S7E3 - Inside NHS MSK Imaging: Workforce Pressures, Backlogs and Innovation

In this episode of AXREM Insights, Sally Edgington and guest presenter Jack Bond speak with consultant radiologist Dr Imran Lasker about the growing pressures facing fracture and musculoskeletal (MSK) imaging services across the NHS. The conversation explores how an ageing population, increasing demand for MRI and CT scans, workforce shortages and post-pandemic backlogs are reshaping radiology services. Dr Lasker shares firsthand insight into the realities of modern MSK imaging, from balancing urgent trauma cases with chronic pain investigations to the rise of community diagnostic centres and specialist scanners designed to ease pressure on hospitals.

The discussion also takes a deep dive into the evolving role of AI in healthcare. Dr Lasker explains how AI is already supporting fracture detection, triage and reporting workflows, helping clinicians work more efficiently while still keeping the human element at the heart of patient care. The episode highlights the importance of person-centred care, the mental health impact of delayed diagnoses and the need for technology to support rather than replace healthcare professionals. Together, the panel considers how industry, clinicians and the NHS can collaborate to build more sustainable, accessible and patient-focused MSK services for the future.

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Transcript

Disclaimer: This transcript was produced using AI transcription software. It may contain errors, misspellings or inaccuracies and has not been fully edited for verbatim precision. It is intended to accompany the podcast audio and should not be relied upon as a standalone or definitive record of the discussion. 

[00:00.000 --> 00:05.000]  Welcome to Axrem Insights, developing healthcare through medtech and innovation.
[00:05.000 --> 00:11.000]  Join Melanie Johnson and Sally Edgington as they talk with our industry leaders and experts.
[00:11.000 --> 00:16.000]  Hello and welcome to Axrem Insights condition series this month.
[00:16.000 --> 00:20.000]  We are focusing on fractures and musculoskeletal health.
[00:20.000 --> 00:24.000]  I'm Sally Edgington and I'm here with my guest presenter, Jack Bond,
[00:24.000 --> 00:29.000]  chair of the Axrem Future Leaders Council and sales team manager at ISO.
[00:29.000 --> 00:33.000]  Today we have the pleasure to be speaking to Dr Imran Lasker.
[00:33.000 --> 00:36.000]  So welcome Imran and thanks for being on our show today.
[00:36.000 --> 00:41.000]  Let's start by handing over to you to tell us a bit more about yourself and your career so far.
[00:42.000 --> 00:44.000]  Yes, so first of all, thank you so much for having me.
[00:44.000 --> 00:49.000]  Really excited to be podcasting. It's been a long time since I did any podcasting at all actually.
[00:49.000 --> 00:54.000]  So I am a consultant radiologist. I've been a consultant for about five years.
[00:54.000 --> 00:58.000]  I work at Basildon and Thorough Hospital, University Hospital.
[00:58.000 --> 01:01.000]  I think it's called Mid and South Essex these days.
[01:01.000 --> 01:08.000]  Lovely job and I also partake in, well, I subspecialise in musculoskeletal radiology and trauma imaging.
[01:08.000 --> 01:11.000]  So that's kind of the boring stuff, I think, although I do love my job.
[01:11.000 --> 01:14.000]  But I also partake in a fair bit of social media.
[01:14.000 --> 01:17.000]  I like to get involved in video editing and podcasting.
[01:17.000 --> 01:23.000]  And I also run my own lecturing company as well on the side, which is how I met Jack a few years ago now.
[01:23.000 --> 01:25.000]  So, yeah, thank you so much for having me.
[01:26.000 --> 01:33.000]  Thank you. And so I assume you're a doctor of bones in kind of simple terms.
[01:33.000 --> 01:38.000]  So everything that you do is kind of like bone related. Is that correct?
[01:38.000 --> 01:41.000]  Yes and no. I do a bit combination of things.
[01:41.000 --> 01:43.000]  So I am a general radiologist as well.
[01:43.000 --> 01:47.000]  So it means I do a bit of out of hours stuff and that means the things that come in overnight,
[01:47.000 --> 01:51.000]  some knocks ahead in a car crash, abdominal pain, those kind of things.
[01:51.000 --> 01:55.000]  And I do some cancer imaging as well with some of the follow up stuff that happens.
[01:55.000 --> 02:00.000]  And I think that's the nature of where I think radiology is when it comes to places like where I work,
[02:00.000 --> 02:05.000]  which is Basildon, which is what we'd call District General Hospital, where we do lots of things.
[02:05.000 --> 02:11.000]  And so it's not a very subspecialist area where we focus very much on being a bone hospital,
[02:11.000 --> 02:13.000]  but we do bone things as well as other things.
[02:13.000 --> 02:18.000]  So I end up being quite lucky that I am able to do a little bit more than bones and things like that.
[02:18.000 --> 02:22.000]  And I actually quite like doing the out of hours and night stuff, which is a bit odd,
[02:22.000 --> 02:24.000]  but I really find that stuff quite interesting too.
[02:24.000 --> 02:28.000]  So yeah, a bit of everything really these days.
[02:28.000 --> 02:31.000]  Yeah, sounds very interesting.
[02:31.000 --> 02:35.000]  So Axe Rem Insights podcast brings together the people, technology and ideas
[02:35.000 --> 02:39.000]  shaping the future of diagnostic imaging and healthcare innovation.
[02:39.000 --> 02:43.000]  Today we're diving into a topic that affects millions of patients every year
[02:43.000 --> 02:46.000]  and sits in the heart of our members' work.
[02:46.000 --> 02:49.000]  Fractures and muscular skeletal health.
[02:49.000 --> 02:55.000]  From rising demands and workforce pressures to the rapid evolution of imaging technologies and AI,
[02:55.000 --> 02:59.000]  MSK care is undergoing significant transformation.
[02:59.000 --> 03:04.000]  Our members are at the forefront of that change, developing solutions that improve accuracy,
[03:04.000 --> 03:09.000]  speed up diagnosis and support clinicians across the entire pathway.
[03:09.000 --> 03:12.000]  So in this episode, we'll explore what's working, what needs to change
[03:12.000 --> 03:18.000]  and how industry and the NHS can collaborate to build a more resilient, patient-centred MSK service.
[03:18.000 --> 03:20.000]  So let's get into the conversation.
[03:20.000 --> 03:24.000]  Thanks, Sally, and thanks Imran for joining us today.
[03:24.000 --> 03:26.000]  It's lovely to talk to you again.
[03:26.000 --> 03:29.000]  It's been a little while since we've had a conversation,
[03:29.000 --> 03:34.000]  and thank you very much for accepting our invitation to be on this podcast today.
[03:34.000 --> 03:37.000]  So I'm going to start by asking the questions, if that's okay.
[03:37.000 --> 03:41.000]  So I've got a few in mind and I hope you'll be able to give some wonderful insights
[03:41.000 --> 03:45.000]  and me and Sally may put some of our own thoughts in as well.
[03:45.000 --> 03:50.000]  So my first question is, what are the biggest pressures currently facing MSK
[03:50.000 --> 03:53.000]  and fracture imaging services across the NHS?
[03:53.000 --> 04:01.000]  From the point of view of increasing pressures, I think MSK became surprisingly busy.
[04:01.000 --> 04:05.000]  That's what I would say about MSK radiology and MSK in general.
