Reflections after the BAPRAS Summer Scientific Meeting

22nd July 2016


The summer meeting was cathartic for my view of the future of our specialty.  Since I started training in Plastic Surgery, we have been worrying that we are doomed as a Specialty and heading to oblivion in the 'rocks' of having taught others to do what we do. 
Those of you who have heard me speak about what I believe is at the core of our Specialty will know that I feel that we are philosophy driven, not driven by procedures.  All Plastic Surgeons are trained from day one that there are numerous different procedures which could be used to treat our patients with almost any problem that they present to us. We are all aware that the choice of procedure, post the Supreme Court ruling, must include our patient's wishes based on giving them the information about all available procedures, complete with complications. I believe the ruling has had less impact on our specialty than on others because we have always tended to consult in that any way and we are also aware that every conversation with our patients is a psychological intervention.

There were three papers at the summer meeting that showed me where we need to head next. The presentations by Umraz Khan, Venkat Ramakrishnan and Professor Raja Sabapathy all had the common themes of efficiency and economy of effort. 

The headline message some may have taken away was the ability to do a microsurgical free tissue transfer in four hours but that was not the real message... Those of my generation will recall the visit of the SRTC (Senior Registrars Travelling Club) to a unit which had thrown down the gauntlet of doing two free flaps in one day. They failed. Why? Because there was minimal economy of effort and very little efficiency on the day. My main memory was of a lot of shouting. In stark comparison, I have seen one of the three Summer Meeting speakers, who when faced with an overexcited colleague in another specialty, invited them to go outside in 'cool off' because his behaviour was adversely affecting the whole team. 

The main message of the papers for me was that various efficiencies and economies had led to a failure rate for free tissue transfers to damaged legs and irradiated chest walls of 2% and that the patients’ recovery was quicker and, one assumes, return to function less problematic (I can recall the days of 12-hour cases, multiple returns to theatre and significantly greater failure rates with patients taking years to return to function!). 

This, ladies and gentlemen, is the way forward. Plastic Surgeons remain some of the best technical surgeons. We are experts at what we do with our fingers but we are not necessarily great team leaders. Nor do we need to be to emulate those three presenters, but we do need to have someone in our team who is and we must find them and encourage them. Ensuring the whole pathway is as smooth as possible depends on being able to motivate a team, and making sure we have specialist teams on the ward, in theatre and in post-operative care facilities who enjoy the work and the excellence of outcome. Every team is only as strong as it’s weakest link.  

The three presenters used the analogy of F1 teams. They are the equivalent of the 'team manager' and know the 'buck stops' with them if their team does not perform. They lead by example and not by shouting. They set the tone and pace, which others must work to. They all seem very laid back and have an efficiency of movement and of effort that is exemplary. They ensure every member of the team knows what their roles and responsibilities are. They trust every individual to do their job and know that they will and, in that knowledge, they don't have to check. They just know...

I encourage all of us to go back and look at how we run our services. Do we lead by example? Do we accept the buck stops with us for poor team performance or do we externalise the reasons for poor performance? If you are the equivalent of the F1 driver, you have to ensure you have the individuals working with who can lead your team and allow you to perform to your maximum. You need to be like the stroke seat in a rowing boat, setting an achievable and sustainable pace for your team in a calm yet powerful way, whilst your 'coach' provides the facilities for you to perform to your maximum. If you can do that your patients will be the winners. 

If we can look at maximising those efficiencies and economies of effort in all areas of our practice, including Aesthetics, our patients WILL do better and we will remain ahead of the surgical pack. A complication rate of 1-2% also means that you will benefit from one of the best pieces of advice given to me by one of my great mentors, Douglas Harrison, namely...."The simpler you can make things the better you will sleep at night!" How right he was!  

I don't think the future has ever been brighter for Plastic Surgery during my professional career. Thank you! 


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