On this episode Fiona speaks to surgeon Bhavin Visavadia. Bhavin is a senior Consultant Oral and Maxillofacial Surgeon based at Northwick Park Hospital London. He performs advanced reconstructive facial and head and neck surgery. Bhavin and Fiona talk about the very moving story of how Bhavin got into his specialism, the amazingly complex work that he and his team do to reconstruct faces, the history of re-constructive surgery dating back as far as 600BC, through to the incredible 3D imaging used today.
Bhavin Visavadia is a senior and experienced Consultant Oral and Maxillofacial Surgeon and Clinical Leader. He is a surgical educator teaching around the world and was a member of Council of the British Association of Oral and Maxillofacial Surgeons (BAOMS). He was also Chairman of the Consultants and Specialists Group here. Bhavin has the position of Regional Director for London (NW) at the Royal College of Surgeons of England. He is also President of the Oral Surgery Club of Great Britain
Bhavin qualified in medicine and dentistry at King’s College London and undertook his specialist surgical training at Queen Victoria Hospital in East Grinstead, Royal Surrey County Hospital in Guildford and Guy’s and King’s College Hospitals, London. Bhavin is highly committed to surgical training supporting mentoring and pro-actively engaging with the development of surgeons, doctors, nurses and dentists.
For more on opportunities to get involved in mentoring or to be mentored go to:
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Fiona
Hello, so today I am absolutely thrilled to be joined by Bhavin Visavadia, who is a maxillofacial surgeon, and a friend. So we're going to talk about Bhavin. You, yourself your journey, what got you to where you are today, which in and of itself is really fascinating. But there's a lot that I always reflect on about surgery and the fact that so much of what you do is just unseen, the results are seen. Actually, the results are seen in some ways with the type of specialism, you're in more than many other types. But the hours, literally hours upon hours that you spend in a theatre, behind the scenes, people don't know what's going on. And it's not really like Grey's Anatomy much too, I'm sure my daughter's disappointment, because obviously, Grey's Anatomy is in a court of medicine. So it's really, really fabulous to have you here talking to me on the podcast, rather than us having one of our lengthy chats that we tend to have without anyone listening in. Thank you so much.
Bhavin
Oh thank you so much for that wonderful introduction. I'm really humbled. You know, we've had so many conversations informally as friends and I've invited you to, to come and talk to some of my colleagues and trainees and doctors from various backgrounds. And it's been really eye opening for me the journey of how I got to where I where I am now, and, and the influence that we can have just by having conversations. So, I'm a consultant, oral and maxillofacial surgeon. Now my 17th year of consulting practice this week, but you know what
Fiona
I thought you were gonna say “I'm in my seventieth year”. Yeah. And Bhavin, you're
Bhavin
17. Yeah. And it's great, because you spend a lot of time reflecting back on, on, where, how we've got how I've got to where I am now. And the changes the environment that I've had to navigate, that we as doctors have to navigate through over the over the few years. And the challenges, particularly the global pandemic, and the challenges that we still continue to face at all levels.
Fiona
I mean, it's immense. And I think it's, it's moved from clapping for NHS once a week to being well, the NHS has totally overwhelmed, isn't it? And that's, it's heart-breaking to see, because of the goodwill, the skill, the pro-sociality of so many people who work within the system, and for whatever reason, it's not fairly rewarded. People are on their knees in terms of where they've got to now. And I mean, I've, I've had conversation with a few people about how it's, in some ways, it's worse now than even during the height of the pandemic, because of the relentlessness of it for people who work in these roles.