[04:05.000 --> 04:09.000]  And I think this is one of the things I'm consistently surprised about,
[04:09.000 --> 04:14.000]  but maybe looking back I shouldn't be that surprised because we do have an ageing population.
[04:14.000 --> 04:18.000]  That's something that is a really big factor in what's going on because as we get older,
[04:18.000 --> 04:20.000]  I mean, even now I've got a bit of back pain,
[04:20.000 --> 04:23.000]  but there'll be people who get back pain for longer periods of time,
[04:23.000 --> 04:26.000]  hip pain, shoulder pain, knee pain, all those kind of things.
[04:26.000 --> 04:30.000]  And so they'll end up getting scans at some point, being an X-ray or an MRI scan.
[04:30.000 --> 04:34.000]  And so we have seen definitely in the MSK world anyway,
[04:34.000 --> 04:37.000]  a significant increase in the amount of demand for imaging
[04:37.000 --> 04:41.000]  and the amount of demand for interpretation of that imaging that's happening.
[04:41.000 --> 04:45.000]  And so when we talk to people who are starting tele-radiology companies,
[04:45.000 --> 04:48.000]  often they are very happy to have an MSK radiologist
[04:48.000 --> 04:53.000]  because such a vast amount of the work is coming from the MSK side of things.
[04:53.000 --> 04:58.000]  And that puts a lot of pressure on the NHS as well because on one hand,
[04:58.000 --> 05:04.000]  one would say that an MSK scan is not as important as let's say cancer imaging, which is true.
[05:05.000 --> 05:08.000]  And you'd say something like, well, MSK scan is not as important as something,
[05:08.000 --> 05:12.000]  someone coming in out of hours, having had a crash or something, which is also true.
[05:12.000 --> 05:15.000]  But then when you talk to a person who's got a debilitating problem,
[05:15.000 --> 05:19.000]  such as severe back pain, unable to work, that's a really significant problem.
[05:19.000 --> 05:21.000]  It's very, very urgent to them.
[05:21.000 --> 05:25.000]  And so the allocation of services can be really hard because you've got someone like me
[05:25.000 --> 05:28.000]  who can do on-call imaging and nighttime imaging and that kind of thing.
[05:28.000 --> 05:31.000]  How much of my time do you want to dedicate to the general imaging
[05:31.000 --> 05:34.000]  over the musculoskeletal imaging that also needs to be done?
[05:34.000 --> 05:36.000]  And I think that's the big challenge here.
[05:36.000 --> 05:41.000]  Like, where do you get the workforce to be able to get on top of this particular problem of,
[05:41.000 --> 05:46.000]  well, I wouldn't say problem, this occurrence of increasing in demand for musculoskeletal imaging.
[05:46.000 --> 05:48.000]  And that's just from the interpretation side of things.
[05:48.000 --> 05:51.000]  We haven't even started going down the idea of like, how do you get these scans done in the first place?
[05:51.000 --> 05:54.000]  And where do you even, when do you do them? How do you do them?
[05:54.000 --> 05:57.000]  So, I mean, there are some, I think we may have opened a new MRI scanner
[05:57.000 --> 06:00.000]  and I'm pretty sure that's going to go to capacity soon.
[06:00.000 --> 06:02.000]  And that's just happening up and down the country.
[06:02.000 --> 06:06.000]  And as a result of that, private scanners are opening up like left, right and centre
[06:06.000 --> 06:09.000]  to get on top of some of the scans that are happening.
[06:09.000 --> 06:12.000]  So, yeah, the pressure is immense. I don't have any answers.
[06:12.000 --> 06:17.000]  I can just comment on what I've said and what I'm seeing from my own experience that this is happening.
[06:17.000 --> 06:20.000]  And I think I understand why now, looking back on things.
[06:20.000 --> 06:22.000]  Yeah, that's a really wonderful insight.
[06:22.000 --> 06:26.000]  And I think you're going to touch on a topic that I think we're probably going to come back to a few times
[06:26.000 --> 06:28.000]  during this conversation, which is workforce.
[06:28.000 --> 06:35.000]  Obviously, as a technology supplier, we would like to try and help the workforce as much as possible.
[06:35.000 --> 06:40.000]  And I appreciate some of the issues we're seeing at the ageing population, which increases the demand
[06:40.000 --> 06:45.000]  versus the how do you allocate the service between what is a critical urgent need
[06:45.000 --> 06:53.000]  against all of the 70, 80, 90-year-olds who are coming in with back pain, knee pain, arthritic pain,
[06:53.000 --> 06:55.000]  which is still very important to do.
[06:55.000 --> 06:59.000]  So, obviously, the tele-radiology companies can help with the reporting
[06:59.000 --> 07:02.000]  and the private scanners can help with that.
[07:02.000 --> 07:05.000]  Is there anything else that technology suppliers, in your view, could potentially do
[07:05.000 --> 07:09.000]  to help with this workforce or workflow issue?
[07:09.000 --> 07:13.000]  Yeah, I've seen this happening already, where I think there has been some significant increase
[07:13.000 --> 07:17.000]  in help from technology companies in terms of the actual scanner itself.
[07:17.000 --> 07:21.000]  So at the moment, we have MRI scanners and CT scanners, which are one size fits all.
[07:21.000 --> 07:25.000]  And that's what they do, because you can scan an ovary, you can scan the uterus,
[07:25.000 --> 07:30.000]  you can scan the abdomen, you can scan all sorts of things, as well as the spine,
[07:30.000 --> 07:32.000]  as well as the arms and legs.
[07:32.000 --> 07:39.000]  And so I am aware that there are now scanners that just do the hands and feet or just the knee.
[07:39.000 --> 07:45.000]  And that can be really useful because that would take pressure away from a vastly more resourceful
[07:45.000 --> 07:48.000]  or something else that needs a lot more resources.
[07:49.000 --> 07:54.000]  Because when you're talking about an MRI scanner, which can scan everything and would scan everything,
[07:54.000 --> 07:58.000]  then when you're doing an MRI spine, that can take half an hour, 14 minutes, maybe even more,
[07:58.000 --> 08:01.000]  depending on what exact sequences you're requiring.
[08:01.000 --> 08:07.000]  But if you're saying that actually we can make sure that we use that for the very complex things,
[08:07.000 --> 08:12.000]  and I'm not saying MSK is not complex, but maybe less complex kind of scanner that may be required
[08:12.000 --> 08:17.000]  to be able to help with the limbs, then I think that's something that can really help,
[08:17.000 --> 08:24.000]  because if you kind of start to go down that road of being able to get on top of the MSK scans
[08:24.000 --> 08:29.000]  using slightly cheaper and smaller scanners, they take less room, less expertise to run,
[08:29.000 --> 08:34.000]  and they can get done faster as well and don't take as much time in the main scanner that we'd be using.
[08:34.000 --> 08:39.000]  So I think that's one of the big areas, and I have seen advances in those areas as well as time has gone on.
[08:40.000 --> 08:48.000]  And I'm quite excited by that, because so much MRI time is taken up by knees and shoulders and spines and stuff,
[08:48.000 --> 08:53.000]  so that would be good to be able to get that out and then get someone else to concentrate on those things
[08:53.000 --> 08:59.000]  and us to be able to concentrate on the bits that matter to the MSK lethal population.
