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The annual Presidential Address of the Section of Surgery, of the Manchester Medical Society, was held on Tuesday 12th October 2004 at 8.00 pm in Chancellors Conference Centre, University of Manchester. Prior to the Presidential Address, the Annual General Meeting of the Section was held and the following Office-bearer and members of Council were unanimously elected for the 2004/2005 session. Unfortunately Mr Lambert was unable to pass the Presidential Medal on as he was still on holiday. Mr Hobbiss therefore introduced the incoming President, Mr E S Kiff (Consultant General Surgeon, South Manchester University Hospitals NHS Trust) and wished him a successful year of office as he handed over the Presidential Medallion. Mr Kiff thanked Mr Hobbiss for his kind words and thanked the President of the Society, Professor J C Lowry, and members of the audience for attending his Address. He than announced his lecture as follows: - "Reflections on a Peculiar Practice" The president began his address with a combined trip down memory lane and tribute to the various surgeons around the region who had featured in the career of the president both as friend and mentor, culminating in his time spent at St Marks where Sir Alan Parks had inspired his interest in functional bowel disease and incontinence. He demonstrated his mastery of audiovisual aids by showing a video clip of a very young president talking to a lady with the problem, which illustrated the problems faced by such patients. The president divided the treatment of functional bowel disease into three categories; conservative, surgical and preventive. The conservative management included adaptation of life style, drugs and biofeedback. Whilst these all had their indications and merits none provided an entirely satisfactory solution with lasting benefits, hence the need to consider alternatives. Various surgical procedures had been described many of which attempted to improve the physiological functioning of the sphincters and in the case of implants artificially replace them. Although in the short to medium term patients experienced significant improvements, none of the procedures were associated with lasting improvement. The importance of clinic organisation was stressed. Patients with functional bowel disorders needed time to talk about problems. Multidisciplinary working was important and the contribution of other colleagues in gynaecology, urology was gratefully acknowledged; in particular the role of medical physics in providing objective measurements of sphincter function was vital to understanding the mechanisms of incontinence. Such studies helped in the planning of appropriate surgery and in studying the long-term effects of surgery in such patients. This was illustrated by the many studies that had been conducted by the president on his own patients aided by various research fellows and trainees over the years. The use of ano-rectal physiology had made a major contribution in understanding the causes of incontinence and establishing the link between birth trauma and incontinence in later life. Stretching of the perineal nerve was a major factor, but there were also patient related factors particularly in the physiology of the connective tissues that may predispose some patients to the problem. Finally there was the concept of prevention. Given the unsatisfactory nature of both conservative management and surgery prevention was perhaps the best approach. This would involve identifying patients at risk by postnatal testing and the use of postnatal pelvic floor exercises. Using archive pictures from the Kiff family album the possibility of identifying foeto-maternal disproportion and taking pre-emptive action was raised. The President concluded by thanking all those colleagues who over the years had referred him patients allowing his interest to be nurtured. Emphasising the need for multi disciplinary working and an even better understanding of the pathophysiology, he reflected that in the modern NHS one of the biggest problems for surgeons as a group was time to think and reflect on what they were doing. The Presidential dinner was held before the lecture in Chancellors Restaurant at 6.30 pm. Members and guests enjoyed a three-course meal and were given a choice of menu for each course.