Bhavin
Yeah, absolutely. I mean, the pandemic was a real challenge. It challenged doctors and nurses on all fronts. highly emotive. And it gave us an opportunity to, to sit and talk as well as everything going on in the emergencies on the emergency side of things. It gave us a chance to sit and talk, have meetings outside of normal hours, have virtual meetings to tplan to strategize to see how we're going to get through this. And we're still not there. I mean, we've still got a lot of work to do. We're still dealing with huge backlogs. And it's, I'm pleased to be in an environment where I can give some oversight. Look at the various aspects of care that the patients need. Patients still need. We look at the waiting lists. Currently over 7 million are waiting for diagnostics and treatment. So really depressing figures, but at least they're dedicated groups of doctors and nurses and allied health professionals who are very keen to, to make things work and also managers as well. And I've talked to a lot of people in my in my various roles to try and deliver a way forward. So, some parts the country really, still put the badly affected that the resources are scant, they're still dealing with winter crises, as well as the onslaught of COVID and flu, etcetera. And, and others are, we've got some way forward, we've made some way forward, and we are able to deliver. So, we are making some impact. But it's, again, the health service is a political football, it always will be. And we've got to navigate our services, our care through that.
Fiona
And of course, another member of your household, being your lovely wife, Medona, is a GP. So seeing a different side of the same system. And she works so hard, doesn't she? I mean, she every weekend, she has work that's coming home to be done outside of those hours that we see the GPs being in the surgery, but I think we don't always fully understand how much there is to do beyond those hours, where they're actually seeing patients face to face as well.
Bhavin
Absolutely. And it's again about GPs trying to work collaboratively so that the practices are bigger now, sometimes 18 to 20,000 patients registered in almost like a Health Campus isn't in GP practice, and you've got to have this, these avenues of communication, open between the partners between the doctors, and also have the hours to be able to deliver that clinical work. And on top of that, the vaccination programme which was crucial, had to be delivered by the GPs and it was delivered very effectively by them. So yeah, admirable the amount of work that goes in and the work that that comes home, the laptops on and still has to be average, it's, I think things are a little a little better now. And in terms of patient getting to see their GPs, it is variable around the country, and where they can, they will and again, just under immense stress.
Fiona
It's hard, it's and also when you think about and can bring it back to you and thinking about why people get into medicine. And I know there's obviously with some there's an expectation from family members, but even then the main driver has to be a desire to help.
Bhavin
Bottom line has to be it's got to come from within, some describe it as a calling. And others fall into it, they look at the work that their parents do, and they get enthused and, and others will make an educated decision having done a degree and coming as mature graduates. So, it's a I think it's about understanding where this course of study is going to take them. And it's so difficult to as a surgeon to educate or develop the grassroots of surgery, which of course, I'm quite biased I want more surgeons, we're going to need them in the future, we're going to need them now. And to try and influence and try and map out a career pathway that that a young student at school student is going to see as the this this is the way forward this is something I could really do. But certainly the, the young people who I meet are just phenomenal when they when they when you talk to them, they have done the reading when they're interested when they come for work experience. They are engaged and you can see those that will go on and do well are those who will who listen to maintain eye contact who have the communication skills and who asked the questions and that's really inspiring for me and that at every level, even my trainees if there's a lack of engagement and quite quick to pick up on it and try and find out what the issues are so that we can get them back on the right track as well.
Fiona
And I think that's absolutely critical - this piece around understanding if someone is disengaged? Why? And obviously, there's all the systemic things we've already talked about, that can be incredibly wearing. But are there other things? And that's something that I mean, having grown up with a stepfather who's a doctor, I don't think, and then having sort of pursued the profession I have. It's not part of the training in the same way as it would be if you're a leader in an organisation at a private sector organisation to say, how do you spot that? How do you notice what is or isn't motivating someone? What means that they're engaged or disengaged? How do you have the conversation that then opens that up in an honest way, and allows you to help that person explore? They're not things that you can just do. They're things you have to learn to do.