[08:59.000 --> 09:05.000]  Yeah, and just to say, I'm a big advocate, obviously, for technology and technology that our members provide,
[09:06.000 --> 09:10.000]  and I know that a lot of MRI and CT scanners now have built-in AI,
[09:10.000 --> 09:16.000]  which I always say that AI is there to create efficiencies that can help with the workforce shortages,
[09:16.000 --> 09:22.000]  because it makes things more efficient, and obviously modern scanners can scan quicker and things like that.
[09:22.000 --> 09:29.000]  But I agree that I know one of our members has recently just launched a new, very small X-ray machine
[09:29.000 --> 09:35.000]  that can help, just as you were saying, to alleviate pressure on MRI and CT.
[09:35.000 --> 09:39.000]  And I wonder as well whether, obviously, for things like that,
[09:39.000 --> 09:47.000]  then obviously I assume that the CDCs would be used to alleviate some of those pressures off the main hospital setting.
[09:47.000 --> 09:51.000]  Is that right? Is that how that happens in your area?
[09:51.000 --> 09:56.000]  Yes, I think they are starting to develop scanning centers that are away from the main hospital,
[09:56.000 --> 10:02.000]  because ultimately the hospital scanners have to prioritize the inpatients.
[10:02.000 --> 10:05.000]  They have to prioritize the people who are genuinely unwell inside the hospital,
[10:05.000 --> 10:09.000]  but they also have to do outpatients for people just walking in and getting their scans done.
[10:09.000 --> 10:12.000]  And I think with an aging population, the risks are twofold.
[10:12.000 --> 10:16.000]  First off, the travel, the time that takes, the amount of time it takes out of the day,
[10:16.000 --> 10:20.000]  especially for some of the more elderly patients who need transport to come in.
[10:20.000 --> 10:24.000]  Then they've got to sit around in a waiting room. There's lots of ill people around.
[10:25.000 --> 10:30.000]  It's not entirely a nice environment for someone that's actually not that unwell.
[10:30.000 --> 10:34.000]  And then they've got to try and get fit in on their appointment time.
[10:34.000 --> 10:39.000]  It's probably better for them to be able to go to a scanning center which is very much dedicated to their kind of problem,
[10:39.000 --> 10:42.000]  where they walk in, they get the scan and they walk out.
[10:42.000 --> 10:44.000]  And we're seeing more and more of that happening.
[10:44.000 --> 10:49.000]  And then it starts to become a bit of a political problem as well,
[10:49.000 --> 10:52.000]  because if we don't get enough scanners, but there's lots of private scanners,
[10:52.000 --> 10:56.000]  then private scanners will start to try and vie for business from the NHS.
[10:56.000 --> 11:01.000]  And I think that's going to be a big political football really as to how much of the private sector
[11:01.000 --> 11:06.000]  do you really want to use to try and alleviate the pressure that's on the main NHS hospitals,
[11:06.000 --> 11:10.000]  whether you want to build our own community scanning centers.
[11:10.000 --> 11:14.000]  So there's a combination of things. It just depends on which way the government wants to go.
[11:14.000 --> 11:19.000]  But in general, I do think that having scanning centers is a good idea
[11:19.000 --> 11:23.000]  because people can walk in and walk out and not have to worry about parking issues and all that kind of thing.
[11:23.000 --> 11:32.000]  Because I mean, being on the other side where I have to like I do an ultrasound list and transport is the issue.
[11:32.000 --> 11:35.000]  You know, a lot of the time patients are turning up late because of transport and there's nothing to do.
[11:35.000 --> 11:37.000]  It's not their fault. It's just there's been traffic.
[11:37.000 --> 11:40.000]  There's been other people the transport have to bring in and all that kind of thing.
[11:40.000 --> 11:42.000]  It delays inpatients and all that kind of stuff.
[11:42.000 --> 11:46.000]  And so I really feel like that is probably going to be the future on some level,
[11:46.000 --> 11:52.000]  whereas the kind of combination of community scanning centers helping with the backlog
[11:52.000 --> 11:57.000]  and also having the main hospital scanners doing the hospital stuff.
[11:57.000 --> 12:03.000]  Yeah. And it plays into the 10 year plan hospital to home and the community diagnostic centers are bringing,
[12:03.000 --> 12:09.000]  you know, diagnostics closer to home and we even have members and they've got a diagnostic car
[12:09.000 --> 12:14.000]  that brings diagnostics all the way to, for instance, an old people's home or, you know,
[12:14.000 --> 12:19.000]  to save them even having to travel, which is always going to be the better option, like you say.
[12:19.000 --> 12:22.000]  So then they're not exposed to other illnesses and stuff.
[12:22.000 --> 12:24.000]  So, yeah, totally agree.
[12:24.000 --> 12:32.000]  So where do you see the most significant bottlenecks in the fracture pathway from first presentation to diagnosis and treatment?
[12:32.000 --> 12:37.000]  And what innovations do you think could realistically remove them?
[12:37.000 --> 12:42.000]  So I think when it comes to the big fractures, you know, the big or the big injuries is pretty obvious.
[12:42.000 --> 12:47.000]  And it's it's not hard to really figure out like when a shoulder is completely dislocated,
[12:47.000 --> 12:50.000]  it's the more subtle things that I think are going to be the ones that get delayed.
[12:50.000 --> 12:56.000]  And I think that's the issue where you've got a big like a small corner fracture, a spinous process fracture.
[12:56.000 --> 13:00.000]  For those that don't know, there's just smaller bits of anatomy that often gets overlooked.
[13:00.000 --> 13:03.000]  And so I think that is a real big problem.
[13:03.000 --> 13:08.000]  And that's why you do need trained people to be able to know where those problems are.
[13:08.000 --> 13:13.000]  Now, I'm going to probably take away a little bit from my own subspecialty in that it can get formulaic.
[13:13.000 --> 13:16.000]  There's only so many ways like ways the body can really injure itself.
[13:16.000 --> 13:21.000]  Right. Once you've seen one and you kind of I know that when I'm looking through X-rays,
[13:21.000 --> 13:25.000]  there'll be certain areas I look at because I've seen subtle, subtle injuries in those places first.
[13:25.000 --> 13:27.000]  And then I'll go for the big things.
[13:27.000 --> 13:35.000]  And you can put into sort of imagination that it wouldn't be that much longer for some level of AI to be able to do those things.
[13:35.000 --> 13:40.000]  And I know that a lot of people don't like the idea that AI could potentially take away a job,
[13:40.000 --> 13:43.000]  some parts of the job, areas of the job or any part of the job.
[13:43.000 --> 13:48.000]  But I also think that we shouldn't be too averse to it because clearly it's a useful, useful thing.
[13:48.000 --> 13:54.000]  And even in my own sort of educational side of things where I've tested out X-rays from Radiopedia
[13:54.000 --> 13:58.000]  and just put it onto like there's something called Claude just to see what it would say.
[13:58.000 --> 14:01.000]  And I was actually quite impressed with what it was coming out with.
[14:01.000 --> 14:06.000]  And so then the question is like, let's say it is possible and is and is completely possible
[14:06.000 --> 14:10.000]  for some level of AI to be able to interpret images.
[14:10.000 --> 14:12.000]  How much are we really comfortable with?
