Sir Robert Jones — the father of orthopaedic surgery in the UK by David Stanley

David star­ted his talk with an account of the life of Robert Jones, who was a sur­geon in Victorian times. He was born in 1857 in Wales and left to study medi­cine at Liverpool University under the guid­ance of Hugh Owen Thomas. In 1881 he was assist­ant sur­geon at the Stanley Hospital, Liverpool and estab­lished him­self as a teacher and thinker.  He pub­lished art­icles in The Lancet and was the first person to use X-Rays, and the first to use the “Thomas Splint”.  This was a device that held the frac­tured leg firmly in an open frame thus allow­ing treat­ment of wounds and ulcers to be per­formed whilst the leg was still immob­il­ised.

He was totally com­mit­ted to the care of crippled chil­dren and was  involved in the cre­ation of Royal Liverpool Hospital for Children.

During the con­struc­tion of the Manchester Ship Canal he was med­ical officer and set up three hos­pit­als en route and treated over three thou­sand patients.  During the first world war he was hor­ri­fied at the treat­ment given to cas­u­al­ties and he set up Shepherds Bush Military Orthopaedic Centre. He believed that no sol­dier should be dis­charged from the army until everything had been done to make him a healthy and effi­cient cit­izen.  He thus began modern day rehab­il­it­a­tion ser­vices.

Robert Jones became pres­id­ent of the British International Orthopaedic Surgeons, and trav­elled to the USA where he met William Mayo (founder of the Mayo Clinic).  It was said of Robert Jones that he was a modest man entirely unaware of his great abil­ity,

David Stanley then changed the focus of the talk to tell us about the chal­lenges for today in Patient  Safety in Caring, Sharing and Innovations.  This involved :

  • being inspired by teach­ers
  • the abil­ity to per­form modern ortho­pedic sur­gery safely
  • being appro­pri­ately trained to allow for future innov­a­tions

He  men­tioned that the NHS is always under fire by the press and great pub­li­city is given to prob­lems like the Mid-Stafford shire invest­ig­a­tion where it was found that fin­ance took pre­ced­ence over the care of patients.

There is a prob­lem with 7,300 patients per year com­plain­ing about adverse events e.g. post­pone­ment of oper­a­tions, drugs not given and gen­eral lack of care etc. The cost of lit­ig­a­tion in 2010 was £863 mil­lion.  15% of claims were of an ortho­pedic nature rising to 60% in the last three years. Common com­plaints included unsat­is­fact­ory out­comes 48%, dia­gnostic error 33%, nerve damage 32% and incor­rect oper­a­tion site 16%.  The bed­side manner given to patients greatly influ­ences whether a com­plaint is made.  Time spent with the patient and a friendly approach result in less claims. An abras­ive approach and less patient inter­ac­tion is likely to increase the number of com­plaints.

David Stanley stressed that sur­geons need to know their lim­it­a­tions and, if in doubt,  to phone a col­league for advice.  Surgeons should know their own com­pet­ence, improve their skills, tech­niques and be will­ing to train other people.  Surgeons should be spe­cial­ists in a lim­ited field i.e. knees, ankles, feet and just spe­cial­ize in those oper­a­tions.

To achieve qual­i­fic­a­tions con­sult­ants have to undergo rig­or­ous exam­in­a­tions. The aver­age pass rate is 70% with more women passing than men.  For stu­dents study­ing abroad there is a European Board of Orthopedic and Trauma Examination.

The Northern General Hospital, Sheffield, holds a trauma con­fer­ence each day when all the X-Rays of trauma patients are dis­cussed.  Those attend­ing include ortho­pedic sur­geons, radi­olo­gists, anes­thet­ists, neurosur­geons and theatre staff.  A pre-assessment clinic decides if a patient is fit enough for an oper­a­tion. Before an oper­a­tion a World Health Organization check list is used to ensure that name band is in place, the cor­rect equip­ment is ready, whether the patient has any aller­gies and the site of the oper­a­tion is well marked.

The talk stim­u­lated numer­ous ques­tions and was well received by the audi­ence.

Thanks to David  Stanley.