Bhavin
Yeah, absolutely. There's more structure in, even for us as doctors to, to be able to teach in and pick up the skills that are educationalist colleagues have. So, there are there are, there are postgraduate courses that we would do to, to be able to master the art of teaching, not everyone can teach. I think it's a duty for doctors to teach. But not everyone can. And I'm sure there's something that we can always impart to individual. And I think it's about picking up the hard skills, have they got the knowledge, you ask the direct questions, you can ask the open questions. And then it's the softer skills, which are like, Well, okay, what would you do if, if you had to break bad news to a patient, you know, someone who you've got the biopsy result in your hand, and you've got to break that news to them. And that's when I think you can see the clockwork, behind the eyes working away, you can see that they're, they look up, and then they get right, okay, this is what I do. And there's a specific way of breaking that news. And almost like holding the patient's hand, but in a, in a clinical scenario, and guiding them through that pathway. I remember when I had to do that, for the first time, and I had two very eminent colleagues watching over me. And, and they actually thought I was first I felt privileged that they could trust me to do that. And secondly, of course, I knew the patient, I could look at, you know, develop my skills, sit at eye level have the tone of voice that I that I have, and break the news to them gently and schematically systematic so that they know where it's going to go to and anticipate their questions. And then just have a pause and reflect and, and just go through the discussion that's going to that's going to follow allow them some time to absorb that information that you know, it may be that they break down in tears, it may be that they get angry, the grief responses, the variations are immense. And only through experience, can we get better and better at that. So it was that particular environment in a clinic, where with everyone sitting around and me as the registrar being watched by the team, guided through that actually helped shape the way I do things. And there's a reason we do things the way we do. And some people do well, others, some people don't do well. And it's it needs to be picked up on. The good thing is that we've got a team and a team that has specialist nurses, and everyone has an equal voice. So, if they can pick up that maybe I'm not saying something in an understandable way that they can chip in. And it's that interaction between us and the patient that makes it much better consultation, and a much better experience. So, the whole team were involved in in that patient's journey.
Fiona
But you know, you know that that's not always the case, because there is a degree of arrogance with some surgeons potentially, as a protective mechanism, potentially as I could talk about it from a psychological perspective, and have they been so focused on knowledge and information and results that they haven't refined those softer skills. But if you know, we've been in scenarios where we've been speaking to colleagues of yours whether there's been one particular gentleman, I can Think of who's human factors and looking at? How do you flatten that hierarchy within an environment with surgeons? Because there are some exceptional human beings in surgery, no doubt whether and then no one's perfect, but there is that tendency for not in all, and not in a majority. But in there is it a pocket in the same way as you would say, with CEOs and founders of more narcissistic behaviour where it puts people in a position with a fearful to actually say what they see.
Bhavin
Absolutely, and those the dynamics that that leads to in the operating theatre, for example, we've really tackled that head on. I mean, human factors are so important, you asked me, how could I? How can I operate for so long? How can I operate for you do a 12-hour operation? And, and or longer? With the team and time and time again, it's actually about making sure that the right team making sure we look at who's the who turns up on the day, everyone? We have, we have a checklist. And that checklist is important. We have a team brief. Everyone introduces themselves first names, it's breaking down barriers, so that when I look at the student, Assistant, nursing assistant, they can we have a report on the senior Anaesthetist, we know they know how I've worked for years, the Senior Sister, she knows how worked for years. And at any point, if there's something that that felt, it's not right, something's not going well. They have the freedom to be able to speak and say, Yeah, can I just please ask you something to stop you there. And when they very rarely happen, but when it does happen, it's fantastic. Because the first thing I do so thank you so much for maybe I picked up a wrong instrument or something, it's something that is that it's not, it's not critical, but it's just something that they've noticed. And they felt that they they're in an environment where they could tell me that and, and that they're contributing to that patient's care. So, it's, and that's to be encouraged. So, breaking down barriers, having the almost out of first name term that's really been quite useful in in these sorts of scenarios, and also, we're all looking after the patient, every single aspect. So, we do check ins before, if there's a change of team members, if someone goes on a break, or someone comes back, there's supposed to be another stop and pause. And we just check again, make sure that everyone's so happy. At the end of the procedure, we do a checklist, again, everything gone the right way. Everything we wanted to do appropriately noted, the labelling of accounts. And then at the very end, a debrief. So, these structures are in place, and it's taken us a while to get there. So that we can build our team and talk and make sure that we're not bringing the patient to any harm, because that's the most important person in the room is the patient. And we all have a duty to make sure that these things are done so that we can actually give them the best outcome. Of course, there's checking the procedure, checking the instruments, and it's all done. Sometimes it's done the night before the day before. If it's very complex piece of kit, it's ordered in, so we have our managers our procurement, so that it's a big deal.