[14:12.000 --> 14:19.000]  And I think that's the bigger question really when it comes to how AI is implemented with health care.
[14:19.000 --> 14:23.000]  Because I think as I say the broader idea of as a species,
[14:23.000 --> 14:28.000]  I don't think we're entirely comfortable with having computers do everything.
[14:28.000 --> 14:33.000]  And even if a computer was to show 99.99% accuracy,
[14:33.000 --> 14:37.000]  I think you probably people would feel a little bit more comfortable that someone just glanced over,
[14:37.000 --> 14:38.000]  just had a look.
[14:38.000 --> 14:40.000]  And that's part of the human side of health care,
[14:40.000 --> 14:45.000]  which I think can be a bit overlooked by the big tech companies who I guess in their best interest
[14:45.000 --> 14:49.000]  do want to try and promote themselves and try and make sure that people pay attention
[14:49.000 --> 14:53.000]  and think that they're going to be the big answer to the big, the big problems.
[14:53.000 --> 15:00.000]  So I think for a long time we're not going to see a big change in terms of AI completely taking over.
[15:00.000 --> 15:02.000]  I think it will heavily supplement what we do.
[15:02.000 --> 15:05.000]  And even at the point where it's going to start being able to do most things,
[15:05.000 --> 15:10.000]  I still think we're probably going to be more comfortable with a human being being involved at some point.
[15:10.000 --> 15:15.000]  And I think we'll take decades before human beings are completely comfortable just letting go
[15:15.000 --> 15:19.000]  and not thinking about it and letting some computer algorithm just do everything.
[15:19.000 --> 15:22.000]  But in answer to your question, where do I think it's going?
[15:22.000 --> 15:25.000]  I think AI is going to play a huge, huge role, a huge role.
[15:25.000 --> 15:32.000]  And I've already seen it make massive changes to my own workflow and some of the tools that I've got to my disposal.
[15:32.000 --> 15:34.000]  And to be honest with you, it's helped a lot.
[15:34.000 --> 15:37.000]  And by helping me, I help more people and help more patients.
[15:37.000 --> 15:44.000]  So it's only positive from my side of things when it comes to the potential solutions that are being available right now.
[15:44.000 --> 15:47.000]  Yeah, I think you raised a really good point.
[15:47.000 --> 15:51.000]  I think there's actually one I scribbled down before we got chatting,
[15:51.000 --> 15:54.000]  is that sometimes I think the smaller issues and smaller fractures,
[15:54.000 --> 15:57.000]  the more basic routine ones actually cause the bigger problems.
[15:57.000 --> 16:01.000]  Because when you look at the statistics in the news, it's always about the beds and the corridors,
[16:01.000 --> 16:04.000]  the wait time to get from A&E to a ward.
[16:04.000 --> 16:07.000]  There isn't as much focus on minor injuries.
[16:07.000 --> 16:14.000]  And you go along, you watch a politician walking through A&E and seeing how busy recess is and how busy everything else.
[16:14.000 --> 16:16.000]  They kind of skip through that first stage.
[16:16.000 --> 16:22.000]  And yes, it's maybe not as critically urgent if you have a spiral fracture in one of your metacarpals.
[16:22.000 --> 16:26.000]  However, you're still one of the patients who are still having part of the journey.
[16:26.000 --> 16:31.000]  I agree, AI is going to be one of those technologies that can help us.
[16:31.000 --> 16:37.000]  But I read a quote recently about how important the invisible technology is.
[16:37.000 --> 16:40.000]  And it's the technology that we don't see day to day and we don't even notice.
[16:40.000 --> 16:45.000]  And actually, if we can find a way of implementing this technology into our general workflow,
[16:45.000 --> 16:50.000]  it's going to help you as a clinician or you as a radiographer focus on the job you're trained to do.
[16:50.000 --> 16:57.000]  You're being supported by almost a digital mentor to give you that decision, to give you the best treatment for the patient.
[16:57.000 --> 17:01.000]  So it's really interesting when you try and look at it.
[17:01.000 --> 17:07.000]  That's actually the biggest problem is to look at the smaller ones and how can we help alleviate these smaller issues.
[17:07.000 --> 17:14.000]  But kind of looking back at how everything's changed then, especially in MSK imaging post pandemic,
[17:14.000 --> 17:21.000]  how has the demand changed after Covid and what does that mean for capacity planning now?
[17:21.000 --> 17:27.000]  I mean, from my personal experience, demand has increased significantly since the pandemic.
[17:27.000 --> 17:31.000]  I think I would have said that I didn't have a busy job going into the pandemic.
[17:31.000 --> 17:34.000]  But after the pandemic, it got really, really busy.
[17:34.000 --> 17:41.000]  And during the pandemic, it was very kind of quiet, wasn't much happening because the backlogs were being dwindled down.
[17:41.000 --> 17:44.000]  There weren't being many new scans, things were being prioritized accordingly.
[17:44.000 --> 17:50.000]  People who these patients who are quite elderly, who've got these long term problems, weren't getting scanned as quickly
[17:50.000 --> 17:54.000]  because the risks of catching Covid were greater than coming in to get a scan.
[17:54.000 --> 17:58.000]  So we saw a real lull in activity during the pandemic time.
[17:58.000 --> 18:01.000]  But after that, I think it caught up and then took over.
[18:01.000 --> 18:05.000]  I mean, the private scanners, they got busy because a lot of the time what I'll see,
[18:05.000 --> 18:10.000]  and this is just, again, my own first hand experience and the indication will literally say something like NHS has taken too long.
[18:10.000 --> 18:16.000]  And I can completely understand that when someone is trying to figure out which scan needs to be done sooner,
[18:16.000 --> 18:21.000]  you're less likely to go for someone who's got a bit of knee pain rather than someone who's actually got significant weight loss.
[18:21.000 --> 18:24.000]  And I completely understand that. But for the person with knee pain, that's a really big deal.
[18:24.000 --> 18:26.000]  And that might mean they can't work.
[18:26.000 --> 18:31.000]  And so they might say, well, you know what, I'm going to spend a couple of hundred quid and go get a private scan and get that done.
[18:31.000 --> 18:39.000]  And so what I've personally seen is that the scanning that's being done in sort of the private sectors is increased significantly from the MSK side of things.
[18:39.000 --> 18:44.000]  Shoulders, knees, spines. And then then we also were constantly playing backup.
[18:44.000 --> 18:48.000]  I mean, a catch up, constantly playing catch up with the NHS anyway.
[18:48.000 --> 18:54.000]  And so then you've got those ones that didn't get scanned during that time that we're trying to catch up on and their follow ups and all the rest of it.
[18:54.000 --> 18:57.000]  So things have got really busy.
[18:57.000 --> 19:04.000]  And, yeah, I did not predict that MSK radiology would be as busy as it is, but consistently.
[19:04.000 --> 19:17.000]  Yeah, if you look across the board, there's backlogs everywhere and scans that need to be done because WiredWell, people who are professionals, weekend warriors, all of these people are coming in to get some kind of level of X-ray or MRI scan,
[19:17.000 --> 19:23.000]  which then needs to be looked at by someone like some professional before they can carry on with their lives and their day jobs.
[19:23.000 --> 19:28.000]  I think one thing we're stopping really is we're not planning for recovery anymore in the NHS.
