E3 - Singapore Sling | Changing Practice | Chris Pearce - Part2

The effects of lockdown on healthcare has resulted in technology being adopted in ways that many have been hoping for.  
As Medics adapt to new ways of working and managing patients Chris Pearce talks openly about the benefits of technology in Medicine.
But there are concerns and he advises caution to ensure that any changes are adopted to facilitate and compliment the doctor's management of patients and not as a replacement.

Transcript

Ros 

I want to go back to where you said that there's a committee that decides which cases can get done, who's involved in that committee and how do they make the decisions?

Chris 

We have an operating committee that works it out and deals with them. Operating theatre-related issues, I used to sit on, but not anymore. Each department has a representative, so you put the case to them. You say, 'I think this patient is urgent and needs to be done'. Trauma or cancer get done anyway, so you don't have to do that for those cases. But things like a high ankle sprain, I had to justify why that couldn't be postponed until the threat level decreases.

Ros 

Moving forward to when you start back, hopefully in July, how do you or how does the hospital decide who gets operated on first?

Chris 

We're actually just working that out now.  As the clinical director, it's my job to sort that out. I haven't quite finalised it yet, but there are two aspects: the outpatient clinic and the operating theatre. We've got about 200 cases for surgery that have been postponed. Generally speaking, they will get the first priority, unless there's something very urgent that comes in. The individual Consultants can choose which patients operations go first. We're going to start with day surgery. We have a 23hour day ward, where the patient stays overnight, they go home in the morning, so they're in the hospital for less than 24 hours. Those beds are 'ring-fenced'. They're not part of the beds used for general patients. So we'll start with those cases first. 

Then we will move on to cases that require an inpatient stay later when things have settled down a bit more. And that's the way we ramped up the COVID response; it was the same. We were allowed to do day surgery cases until March, but we stopped doing any inpatient, non-urgent inpatient cases, at the beginning of February. 

For the outpatients, we've got thousands of patients obviously that were deemed to not be urgent. We'll start with the ones that have had the delay the longest. So the patients that were stopped in February will be the first batch to come back. Patients that were on the verge of needing surgery, we'll prioritise those ahead of those that are one year follow up for operations such as knee replacements.  There are the ones that can still wait a bit longer unless they have any problems. 

We are doing teleconsultations as well. It sounds like you in the UK are ahead of us. I'm just going through the training for it next week.

Ros 

Yes the Private Sector is slightly ahead of the game, and we've certainly been using it and now in the NHS as well.

Ros 

But it's almost as if healthcare seems to be behind the curve compared to other industries; gaming technology and Netflix.  By harnessing the current technology that's available and potentially what will be available within the next five to 10 years, how do you think that will to change your practice?

Chris 

I think a lot of this teleconferencing which we never really used before either at work or socially.   I had a zoom chat with a lot of mates from school, the other day, we're all commented, 'why weren't we doing this before?' You know, they live all over the world; one in America, one in Switzerland and one in the UK.  It was the COVID situation that prompted us to use it. Other than that it was Christmas time and once every couple of years. I think the same goes for medicine. 

I'm the director of research in my hospital. People who are in the research office, hardly any of what they do really require them to be in the building. They are all working from home. And that doesn't seem to affect anything much. Quite a lot of the stuff we could do if we had access to it. 

We do have electronic patient records, but I actually don't have remote access to it at home, which is an issue, there was a big issue with people's data being stolen recently. So, that circle has to be squared or at some point, but there's there is a lot of work that we can do remotely.

Conferences I don't want conferences to be done online, because I like going overseas and meeting over the bar with people like you. But you know that conference that Mark Myerson organised, that that worked really well. Actually, maybe we should be thinking more about doing audit or case reviews, or something like that across the continents with this new way of working. In terms of seeing patients remotely, I think, there's a medico-legal issue. 

I think there's a certain percentage of patients that are amenable to it—one good example of something that Matt Solon set up ages ago.  We used to see the patient in the clinic and say, 'well, I think you've got this, we'll get a scan'. We'd have the radiology meeting, we'd go through all these cases, and with quite a lot of the patients, we could phone the patients and tell them what the scan showed.  We could recommend they carry on with their physio for three months.  We didn't have to bring them back for an appointment. Matt (Solan) set that up ten plus years ago. So I think we can do more of that. There's definitely a lot of appointments that don't need to be. But the new cases or the post-op cases, obviously we can't do that. We are less able to do that than some other specialities probably.

Ros 

Back to conferences, there are two aspects of how this technology affects conferences. Meeting up in person, and definitely the fireside chats at the bar, you get a perspective that you may not get on a 'zoom 'conference, but certainly, the actual educational part of it, the presentations, does lend itself well to virtual technology. It would be a real shame if we lost the other fun aspect of medicine. If all we're doing is work, and no play, then some of the creativity that brings about change and innovation gets lost. 

Chris 

I think actually that is the main reason I go to conferences these days is to see people and as you say the fireside chat. I think I probably learned the most important lessons of my life work-wise, and everything else was in the fireside chat aspect of things.

So that doesn't translate to online conferences for the rest of the world, although I probably saved 20 or 30,000 quid this year by not going to conferences.

Ros 

A lot of these conferences are held heavily sponsored by industry, and their budgets obviously have been fairly dramatically cut in the months that those orthopaedic implants haven't been getting put in.

There will be some changes, and we really need to think about one how to deliver the education differently. And that's when you start to go into the whole realm of AI technology and how you potentially could start to use that within the theatre setting. 

You could have a senior surgeon assisting with technology in two or three theatres, which may not necessarily even need to be in the same country! That's the bit that really kind of blows my mind.  Engineers, scientists and surgeons are looking at how to operate on Mars, which is, however, far away.  So, if we can do that, it kind of seems crazy that we can't actually work out how to operate with COVID around. 

Chris 

That's sort of thing with the da Vinci robot, which is currently used for knee surgery.

Ros 

Do you think there were barriers before? I'm not sure what all those barriers were, whether it was red tape or just the very paternalistic side of medicine.  Do you think the lockdown for COVID provides an opportunity to move some of the barriers aside?

Chris 

In some ways, yes. But the personal touch in medicine is important.  The doctor-patient relationship and also there is the collegiate way as well. I kind of hope not actually.  Maybe that just shows my age.