Fiona
And I mean, it's particularly big. It's the thing that I'm amazed at having seen pictures of the surgery that you carry out is the minute detail and complexity and when it comes to someone's face, if you get something just a tiny bit wrong, it notices or if something is just slightly misaligned, just by millimetres it notices not just to that person but by other people because that's where our vision is the whole time. That's how we a big part of how we communicate is looking at someone else's face and the surgeries that you do so there was one in particular that we actually presented together somewhere. And you started off with pictures from that surgery and it was a woman who You had a very big cancerous tumour in her car. Yeah. And it was just this massive, massive lump on her jaw on the side of her face. And I probably got the proximity bit wrong, but you'll remember. And then afterwards, once you've done the surgery, you almost couldn't see that you've done that surgery. And that takes immense skill. But it also it's one of these examples of a 12 hour plus operation.
Bhavin
Absolutely, absolutely. So, we started from what the pathology is, if the pathology is guided by that if there is a tumour in the, in the top jaw, the lower jaw, we it's all mapped out scanned, biopsy, and everything is staged. So, there's a good few weeks of work that's gone in to know exactly the state of the patient's condition and the state of that stage of that tumour, before we then embark on a treatment plan. And then that treatment plan would mean access, how do we get into the face and take the take the cancer out, and put everything back together, reconstruct the areas and then zip everything back up seamlessly. And that's that these skills come from our training in facial trauma. So, from even from Harold Gillies in 1914. And, and war injuries to McIndoe in Second World War and, and the Maxillofacial Surgeons developing from dentists to managing facial trauma by putting the teeth where they should go. And then the jaw bones added on top, so they would be in the in the right position. So, picking up those sorts of skills and applying the skills of reconstruction where we borrow tissue from another part of the body, that particular case you saw, had the upper jaw reconstructed with bone from her leg, which was the fibula. And so, the bone formed the structure of the facial skeleton, the soft tissue, the Skin Component, and hoobie, the muscle helped to fill in the soft tissues and seal off the hole in the palate in the in the skull base. And then the blood vessels from there, were joined to the blood vessels in the neck one to the artery and one to the vein. So, it's a living reconstruction. In order to get there and the case very well of course, it's we had to open up the lower jaw and split the loads, you're likely like you would like a trapdoor open up, and then put everything back together with very tiny titanium mini plates and screws. And so that takes a fair bit of planning. And now that we've got 3D software that we can manipulate, we can map out the cheek and the and the bone from the other side the good side. And then design our templates if we need to our cutting guides, and it actually means that I can spend a couple of hours with a bio engineer and design the exact cuts that I need to make in order to take the cancer out safely. And then design the reconstruction for shaping a straight piece of bone from the leg into a curved three-dimensional reconstruction of one of the most complex bones which is the maxilla. And, and security safely. That takes a lot of a lot of thought. And this isn't done just by myself, we always work in pairs. So, there's always two consultants and were teamed up with buddied up, and my buddy have worked with him for 17 years. And it's a privilege to work with someone like Mick McGill, who is a good colleague and friend, who has just years of experience. And the two of us have really done some of the most complex work. And it's been great because we can innovate. And we can we can move things that little bit further forward. If we look at one of the most complex operations, which was reconstructing a nose isn't working in over the noses, the faces that is the people concerned about a little hump deformity or a little deviation of the septum. I had a patient who had a cancer of the nose. And now throughout my training, I've always had an interest in getting the nasal reconstruction right. And this patient said, "Well, I read about you, I think you can make me new nose." It was an engineer as well. So, remember when he said about this cancer, he had to cancel the nose all planned. And we designed an operation. And that worked beautifully. So, when he woke up, he had a nose. And we made the infrastructure from tissue from his forearm, and then the superstructure from his forehead and some cartilage from the ear cartridges. And it sounds horrendous. But he actually you could be sitting next to him, and he wouldn't really notice.