[19:28.000 --> 19:32.000]  We're just planning for a permanently higher baseline that we all have to work towards.
[19:32.000 --> 19:39.000]  And one of the things we can help in and it's going to alleviate is the CDC program and having the diagnosis in the community.
[19:39.000 --> 19:44.000]  But you mentioned a point then about getting say you have an arthritic knee and you're getting the scan.
[19:44.000 --> 19:57.000]  What do you think from a patient's mental health point of view is to say having a scan and the ability to actually have an X-ray or a CT and MRI in the community.
[19:57.000 --> 20:00.000]  Because of the amount of backlogs still and the amount of workforce shortages.
[20:00.000 --> 20:10.000]  Do you think there is a potential implication to the patient's mental health if they can have to wait an extra couple of weeks for a diagnosis to come through just because they've had their scan doesn't mean actually get the answers on the day.
[20:10.000 --> 20:15.000]  And how do you think that's going to impact how we view patient care in the community?
[20:15.000 --> 20:22.000]  Well, I think that people underestimate mental health in general, quite frankly, especially when it comes to our patients.
[20:22.000 --> 20:29.000]  And so I think as doctors, we're very guilty of just seeing a patient as a body and figure out what's wrong with bits of the body and don't think about much more.
[20:29.000 --> 20:43.000]  But what I realized from my short stint in GP when I was an F2 and during my training is that mental health is a huge, huge part of the problem or not problem, but part of their their work is mental health.
[20:43.000 --> 20:51.000]  And so when you've got someone that is normally able to work and let's say push around a trolley in Asda and stack the shelves or whatever it is and suddenly their knee hurts all the time.
[20:51.000 --> 20:54.000]  That's something that they've got to live with every single day.
[20:54.000 --> 20:59.000]  And any step towards finding an answer is helpful for their mental health.
[20:59.000 --> 21:06.000]  At least if they had a scan and know that a scan has been done and then they're going to have an answer at some point, it makes them feel better.
[21:06.000 --> 21:10.000]  And it's that first step of being taken seriously that I think a lot of people get very upset about.
[21:10.000 --> 21:13.000]  And so you'll often hear about people complain about the GP.
[21:13.000 --> 21:16.000]  I can't remember the last time I talked to someone who said they had a great GP.
[21:16.000 --> 21:18.000]  But I understand that like GPs have got pressures.
[21:18.000 --> 21:20.000]  They can't just say yes to everything.
[21:20.000 --> 21:23.000]  But from a patient's point of view, that's the first person that they see.
[21:23.000 --> 21:26.000]  And if they don't get a scan or some sort of investigation, they feel hard done by.
[21:26.000 --> 21:29.000]  They don't feel like they've got the best care that they could have done.
[21:29.000 --> 21:35.000]  So I think on a lot of levels, radiology is the first step and the thing that people want.
[21:35.000 --> 21:39.000]  And I will have patients who come into my ultrasound clinics.
[21:39.000 --> 21:43.000]  And you can tell they're very difficult patients in terms of they're very worried and they're very kind of strung up.
[21:43.000 --> 21:45.000]  And they've got lots of things to tell me about lots of things.
[21:45.000 --> 21:48.000]  I've got nothing to do with what I'm trying to do, which is scan their finger.
[21:48.000 --> 21:50.000]  But they're telling about their stomach pains and all these kind of things.
[21:50.000 --> 21:53.000]  And I listen because I get the pressures from the other side.
[21:53.000 --> 21:56.000]  The GPs don't have time to listen to absolutely everything.
[21:56.000 --> 22:01.000]  And although I can't help with everything, I can be part of the solution in that I can't help with the outdoor pain right now.
[22:01.000 --> 22:06.000]  I haven't asked to scan your tummy, but I have been asked to help with your finger and I'll have a look at that finger.
[22:06.000 --> 22:11.000]  So at least they've got one less thing to worry about because it feels like something is being done.
[22:11.000 --> 22:14.000]  And that's something I think people underestimate.
[22:14.000 --> 22:20.000]  And then I think sometimes we as medics get very focused on if we do this scan, what's the outcome?
[22:20.000 --> 22:22.000]  What are we physically going to see?
[22:22.000 --> 22:25.000]  But we're not really thinking about what's mentally going to happen to a person.
[22:25.000 --> 22:30.000]  So if the lightness of someone having something wrong in the abdomen is very low and we can all tell that.
[22:30.000 --> 22:38.000]  But the patient's constantly worried about their abdominal pain or something, then I don't think it's a terrible thing to do the scan just to alleviate that that problem.
[22:38.000 --> 22:43.000]  So they can move on to whatever else they need to do, maybe move on with their life and think about other things.
[22:43.000 --> 22:50.000]  And like your health is pretty much like we were talking about things that you don't think about because it works well.
[22:50.000 --> 22:53.000]  Health is one of those things like when it's working well, you don't think about it.
[22:53.000 --> 22:56.000]  But when it doesn't work, that's when you start thinking about it a lot.
[22:56.000 --> 23:03.000]  And as health care professionals, I think we overlook that that that that small thing may be niggling to me or you and may not sound like a big deal.
[23:03.000 --> 23:08.000]  But for the person has to live every day, that's a really big deal and can really, really great them down over time.
[23:08.000 --> 23:15.000]  And I think that's one of those areas where I think radiology is they don't really realize how important it is.
[23:15.000 --> 23:20.000]  Well, people don't really realize how important it is that, yes, we are putting a lot of resources towards imaging.
[23:20.000 --> 23:26.000]  But like you said, Jack, I think it's not just about finding problems in terms of physical problems.
[23:26.000 --> 23:32.000]  It's also about treating something, anything, trying to show that you're doing something and that can help people a lot as well.
[23:32.000 --> 23:35.000]  Get them back into their lives. Right.
[23:35.000 --> 23:41.000]  Yeah. And I think that all leads into person centered care, you know, making sure the patient is at the center.
[23:41.000 --> 23:48.000]  And also, I think that these days as well that, you know, patients like to feel like they're part of the decision making process and kind of, you know,
[23:48.000 --> 23:55.000]  have an element of control over what, you know, the next steps might be in the actions relating to their care.
[23:55.000 --> 23:58.000]  So I absolutely agree with that.
[23:58.000 --> 24:06.000]  We've already touched a little bit on AI, but what role is AI now playing in fracture detection, triage and reporting?
[24:06.000 --> 24:13.000]  And what evidence do we have about its impact on accuracy and workflow from your perspective?
[24:13.000 --> 24:22.000]  So I've seen a few algorithms algorithm so far, and it's been quite smart in that it gives me a percentage idea of what it thinks the problem is.
[24:22.000 --> 24:26.000]  So it says, I think the problem is here and gives a percentage of how correct it thinks it is.
[24:26.000 --> 24:32.000]  And that's been useful and sometimes because sometimes it'll alert me something that maybe I should have looked a bit closer to.
[24:32.000 --> 24:35.000]  But so far, it hasn't been that great.
[24:36.000 --> 24:43.000]  But this is the thing, like when you look at the mobile phone and think about where it started to where it is now, you never really thought that it could do so many things.
[24:43.000 --> 24:46.000]  And I think that over time it will get good. It'll get really good.
[24:46.000 --> 24:50.000]  And even if it gave didn't give me the percentages, but gave you like yourself a percentage.
