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.