Fiona
Absolutely,
Bhavin
really, but, you know, again, those skills come from and that those techniques come from people how Gillies who in the First World War shrapnel injuries to the, to the nose, and he designed he would use the forehead. In fact, the forehead flap has been used since 600 BC, by an Indian surgeon, just right. And this is well documented. But Gillies took that technique and help to rebuild noses and some fantastic examples of his of his work at Sidcup. And then I just I use the free flap, borrowing tissue from the forearm, little strand of bone from the radius and making it make the whole pyramid of the nose and then borrowing the forehead idea and building the thinking from there. And that's, that's worked really quite well. It's been, it's been a very interesting journey for me. And it's been superb journey for some of the patients who are affected by this horrendous cancer because a lot of times these aren't, aren't dealt with, as well as we would expect them to be,
Fiona
Which then ends up with, well, if it's if it's not death, its deformity isn't really? But I mean, I always just find it mind blowing. And I smiled when you mentioned that 600 BC, just because you've mentioned that before and at the time was that, wow, that's just incredible. But even over the last 17 years, something has progressed. Well, not something, it's something that's progressed so far, because of the way in which technology has brought us forward with 3D imaging and what have you. But I think about you for a moment, because I'm interested in you. And I'm sure our listeners will be as well. What if you can put it into words which you might not be able to, but what would you say is your core driver? So what? Well, I mean, if we start with how did you end up doing what you do?
Bhavin
I mean, I think my story is, is it starts off when I started dentistry, and never wanted to do medicine, who was it was always sold me has been to longer career path. When I started, I started as a dentist at Kings. And in my very first year, very sadly, my sister died from math, cancer. And she was 28. And I was 18. And that really shook my world. So, from that experience, just not knowing not even know what it wasn't even talked about in the family. It just taboo, you just you just wouldn't the C word is never mentioned. And until it was too late now, I'm coming home from uni, and someone says oh, by the way, she's terminal. And I'm anxious, which is just talked to her What do you mean she's terminal. And having to be having to have that explained to me, by my one of my sisters, and it was just very, very just heart-breaking. But it led me on a on a journey to find out what will How did this how did she get cancer? How does she what happened? You know, what's, what was going on? And because I was learning about the mouth, and I met a superb consultant who became my role model, mentor, coach, but old and that's John Langdon and John was Professor of maxillofacial surgery at Kings. And he came and gave us a talk on how to manage mouth cancer and putting together the anatomy that we were learning in our first year with the surgery that he was doing. And it was the most fascinating lecture I couldn't believe that he was a man who was intently qualified, and he then had done medicine as well of course, but he was talking to us and he was just charming. And they got to know John very well and he's doing a very good friend. And I wanted to have him as one of my one of my friends that he, he trained me, he, I worked with him as a registrar and I did a lot of my training with him. And we would sit and talk and he had the empathy to talk to me, he had the charm to be able to sit, sit me down and say, actually, you know, this is where you are now in your life, this is what this is what's going to happen to your sister. And if I needed to talk to him when it was, it was great to have that, that's that support. And of course, so as I went through dental school, I was had a surgical leaning anyway. And wherever I had a chance, I'll be taking teeth out to the ground floor of the dental school, and I'll try and get an extra session and just to practice my surgical skills was great. And then eventually fell into working in a hospital environment. And there was no stopping me. It was, it was great, because you just get more and more encouragement. And I think it's structured in a way that you would sit an exam, which would give you that specialist knowledge that will put you above the general knowledge that loads already amassed. And then all of a sudden, you're talking to peers, and you're reading papers and, and it's just so excited, we should that sets that age, and there to come a time when to make a decision on whether to go to medical school or not. And I know it sounds tragic, but actually my mother died of math cancer. And that was a very difficult time because she wasn't going to have any surgery. So, she went through a very traumatic death, there was a lot of worry