[24:50.000 --> 24:56.000]  So let's say you walked into Amy, you had an x-ray done and it said 99 percent or 90 percent chance of no fractured.
[24:56.000 --> 24:58.000]  You still want to see someone.
[24:58.000 --> 25:01.000]  And then you think to yourself, well, I said 90 percent, I actually feel all right.
[25:01.000 --> 25:03.000]  Maybe I won't see someone. And then you go home.
[25:03.000 --> 25:06.000]  And yes, you might get called later because there was a bit of an error in that.
[25:06.000 --> 25:10.000]  But you may you've been given that choice of saying that there was a 90 percent chance that this is going to be normal.
[25:10.000 --> 25:14.000]  But 10 percent chance. Are you willing to stay for the 10 percent or are you going to go home?
[25:14.000 --> 25:20.000]  And I think that those areas where I think that we haven't really thought about like, yes, of course, it's nice to try and help me.
[25:20.000 --> 25:25.000]  But what about the person on the other end that can get like a near answer as quick as possible?
[25:26.000 --> 25:34.000]  Sometimes, you know, I remember I went to I was called into a private scanner up the road because they couldn't send out the scans anymore.
[25:34.000 --> 25:40.000]  Something had happened. So they asked me to look at the scans at the actual scanner and just make sure there's nothing major going on.
[25:40.000 --> 25:48.000]  And I overheard one of the people patients say, if I paid a little bit more, could I just talk to the person right now just to see what they think from the offset?
[25:48.000 --> 25:52.000]  And they weren't allowed to do that, obviously, because there was no I didn't know that could even be a service.
[25:52.000 --> 25:58.000]  But like even a half answer is useful to people in the very first instance of having a scan.
[25:58.000 --> 26:01.000]  And I think that's probably where we'll probably we will start.
[26:01.000 --> 26:05.000]  But I think right now the focus really is on trying to be as useful and as accurate as possible.
[26:05.000 --> 26:14.000]  But I kind of feel like maybe we should be focusing on the patient's care and think about where could it be useful for a patient if they got a percentage like likeliness of them having an injury?
[26:14.000 --> 26:18.000]  Would that be better for them to be able to make a more informed decision about what they want to do next?
[26:18.000 --> 26:22.000]  Do they want to sit in any for two, three hours or do they want to come home and get a phone call later?
[26:22.000 --> 26:26.000]  That kind of thing. So I think that's where I think it'd be useful.
[26:26.000 --> 26:29.000]  The ones that I've used so far have been pretty good.
[26:29.000 --> 26:36.000]  But one of the areas that I've seen a significant increase in AI activity is the actual generation of reports.
[26:36.000 --> 26:38.000]  And that is something I've seen across the board.
[26:38.000 --> 26:47.000]  I played around with the odd bit of software here and there where radiologist time is being freed up from having to write verbose reports by saying one or two things.
[26:47.000 --> 26:51.000]  And then the report generates itself and then you check it and put it through.
[26:51.000 --> 26:57.000]  I think that's another area where that will help reduce the amount of time it takes per scan.
[26:57.000 --> 27:01.000]  Because I think sometimes and I know people are not going to like what I say here.
[27:01.000 --> 27:04.000]  Sometimes what I do is a little bit performative.
[27:04.000 --> 27:07.000]  And that goes down from writing report to doing an ultrasound.
[27:07.000 --> 27:11.000]  So, for example, when I'm doing ultrasound, I've got a patient, I've checked their knee, everything's fine.
[27:11.000 --> 27:14.000]  But I still have to ask them, where do you feel the problem is?
[27:14.000 --> 27:20.000]  Then they'll point to where the problem is. I scan that and everywhere else to make sure that they know that I've looked everywhere.
[27:20.000 --> 27:27.000]  Or even if I didn't see, even if I know it's not going to make a difference, that they fit, they walk out feeling as though something has been done.
[27:27.000 --> 27:30.000]  So I notice the same is true for when you write a report.
[27:30.000 --> 27:33.000]  If I just write the word normal in a report, then people don't like it.
[27:33.000 --> 27:36.000]  They say, well, did you even look like why would you say normal?
[27:36.000 --> 27:38.000]  You can't just say normal. Like, what about the rest?
[27:38.000 --> 27:43.000]  Even though I may have seen everything else, if I just write the word normal, it looks like I haven't done that much to it.
[27:43.000 --> 27:52.000]  One of the areas I've seen is that the AI is creating larger reports from very little information that you need, the positive information that you put into it.
[27:52.000 --> 27:54.000]  Arguably good or bad, who knows?
[27:54.000 --> 28:05.000]  But I think that from a patient perspective, if they get a nice, long worded report going through all the negatives and positives and has the positive finding that the radar has seen, it feels better.
[28:05.000 --> 28:12.000]  And if we're able to produce those kind of reports faster, then I think that's an overall positive thing for people and we can get through more work.
[28:12.000 --> 28:16.000]  So that's one of the areas I've seen a significant increase in activity of late.
[28:16.000 --> 28:20.000]  Yeah, and it takes away that administrative burden, you know.
[28:20.000 --> 28:23.000]  Yeah, because it is sort of more the writing side of it.
[28:23.000 --> 28:41.000]  So, you know, if you can use that, and I know even in other areas of the NHS, AI is having a massive, you know, impact in terms of kind of, you know, being able to dictate, if you like, into an AI algorithm to, you know, do patient records and stuff like that.
[28:41.000 --> 28:51.000]  I've seen with our members where they've got an AI tool that can read a scan and triage it to the top of the list so that it's reported quicker.
[28:51.000 --> 28:56.000]  You know, so obviously someone isn't sitting there feeling anxious and we were talking about mental health and stuff like that earlier.
[28:56.000 --> 29:02.000]  I think that plays into that piece as well.
[29:02.000 --> 29:03.000]  Yeah, exactly.
[29:03.000 --> 29:18.000]  Exactly. And I think that's the thing like we, a lot of time, I mean I spent a lot of time as a junior doctor writing notes, like it's amazing how much time I spent writing notes, but now with electronic systems with the AI note taking systems that we have.
[29:18.000 --> 29:31.000]  It means that now you could actually technically do more things so we used to be very upset about how we couldn't get really stuck in with some procedure on the ward or get involved with some surgery that was going on, or maybe see more patients or something like that.
[29:31.000 --> 29:38.000]  But now with the help of AI, you're able to actually concentrate on the more human side of things.
[29:38.000 --> 29:51.000]  And this is one of the things I used to feel bad about, and maybe it's just me, I don't know, I can't speak for everyone, but I remember we had a patient and the daughter kept coming in to speak to me specifically because she seemed once and I was quite chatty and tried to make sure she was okay.
[29:51.000 --> 29:55.000]  But a couple of times I was way too busy. I was literally running off my feet.
[29:55.000 --> 30:03.000]  And it's those kind of times you think like what part of me is being a doctor, is it writing in these notes or is actually talking to you and just making sure that you feel okay about things.
[30:03.000 --> 30:11.000]  And I think these tools will help us go back to kind of what it was meant to be about, rather than just note taking and tick boxing and all the rest of it.
[30:11.000 --> 30:20.000]  Maybe we should get to a point where the AI does all that stuff and we just get back to talking to people. It was an odd thing to say as a radiologist because I don't talk to many people these days.