A meeting of the Section of Surgery of the Manchester Medical Society, took place on Thursday 18th November 2004 at 8.00 pm at Chancellors Conference Centre, University of Manchester. Twenty four members and guests were in attendance and the minutes were read and approved by the President. The President of the Section, Mr E S Kiff, opened the meeting and welcomed members and guests of the audience. Mr Kiff then introduced the evening’s speaker as follows:- Professor A K Maynard The Speaker was Professor Alan K Maynard from the York University Health Services Unit whose lecture was entitled "Practising Surgery – A Guide to Survival!" Professor Maynard introduced himself as an Economist working with doctors since 1983. Recently he had been appointed Chairman of the New University of York Medical Trust. He commenced his lecture explaining that in life there were two principles for health namely to provide care at a fixed cost i.e. rationing, or to provide all health care at no cost. The NHS has a 75 billion pound budget and clearly some form of rationing has to take place. This is described as cost-effective treatment. The role of the health economist is to minimise taxes while hoping to improve life with a reduced cost. Professor Maynard emphasised the problem of efficiency and ethics. Inefficiency deprives patients of care as well as being unethical. He used the example of Harvey Cushing the famous American surgeon whilst operating at the Battle of the Somme in Belgium. Despite 50,000 injuries per day Cushing still only performed two operations personally so that he did not compromise his principles demonstrating inefficiency. Trust was emphasised by Professor Maynard and confirmed the public still trusted doctors but did not trust managers. This was despite a documented death rate due to errors by doctors of 3–5% which is a greater number of deaths than the combined deaths road traffic accident and HIV in the UK. Professor Maynard emphasised that we must have data on our performance both compared to colleagues along with outcome data. Surgeons are poor at collecting data but he pointed out that this data was being collected on the Hospital Episode System (HES) and that we must as surgeons own this data on our own performance. Recent research by Professor Maynard had dispelled the myth by politicians that part-time surgeons do less work in the NHS as they are away in private practice. The problem now is to explain why full-time doctors do less work than part-time doctors. There is no doubt that Mr Blair is in trouble with the health service in that he has increased spending but activity has fallen. It is important outcome measures are kept and understood by surgeons to neutralise any new directives from government. Finally Professor Maynard emphasised that the HES data will be useful for revalidation and our own protection and will help us satisfy the need for clinical transparency. This may help prevent the many reorganisations by government which occur regularly without evidence or evaluation. There was interesting discussion over many questions and a vote of thanks was given by the Secretary of the evening. It was concluded that Professor Maynard had given an interesting and refreshing talk with certainly food for thought.
A meeting of the Section of Surgery of the Manchester Medical Society, took place on Tuesday 14th December 2004 at 6.30 pm at Chancellors Conference Centre, University of Manchester. The President, Mr E S Kiff welcomed members of the audience and then introduced the evening’s speaker as follows: - Mr Robert Ingham Robert has his own business, Robert Ingham Designs, where he makes one-off pieces to commission and for exhibition both in this country and abroad. Several of his pieces have been awarded Guild Marks. He has exhibited in the States- at Pritam and Eames Gallery, New York, and has important pieces in private collections in this country and America. He shows regularly at Decorative Arts Today at Bonhams, A Celebration of Craftsmanship, Cheltenham, and at the Society of Designer Craftsmen. He has also taught summer schools, both in this country and at Anderson Ranch Arts Centre in Colorado, and the Centre for Furniture Craftsmanship in Maine. Mr Ingham started his talk by describing his love of materials, design and tools. This started at the age of 7 when he was given a fret work saw which he put to use on a dining room chair! He was later encouraged by teachers in metal and woodwork to see such work as a profession rather than trade and by his brother to attend art college to give his work expression, because furniture making combined both the technical skill of working in wood and use of artistic expression. He went on to show a number of the various pieces that he had created, many of which were to specific commissions. These included coffee tables, display cabinets, occasional tables, bookcases, dressing tables and even Mr and Mrs Hancock’s bed – minus Mr and Mrs Hancock! Each piece illustrated a particular aspect of the fusion of craft and design and how technical problems such as producing almost invisible wooden hinges could be achieved. Of the various wood working tools the router came in for particular praise as the tool making the greatest progress in the last 30 years. Mr. Ingham concluded by making a plea for members to support young artists in wood, pointing out that originators of great art throughout the ages have never been top band tax payers and needed our support both financial and spiritual to continue their work. An enjoyable carefree discussion followed Mr Ingham’s lecture and he received a vote of thanks for sharing his expertise with the Section. After the meeting, a wine reception was held in Chancellors Restaurant, which was closely followed by the annual dinner. Mr Ingham was the guest of honour and he and members and guests of the Section had a pleasant evening.
A meeting of the Section of Surgery, of the Manchester Medical Society, was held on Thursday 20th January 2005 at 8.00 pm in Chancellors Conference Centre, University of Manchester. The President of the Section, Mr E S Kiff, read the minutes of the previous meeting and these were approved. He then introduced the two speakers for the evening and the topic they spoke on as follows:- Mr J Hill Mr N A Scott "Training of Surgeons in the Future" Both speakers gave informative lectures, which inspired a lively discussion. An informal dinner was held prior to the meeting in honour of both speakers, at Chancellors Restaurant, where they were joined by members and guests of the Section.