about what would happen if she had surgery. And again, you know, my colleague and mentor, John brought every member of my family and my family isn't small, it's huge, every member of her in to talk to them, so please get your mother to have something done. In fact, she went and had radiotherapy and it wasn't enough. So as sad as it may be, I learned a lot, I grew up a lot. And an opportunity arose for me to go to medical school and become the surgeon. And I, I jumped at it. And it was a great time for me to have a complete change of scene be surrounded by people who are much younger than me live my life a little bit and also reflect and move things forward. And I always went through medical school keeping my eyes open for anything other than maxillofacial surgery, because I knew what it was involved. But I kept on being drawn back to the wonders of what we could do, and how we could rebuild lives rebuild patients. And I ended up in as a consultant inherit, which is a large Asian population, the risk factors for mouth cancer, chewing tobacco chewing a beetle nut, which is what caused the changes in in my sister's mouth in my mother's mouth beetle nut is a widely available in in the Asian population and East Africa and also in India. But tobacco and alcohol also risk factors but so work in an area which is which has got a huge problem with math cancer. In fact, we've we have never been busier in this current time. We are just so busy with the number of cases that are coming through. But it was an opportunity to build it build the unit and we built a unit 17 years ago in the in northwest London, and it's one which has an excellent reputation. We have been its clinical lead. I've been a clinical director there. And I work with the College of Surgeons through there as well. And it's and it's great that I've got a great base and it's a family of consultant colleagues and we're all friends as well. So, it's actually it's a lot of good has come out of those experiences that I had when I was younger and now, I have a such a deep understanding of a patient's journey. And the experiences that they will go through that it almost comes naturally to have that conversation. Like to give the honest, frank opinion and a lot of my patients prefer that. Of course, there's some who who'll be frightened and run away, but they do come back. And we do get them through to treatment. We can't cure everybody. But the ones who we can cure will do to the best of our ability. And it's great. I'm just, it's a privilege to have the colleagues I have with me and the Max Max team at Northwood Park is has got an outstanding reputation. And we're really blessed that actually the people we work with the hospital, the managers, everyone are really positive and pushing us to, to do the best we can.
Fiona
That's, it's, it's cruel to have lost your system when you were so young. And it's grown when it's something that's so close to what you were starting to study Anyway, before even realising. And then to lose your mother of the same thing is really, really hard. And I think that has to build a level of understanding and empathy that is very difficult to replicate without having had those experiences.
Bhavin
Yeah, absolutely. It's and I think it's about holding that patient's hand through that through what they're going to go through. We do have a holistic approach to providing cancer care, it's so important that we get it right. Not everyone wants to go through major surgery, not everyone wants to go through radiotherapy, some people have made the decision that they want to live with their disease. But the advancements we've had, it's phenomenal in terms of surgical skills, the diagnostic tools, we've got the teams who are specialising. We have a multidisciplinary team meeting every week. And it is to discuss every single patient who is going to go down this cancer journey. And the success stories are great. And then even if something comes back the dreaded recurrent, we have developing fields in immunotherapy, which is targeting drugs to mark-up cancer cells so that the body can deal with them through the immune system. And through COVID, I remember a patient who I actually read lost contact, I'd lost contact with the I thought that they were in the they were shielding and in fact may have come through this horrendous disease. And actually, through immunotherapy, they were presented to my clinic, and I was just so pleased to see them, because they're still alive and keeping patients alive that much longer. So, it is very interesting how things are developing. And in our network, we have a great group of young enthusiastic oncologists who are very well read, we will attend the conferences will enterprise into trials. And then we have links as well. So, we have links with some of the biggest cancer units in the country, so that we aren't, you know, keeping things current. And this is the NHS and I'm thinking well, actually, this is actually pretty good. What we can do.