[30:20.000 --> 30:37.000]  Yeah, but I think you're right there and it's kind of going along the topic of the conversations we've had already is how can we use technology or how can we put something in place to free up your time to get you back to doing the jobs that you are trained to do as radiologists, radiographers, doctors, nurses or whatever your profession.
[30:37.000 --> 30:50.000]  What can suppliers do to help you alleviate some of the issues and pressures? And I think that there is a lot of focus, but I know there's a lot of focus on AI in terms of the generating a report and reading the images and prioritizing.
[30:50.000 --> 30:55.000]  But maybe there's other areas that AI could help involve the workflow process.
[30:55.000 --> 31:10.000]  One thing I've spoken to some suppliers and some trusts in the past is could we use AI maybe to look into actually not fracture detection, but diagnostic detection of an X-ray and give you a percentage of is this X-ray technically suitable or not?
[31:10.000 --> 31:25.000]  And then how can we use the workforce to alleviate some of the pressures? It might be that we can use APs in more of a capacity or train a nurse in radiation protection to take some very routine X-rays.
[31:25.000 --> 31:34.000]  If you've got a system that's giving you an example of yes, this is diagnostic quality or not, that will then empower another clinician to take some of the pressure off radiology.
[31:34.000 --> 31:40.000]  So the radiographers and the radiologists can do maybe some more of the advanced procedures and practices.
[31:40.000 --> 31:54.000]  Taking it one step further, and I'll be interested in your opinion on this, do you think AI could be used to help the doctors and GPs who put in CT and MRI requests who need a protocol to say when they put a request in, do you think this would be accepted or not?
[31:54.000 --> 32:00.000]  Do you think an AI adoption in that area would help relieve some of your pressures and some of your workflow?
[32:00.000 --> 32:06.000]  To be frank with you, I'm surprised it hasn't already. And if it hasn't happened already, I expect it to happen quite soon.
[32:06.000 --> 32:12.000]  And I think it's because, I mean, a lot of this is because of a difference in knowledge about certain areas.
[32:12.000 --> 32:16.000]  So there's obviously things I don't understand about how Northropod does a particular procedure.
[32:16.000 --> 32:23.000]  But there will be things that they don't understand about what kind of scan is best with regards to what kind of osteomyelitis they've got, what kind of bone tumours going on.
[32:23.000 --> 32:33.000]  And I think that maybe AI can be the bridge between the two of us, enable us to essentially be a translator of the same language, right?
[32:33.000 --> 32:41.000]  And that's all this is. I'm trying to listen to what they're saying and then translate it into something that is useful for me to be able to do my job.
[32:41.000 --> 32:53.000]  And I have seen examples of this where AI has just listened to what the person is requesting and then figured out these are the most likely tests that exist, scans that you will require for this particular thing.
[32:53.000 --> 33:02.000]  And I found them to be fairly accurate, actually. And I think for us anyway, where I work, vetting and triaging takes a huge amount of time.
[33:02.000 --> 33:10.000]  And it can't just be anyone. It can't just be a junior doctor who just started to triage through things because they have to understand what scan has done for what reasons.
[33:10.000 --> 33:14.000]  And that's why Irma exists. And that's why these qualifications exist in the first place.
[33:14.000 --> 33:24.000]  But AI can definitely, with the knowledge base that it's got and the amount of reasoning, especially with the newer models that I've been playing around with, like OPUS 4.7, it's just incredible the amount of
[33:25.000 --> 33:33.000]  Intricacy that it can see and figure out what, and it can even give you an explanation as to, OK, this could be the scan that you'd want to get, but this is going to be the limitation.
[33:33.000 --> 33:42.000]  It's just incredible. But this is the thing, right? I think that some technologies are already here, like the one that we're talking about in terms of triaging and figuring out what the best scan protocols are.
[33:42.000 --> 33:52.000]  It's just a case of whether people really want it. And also there's lots of red tape when it comes to these things, because ultimately you're entrusting a computer to do some level of health care.
[33:52.000 --> 33:59.000]  And are we as people OK with that? And is the government going to be OK with that? Are doctors going to be OK with that? And more importantly, are patients going to be OK with that?
[33:59.000 --> 34:09.000]  And I still think that, you know, there was this whole problem, I don't know whether it's still a problem, or I don't want to say problem, but challenge, where people were talking about, I know doctors are talking about
[34:09.000 --> 34:16.000]  radiographers reporting. And if they, if radiographers start reporting, then they may, there'll be less work for radiologists to do.
[34:16.000 --> 34:22.000]  But I think that ultimately depends on the people who are getting treated, like what do they want? You know, like what do they want?
[34:22.000 --> 34:29.000]  And I don't really have an issue with whoever they want to get treated with, because actually most of the time the x-rays and things I've seen from radiographers are completely fine.
[34:29.000 --> 34:37.000]  There's no, there's no problems with that. And they probably pick up problems with my reports and vice versa. But it's about what do people want? And what are we comfortable with?
[34:37.000 --> 34:48.000]  And I think that as time goes on, we will get to a point where we're comfortable with AI doing those bits, triaging, maybe even figuring out what protocol is going to be done and maybe even doing the scan.
[34:48.000 --> 34:57.000]  And then maybe at some point we'll get OK with people like the AI to give us a full report. It's going to take a while, though.
[34:57.000 --> 35:04.000]  And the only reason I say this is because blood tests obviously has been around for many years. And even when I was training, it would highlight what's red and what's not.
[35:04.000 --> 35:09.000]  And would even tell you that person's anemic or not anemic and pretty much tell you most things about what was going on.
[35:09.000 --> 35:17.000]  But people still want to talk to someone when they get a blood test result. They still see the reds and the blues and the rest of it and still want to talk to someone to figure out what's happening.
[35:17.000 --> 35:23.000]  And until the human element of health care completely goes, I cannot see AI taking over everything just yet.
[35:23.000 --> 35:31.000]  No, and it's that common conversation that AI is going to replace everyone that's taken away all of our jobs. It can't and it's not.
[35:31.000 --> 35:43.000]  AI is not going to replace anybody. But what is helping is everyone to become more scalable in a system that's having issues and problems, whether it's workforce or systems integrations or everything.
[35:43.000 --> 35:52.000]  How can we try and alleviate our big pain points and say if vetting is one of your pain points in terms of this takes time because it has to be done by a skilled person, then can we use AI to alleviate some of that?
[35:52.000 --> 36:00.000]  I am a big advocate for radiography reporting. Speaking as a radiographer, it's pattern recognition, pattern understanding.
[36:00.000 --> 36:06.000]  And yes, I might not know all the clinical backgrounds and everything else, but I can see what looks normal, what doesn't look normal.
[36:06.000 --> 36:15.000]  And I'd be able to put a message to that. I think empowering our workforce and getting everyone up skilled will help everyone.
[36:15.000 --> 36:27.000]  And ultimately, how do we impact the patient care? But obviously with the ongoing workforce shortages and technology, it can be a bit slow to implement and costly.
[36:27.000 --> 36:36.000]  How can technology support sustainable MSK services without adding a burden to an existing service?
[36:37.000 --> 36:38.000]  Or can it?
[36:38.000 --> 36:45.000]  I think it can. And I think that it would just demonstrate it in terms of being able to increase the workflow coming through, increase the number of scans that are happening.
