Mr John Black, president of the RCS

Hospital Dr invited Mr John Black, president of the Royal College of Surgeons of England to answer 12 questions and complete a half finished sentence…

1. What is the biggest challenge the profession faces? 

“Restoring all that has been thrown away in the modernisation fervour of the last decade. An awful lot of babies have gone out with the bathwater. Basic sciences and acquiring factual knowledge have to be restored to the medical school curricula; in postgraduate training, educational theory has to be replaced by classic apprenticeship; and whatever the health care model the country chooses it must be based on achieving the best outcomes not irrelevant targets and political expediency.” 

2. When did you last laugh and why?

“Last weekend my two-year-old granddaughter was asked if she was tired and replied: ‘I’ve had a long day!’”

3. What are the RCS’s priorities over the next year?

“To restore continuity of care to patients, so that they are referred electively or as emergencies to a single consultant and their team, who look after them throughout the entire hospital episode. This means reforming Choose and Book, removing the target culture if not all targets, and getting rid of the European Working Time Directive for surgeons.

“On the training side we need to support MEE in restoring the intensity of training. This means acknowledging that competence is not enough. It is just the start after which comes experience until the doctor is confident and safe to work independently.”

4. Which person influenced you most as a doctor and why?

“No single person stands out from the many amazing surgeons and people I have worked for and with.”

5. When were you most in danger?

“When an operating light fell from the ceiling a few hours before I was due to start operating. It seemed funny until we heard that it happens several times a year throughout the world and is usually fatal to both patient and surgeon.”

6. How will royal colleges maintain their relevance?

“By continuing to set the very highest standards for practice and training and then to work ceaselessly with politicians and everybody providing healthcare to make sure they are achieved. There was an overt anti-college agenda a few years ago, which has now gone. Colleges started long before politicians!”

7. What is your favourite piece of music?

“Where do I start? Perhaps one of the late piano sonatas, late quartets or the string quintet of Schubert. Mind you I’ve just been to the Birmingham Royal Ballet Nutcracker and can’t get the tunes out of my head! Mendelssohn’s Octet is playing as I type. Sorry, I can’t nominate a single piece.”

8. How can surgeons be encouraged to share their performance data?

“Very easily, as they all want to. The problem is selecting the best outcome measures and making sure they are risk adjusted.”

9. What is your guiltiest pleasure?

“White Burgundy.”

10. What are the hallmarks of an excellent surgical team?

“Just that, being a team. Losing the old fashioned ‘firm’ is one of the worst things that has been inflicted on surgical training. Only in a team of that size is there the bonding to guarantee optimum patient care and training, not to mention morale.”

11. What was your most embarrassing professional moment?

“A lot of the time when I was a trust medical director, pretending to be a manager in areas where I knew nothing. I was fine on the professional issues and things such as organising services, but all at sea on a lot of the rest. Clearly I was fundamentally a clinician.”

12. Of what achievement are you most proud?

“Managing jointly with a colleague, Phil Morris, to raise over £4m for the Education Centre at the new PFI hospital in Worcester. It was painful and a big worry for a couple of years, but now we have got there, as a freestanding charity, we have the key advantage of independence. The architect is also a genius and the building is distinctive.”

Finish this sentence: trainees working to a 48-hour week will…

…have a miserable time, be isolated and stressed by being flat out all the time, exhausted by night shifts, miss out on the training received by previous generations and, most of all, have to work in a fundamentally unsafe manner where they never see a patient through. By the way, this insane legislation is designed to make their lives better!