Fiona
Yeah, the NHS is an incredible system. It's Sorry, I'm really struck still - I know, you've told me before, but I'm still really struck by that experience, which is so tough. And you must, to some extent be reminded of it time and time and time again, when you see other people coming through your door. Yeah, so I mean, that that's always been a core driver. Something else that I see in you. A lot I see a lot of, and we talk about a lot is this. It is referring back to something you said earlier, which we all have a responsibility to teach. And what I found really interesting when I was researching mirror thinking was you can look into all fields and there is not a single field that relies upon the concept of mentoring and teaching as much I would say as medicine what there's definitely not as much research in any other area. And that element is not just the cognitive skills and the analytical abilities and the knowledge, it's actually the soft skills as well, that are passed on through that mentoring. Yeah. And that's something that we've talked a lot about the people that you've mentored the people that you've encouraged, you have a real passion for. For that it's not a duty, I would say it's a passion, you know, I'm sure there are some people it feels more duty bound. But it's definitely for you something that really, really deeply matters.
Bhavin
Oh, it does, it's just so important. I mean, there's, there's nothing more satisfying than having someone you've trained, come through, do an operation, the way you do it, the way I do it, and to go through the patient's journey with them, and the patient coming back to me saying, you know, your registrar's fantastic, and they really have bonded with them. And you can, you can see that actually, that they, they get a lot out of that, and given that give them the freedom to, to express themselves to go and collect this, we call them junior doctors, but these guys are guys or girls who have done dentistry to the highest level medicine to the highest level, their exams, they are rigorously assessed, and we call them junior doctors, but they're very close to becoming consultants. And it's a real privilege to work with them, and prepare them for their exams, or the journeys that they go through with the patients, I get to reflect on them. And we have an open-door approach. So, they can then conduct anytime they want to, during COVID, it was a matter of let's have a Zoom meeting, just to just have a chat. And half an hour from my point of view is really well invested in in just having a conversation, because I'm developing human beings developing the skills that they will use in their practice and carry them forward. And that's part of a legacy, I guess it's not I don't want to get too attached to that, that sort of title. But but I think that's part of my duty, because I can, and I've done it for a long time I was the lead trainer in the unit, I've been an external for quality assurance for the, for the college as well for many years. And it's, you see that when we do have an insight into the whole individual and we have to look at every surgeon individually, look at what they're going through, some are less than full time to part time, some are getting married, having children, some are full time dedicated, but they want to go off and do research, every single thing is, has to be looked at. And if we can make it work, then and they've got support from someone like me, then that's great, because it means that we're advancing the specialty, we're advancing research, and we're encouraging people drawing people to this, they can stay in remaining specialty, at the moment, the attrition rates are quite high in surgery, there are lots of attractions in terms of going off into the pharmaceutical industry or, or leaving completely going into the city or leaving the country because of the of the problems in the in the NHS. So, if we can do something that can try and make that journey more acceptable. help give them some insight is what they don't know, really give them some insight into what is possible, and then support them. The new consultant of today is not the consultant I started off when I was started off as 17 years ago, I had 100 hours a week sometimes of training of work, one in three on call moving to one in five, and then you know, big long list twice a week, sometimes three times a week as well as trauma. So, it's about getting them making them safe giving them the environment in which they can train and adapting our training pathway so that we can actually make it more inclusive. And talking to making it yes, they have lots of ideas what's what could be better, we could design apps, we could be looking at online learning we could look at sending them on courses internationally nationally, so that we can just make sure that they have a good time during their training. One of the best times is training as a registrar because you have the freedom to it. express yourself. It's a bit it's a protective environment, but it works both ways. You've got to, you know, you're also being monitored, to see how good a consultant you are. And that's how rigorous surgical training is.
Fiona
Really is I mean, it's just immense the number of years you have to put in to, and then it doesn't stop. There’re still exams to do once you once you're trained or qualified or, and I guess on the one hand, that's actually what life should be about is continuing to learn and grow. But on the other hand, it's, it can properly sometimes feel like it's just another pressure on top of all the other pressures that are there.
