assist those in need (or, at least, those lucky enough to have the funds to be able to afford proper healthcare). The enormous negative impact of the government’s political lockdown policies on the health of our nation will be felt for many years to come.
OPN: What’s the best part of your job?
IM: Seeing patients achieve positive outcomes.
OPN: … and the worst?
IM: The stress of worrying about every patient and every outcome! If someone gets a complication of any kind (which, statistically, is inevitable if you do big enough numbers), then it’s almost impossible not to take it personally and not to dwell on it. However, self-reflection and a regular review of one’s practices is a good thing.
OPN: What has been the highlight of your career?
IM: I’ll tell you when it happens and when I get there!
OPN: Are you currently involved with any scientific research?
IM: I’ve always been ‘into research’, and I think this is a really important part of clinical practice. If you have an inquisitive mind and if you care about patient outcomes, then you’ll be constantly looking at what you’re doing, what’s out there that’s new and potentially better, and how you can improve what you’re doing. You just can’t divorce research and academia from clinical practice.
Personally, I took a year out from my registrar training to do a year of full-time research with Professor Andrew Amis, at Imperial College, and this made a major and lasting difference to my entire career. We did research into meniscal transplantation, and that ended up becoming one of my key areas of specialist clinical interest, and this is still one of my main areas of specialist practice now. I’ve published a fair amount and have done too many presentations to count, and several years ago I was made an Honorary Professor Associate in the School of Sport and Education at Brunel University. I’m also on the editorial board of the Orthopaedics and Trauma journal and also The American Journal of Sports Medicine, plus I review for a number of other journals too. This means that I read a lot, which is key to keeping up-to-date, and if you don’t make constant efforts to keep up-to-date, then you’re simply slipping backwards without even realising it. I still keep active academically with ongoing research and audits within our practice, and a few years ago we set up The Sports Orthopaedics Research Foundation, which is an independent registered charity, with the aim of helping to promote and assist with research and education within the private sector.
OPN: Are you planning to attend any orthopaedic events this year?
IM: I’ve attended a few orthopaedic meetings remotely over the past year. I’m due to give my first face-to-face talk at a meeting in London in September (assuming we’re actually ‘allowed to’ by then). Remote meetings are certainly convenient and cost-effective, but they’re just not the same as proper face-to-face meetings, and I can’t wait for these to finally come back.
OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2021 and the next decade?
IM: Both grim and good! Orthopaedic surgeons are going to get increasingly busy, as the demand for orthopaedic surgery continues to grow. However, our profession’s biggest challenges are likely to be:
- how to not just maintain, but actually improve quality, in an environment of cost-cutting and increasing volume,
- how to promote innovation in an atmosphere of risk-aversion and litigation,
- how to avoid the evils of ‘managed healthcare’, with surgeons ending up as little more than just technicians, following didactic protocols drawn up by corporate entities who wish to commoditise healthcare, and whose interests are profits, not the individual patient.