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Evolution of Surgical Practices: A Personal Journey Spanning 46 Years

Join Robin Souter from Milton Keynes on Graduation Day as he reflects on the Changes in Surgery over nearly five decades. Explore transformations in Peptic Ulcer Disease management, rise of surgical sub-specialties, impact of audit and nurse specialists, interventions in Morbid Obesity, developments in radiology, and advances in Organ Transplantation. Witness astonishing shifts in Public Health policies, genetic understanding, and joint replacement techniques. Navigate challenges with Litigation, Political Interference, and Internet Influence. Discover Glasgow's contributions, technological advancements like MR and CT scans, and the era of Digital Imaging. Uncover the evolution from Dreaming Spires to Concrete Cows in the medical landscape. From the early days at RAF Gan to the modern ISTC NHS Treatment Center, explore the journey of surgical practices towards enhanced recovery and patient satisfaction.

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Evolution of Surgical Practices: A Personal Journey Spanning 46 Years

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  1. Changes in Surgery over 46 yearsA personal perspective RobinSouter Milton Keynes

  2. Graduation Day

  3. Changes;Surgical • Peptic ulcer disease • General – sub specialists • Audit • Nurse specialists • Morbid obesity

  4. Interventional/diagnostic radiology • Vascular • Neuro • Breast • General/hepatobiliary • MR scans • CT scans • Digital images • Image transfer

  5. Astonishing general changes • Public Health • Epidemiology Doll and Hill • Genetic understanding - Double helix- human genome • Organ transplantation- immunosupression • Joint replacement

  6. General public • Expectation • Litigation • Political interference • Internet trawlers • Understanding/misunderstanding

  7. Some Glasgow contributions • GCS • Griseofuelvin • U/S scans • TIVA • Bio engineering

  8. Short stay surgery/ RGS

  9. RAF Gan, Maldives 1975

  10. NDS Oxford 5 years in a fast developing environment Embryonic day surgery Julian Britton LA day case hernia repairs in Abingdon facility available expediency day case nylon darn hernia repairs Jean Miller in the Churchill hospital “Do not use opiates”

  11. From the dreaming spires to the concrete cows!

  12. Milton Keynes Hospital 1983 Exciting times

  13. MK Hospital Concept 2/3 patients treated locally remainder to travel to Northampton and Stoke Mandeville 1.6 beds:1000 population 2.4:1000 national norm Concept fatally flawed!

  14. Partial solution – move to day case surgery • Portakabin 1985. Fight for pipes! • Mainly paediatrics and scopes • Core enthusiasm for day care surgery • Original protocols extremely cautious

  15. Milton Keynes Hospital • Green field site opened April 1984 • 1.6 beds/1000 population • National norm 2.4/1000 • Concept 1/3 of patients continue to travel to Northampton or Stoke Mandeville • Concept doomed to failure

  16. Drivers for change • RCS working parties • Audit commission • Politicians • VFM • BADS directory “aspirational targets” • Improved techniques Surgery/anaesthetic/analgesia • Public wish

  17. Public issues • Concerns about hospital cleanliness and outcomes • Worries about chaotic in patient wards- mixed sex, mixed elective emergency care • MRSA/ C.diff. (we were warned!!!)

  18. Where am I now?Ramsay NHS ISTCBlakelands, Milton Keynes ISTC NHS treatment centre Day case surgery only TIVA Enhanced recovery / Australian model hernia repair 4 hours door to door! Careful follow up and audit High patient satisfaction

  19. Where next ? • Joint re-modelling • Improvements in minimally invasive procedures • And that reminds me!

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