Bhavin
Yeah, yeah, absolutely. And, you know, we can talk a little bit about burnout. And where we've seen colleagues, you say, particularly, you know, the pandemic was just something that really did affect the resilience, the, the thought processes, the, the coping mechanisms, for individuals who were pre COVID work, some of the strongest colleagues that I've come across, and it really has tested people. And the stories that come from doctors’ experiences are something that we should we should be learning from, you know, we've had dentists who would be working in a hospital expecting to be in a really protected environment next in the nursing in intensive care. And well, what happened, what happened there were no nurses who were supposed to be in outpatients. Next thing, they're turning patients in, in ICU, or looking after patients on nursing wards. So, the experience is, from home, that I think there's a lot to block to learn. And I hope that, you know, there are collectors of stories of people who will do talk, I hope they do have that ability to talk things through what's good isn't in quite a few units, the well-being has really been stepped up. And so, there is access is not enough, but there is access for, for well, for people to go and talk and get some psychological support. But I think burnout is burnout and burnout. And when it hits you, it's, it's, it's like a tonne of bricks, I think. And it's all encompassing, it is very, very important that we try and find, find the root source of that and just try and get on top of that.
Fiona
And I think to an extent it comes back down to that support piece. That social support component is so core. And you spoke about earlier in your career, your mentor, your role model being, you use the word support, and you've used that word when you've talked about the junior doctors, and what you do with them as support. And actually, as humans, we should be supporting one another. But when life become so overwhelmed by the systems and processes and protocols, and bureaucracies and barriers that get in the way, it can be difficult for us to even consider supporting ourselves that alone other people.
Bhavin
Yeah, it's exactly it is difficult. And we don't always get it right. Maybe organisations don't always get it right. And there's lots of there's lots of changes that are afoot at the moment as we organise our healthcare services. And it's an opportunity to try and get things right. Because we have just what was used as a tool of the appraisal mechanism, for example, is used as a mechanism to find out the needs of that individual and every doctor should have an appraisal. So, it's a one to one conversation, looking at their practice annually, and an opportunity to choose for them to develop themselves as well and also an opportunity to find out if there are any problems. And that came about as a result of some serious medical scandals in the past, and it was felt that doctors weren't checked rigorously enough. The appraisal mechanism I found it to be a fantastic tool for me to have some dedicated conversations with my appraisers who are actually superb consultants. And to have the appraisal paperwork done no problem and actually extend the conversation to as long as they will to take and talk about how they want to develop themselves, and whether I can help them to get to where they want to get to. So, it's all of a sudden become a coaching session. But actually, it's part of in a formal mechanism, but we're talking about avenues that they want to explore. And I think we've had some really good successes to solve that approach. I haven't formalised it but it's just a matter of time before we haven't incorporated that into our standard appraisals. We've talked to most people the appraisers are sometimes it's a bit rushed, but the GP is doing very well. They spend a lot of time doing their portfolios. And, and, and going through these. But in the hospital setting, it's certainly something that I think we can open up that a little bit more and get the get the best out of our colleagues.
Fiona
Well, there's lots I would still like to explore what's going on what's going through your head during those surgeries that maybe we need to do another one. But I'm also conscious that you have important things to do like saving people's lives and training the next generation of doctors. So massive, massive, massive thank you for coming on and talking. I know that people will find it fascinating. I am pre-empting that people will want to hear more as well, because there is there is so much more to hear. But I really appreciate you giving up an hour of your time to speak to people on the podcast.
Bhavin
Oh, thank you. Thank you so much. It's been it's been a real pleasure.
Fiona
Thanks to my guest, thanks to you for listening. If you want to find out more about me and my work, go to funimation.com or my social media handle is also Fiona Murden. If you enjoyed this, please do subscribe, review and tell your friends it'd be a massive help. But for now, goodbye and I hope you have a great week.