The twenty-fourth Michael Boyd Memorial Lecture, of the Section of Surgery of the Manchester Medical Society, was held on Tuesday 8th February 2005 at 8.00 pm in Chancellors Conference Centre, University of Manchester. The memorial fund was established in 1981 in honour of Professor Michael Boyd, Professor of Surgery at the University of Manchester from 1947 to 1970 and Emeritus Professor until his death on 7th April 1973 at the age of 68. Since 1981 an honorarium of £100 had been awarded to speakers giving the Michael Boyd Memorial Lecture. Council of the Section of Surgery agreed last year that rather than to continue offering an honorarium, each speaker would be presented with a commemorative medal marking the occasion. Mr Kiff then announced that it was the section’s pleasure to present the second medal to the evening’s speaker as follows: - Professor N J M Mortensen "The Surgeon Scientist – an
endangered species or a Prof Mortensen began his lecture by reminding us of the archetypal surgical professor of several years ago who combined the roles of undergraduate teacher, postgraduate teacher, researcher and University politician. His fall from grace had been brought about by the advent of medical educationists, increasing power of postgraduate deans and the increasing effect of the research selectivity exercise in universities. This had resulted a lack of role models for young surgeons, unfilled academic posts and consequent rationalization of departments of surgery with in some cases their disappearance or amalgamation. Recent changes in the rules over ethics had further discouraged participation in research. He went on to look at his own career and used it to illustrate how luck and being alert can have a major influence on research involvement, his encounter with a lost urologist pushing an ultrasound machine leading to his early work with rectal ultrasound being an example of both. He concluded his lecture with the advice to young academic surgeons that they needed to stay curious, be pragmatic, find a basic scientist friend and be lucky. A lively question and answer session followed and a vote of thanks was given to Professor Mortensen for his enthusing lecture. Prior to the meeting, an informal dinner was held in honour of Professor Mortensen at Chancellors Restaurant.
MARCH 2005 The President, Mr E S Kiff, was in the chair and introduced the trainees and their presentations as follows:- E L de Sousa A Jibawi N Khwaja "Early pathophysiological events
in ischaemia-reperfusion F J McNicol F Serracino-Inglott As with last year, the audience participated by evaluating the presentations and recording their opinions on a scorecard. The results would be tallied at the end of the meeting and compared with the adjudicating panel. The five presentations were short-listed from a total of twenty. Mr Kiff thanked all presenters, on behalf of the section, for delivering their excellent papers. He then acknowledged the audience for their participation with the marking scheme and informed them that the results would be announced that evening during the meal at Chancellors Restaurant. After much deliberation the President announced that the winner of the Trainees’ Prize for 2004/2005 was Miss F J McNicol who was awarded the prize money of £250.
A meeting of the Section of Surgery of the Manchester Medical Society, took place on Tuesday 12th April 2005 at 8.00 pm in Chancellors Conference Centre, University of Manchester. Mr E S Kiff Lambert, President of the Section, chaired the meeting and introduced the speaker for the evening, Mr D J Jones. That evening Mr Jones gave a lecture entitled :- "Patient Choice: what it means to you" Mr Jones gave a comprehensive address on the issue of patient choice covering the politics of this, the infrastructure established in Manchester to introduce it and the information systems and websites available for patients to make their choices. He felt that the element of choice had been introduced by the Government to exert competition within healthcare and that it was accepted that some hospitals might close as a result of this competition to attract patients. The Choose and Book System was to be introduced by the end of 2005 with patients having a free choice anywhere in the country by 2008. Some 8 to 15% of surgical activity would take place in the independent sector by this date. Independent Surgical Treatment Centres have been established, there are to be 80 in the country by the end of the year. Details of the one in Trafford were illustrated. 70% of the staff were from overseas and were on a fixed contract for 5 years to do largely general surgical and orthopaedic operations. Interestingly they were not to be responsible for their own complications. A study in East Anglia compared choice with no choice. The priority for patients seemed to be ease of access and quality of care; they were not too concerned about waiting times. A large study that Mr Jones had carried out with the School of Nursing and the University of Manchester looked at decision making in colorectal cancer. Patients wanted people who know what they are doing to make decisions for them. They themselves are worried that they might make the wrong choice. They were clear that they wanted to participate in decisions but not to make them. This finding came as no surprise to the surgeons in the audience. Mr Jones then illustrated what was available on the Dr Foster website about hospitals in the North West. There were interesting variations in toilet cleanliness, food, infection rates as well as patient satisfaction and mortality rates. Following the presentation a thoughtful discussion took place with the consensus being that this was a politically driven agenda to give people something they did not want. Prior to the meeting, members and guests of the Section attended an informal dinner held in honour of the speaker in Chancellors Restaurant.
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MANCHESTER
MEDICAL SOCIETY