[36:45.000 --> 36:57.000]  And it's also about the outcomes of the patients and how they feel about what just happened. So I think it will get to a point where we'll be very, very comfortable with healthcare being done on some level by AI.
[36:58.000 --> 37:06.000]  And I mean, even like I think the other day I was talking to someone, this is completely random, but they're talking to me about laser therapy on the skin or something.
[37:06.000 --> 37:13.000]  And I thought that was really kind of subspecialist dermatology thing to do. But it turns out you don't have to be a subspecialist dermatologist to do it.
[37:13.000 --> 37:18.000]  And apparently there's a whole areas of skin care that don't need a dermatologist at all.
[37:18.000 --> 37:23.000]  And so then that therefore that means that what I assumed was a dermatology job is not a dermatology job.
[37:23.000 --> 37:28.000]  And I think there probably was a point in life when everyone thought assumed that that would be a dermatology thing to do.
[37:28.000 --> 37:37.000]  But I think as a population, as time's gone on, we've been able to identify that actually you don't need someone who's a dermatology consultant to be able to do these particular things.
[37:37.000 --> 37:41.000]  And therefore we don't always need that level of their care for absolutely everything.
[37:41.000 --> 37:52.000]  And so I think the same same as like so many things now, especially with the AI things that there will be a point where we realize there'll be massive sways of things that don't need that much human traction.
[37:52.000 --> 37:55.000]  That much that much of a person, a human being to be involved with.
[37:55.000 --> 38:03.000]  But like you say, Jack, there will be areas where the truth about medicine is that is still a bit of a bit of a science.
[38:03.000 --> 38:10.000]  Like I've seen and I'm sure you've seen where you've got two patients got pretty much identical things, but one doesn't make it and one does.
[38:10.000 --> 38:15.000]  And you have no idea why. And even if you did exactly the same thing for both people, they still have different outcomes.
[38:15.000 --> 38:18.000]  And that's where it becomes a bit of an art.
[38:18.000 --> 38:25.000]  You have to sort of balance what you've seen, what you know, what you've read all together to come to some sort of outcome.
[38:25.000 --> 38:28.000]  And as long as it's not it's not an algorithm.
[38:28.000 --> 38:40.000]  And so therefore, as long as people are not algorithms are not presented like a textbook, you're still going to have that human element of having to make that that choice, informed decision and take responsibility for what's about to happen for someone.
[38:40.000 --> 38:44.000]  So, yeah, I think it's going to be I'm actually quite excited.
[38:44.000 --> 38:48.000]  I know people are quite scared about the Terminator or the rest of it taking out taking us all out.
[38:48.000 --> 38:52.000]  But I'm quite excited to see and I've been very impressed with what's been happening so far.
[38:52.000 --> 39:06.000]  Sorry. In fact, the other day I found out that some cars are going to have Gemini in incorporated into the car, which for those that don't know is Google's version of AI, which would therefore mean that you could go and see and have a conversation with your car.
[39:06.000 --> 39:08.000]  And I just thought that's just really that's going to be mind boggling.
[39:08.000 --> 39:10.000]  Imagine if you had an argument with your wife is, you know what?
[39:10.000 --> 39:16.000]  I'm going to go talk to the car and just go sit in your Volvo or whatever it is and just chat away about life's problems.
[39:16.000 --> 39:19.000]  It sounds bizarre, but you can already see it happening.
[39:19.000 --> 39:21.000]  It's going to happen.
[39:21.000 --> 39:24.000]  We're going to have friendships with the toaster.
[39:24.000 --> 39:30.000]  I'm not too sure what if what my car think about me when I've had a bad day and get the car starts singing on the way home.
[39:30.000 --> 39:34.000]  If the car then starts reacting to my singing, the whole idea is I'm on my own.
[39:34.000 --> 39:37.000]  I can do what I need to decompress after a long day.
[39:37.000 --> 39:42.000]  I mean, on the kind of topic of random and sort of going completely off off kilter a little bit.
[39:42.000 --> 39:43.000]  I'm going to take it even further.
[39:43.000 --> 39:49.000]  And I'm actually I'm reading a book at the moment called Unreasonable Hospitalities about how to run a restaurant.
[39:49.000 --> 39:55.000]  There is actually a lot of transferable things to day to day business, NHS, home life, everything.
[39:55.000 --> 40:00.000]  And one of the one of the topics I've learned from it is that actually the importance of slowing down to speed up.
[40:00.000 --> 40:10.000]  And I kind of when I when I was looking at these questions, I thought actually this is where this kind of comes into play is that when you want to implement a new technology, a new system, a new server, a new A.I.
[40:10.000 --> 40:18.000]  Anything you do need to slow down because you have to learn, you have to adopt, you have to adapt and you have to understand how this is going to help.
[40:18.000 --> 40:26.000]  And I just I was thinking is do you think that actually one of the reasons why the NHS isn't adopting all these new A.I.
[40:26.000 --> 40:31.000]  systems or technologies is not ignore the fact about funding and ignore how much it costs.
[40:31.000 --> 40:35.000]  It's just because there is so much pressure on to speed up and get the services.
[40:35.000 --> 40:41.000]  And do you think there's better benefit in actually slowing down and almost stopping for a day just to reevaluate?
[40:41.000 --> 40:47.000]  And and what kind of pressures do you think that will put on you as a clinician and the patient?
[40:47.000 --> 40:50.000]  It's such a good point. I mean, I think the world got itself into a bit of a rush, didn't it?
[40:50.000 --> 40:54.000]  I'm trying to get to somewhere, but we don't even know where that is.
[40:54.000 --> 41:00.000]  I mean, from a departmental point of view, we do have audit days and that kind of thing where pretty much the department slows down or stops.
[41:00.000 --> 41:07.000]  And we go through everything that's happened and go through discrepancies and service issues and that kind of thing.
[41:07.000 --> 41:13.000]  And you have to slow down the department. Undoubtedly, productivity drops on that day.
[41:13.000 --> 41:19.000]  But it's necessary, isn't it, to see what the bigger picture is, take a step back and figure out are we doing OK, where can we get better?
[41:20.000 --> 41:32.000]  And true to your point, I do wonder, actually, now you mention it, whether, yeah, with with all this adopt and adoptions of new technologies, we do need to slow down and really think about where it's actually useful.
[41:32.000 --> 41:43.000]  Where is it really going to make that much of a difference rather than just running around and picking up the next new shiny thing and then realizing it's not actually that useful than moving on to the next thing?
[41:43.000 --> 41:48.000]  It's interesting point. I might read that book and send it my way later.
[41:48.000 --> 41:53.000]  I might I might have to as well, Jack. Right. I'm going to lighten the mood a little bit now.
[41:53.000 --> 41:57.000]  We always end our podcast with a quirky question in run.
[41:57.000 --> 42:04.000]  So our quirky question today is what's the quirky habit or ritual you have that makes you happy?
[42:06.000 --> 42:10.000]  I was thinking about this and I realize how boring I am when you ask me that question.
[42:10.000 --> 42:16.000]  I just I don't really I think one of the things I try to do these days to pick up more and more skills as time goes on.
[42:16.000 --> 42:21.000]  And I think is based on what I've noticed about my children in that they're so young.
[42:21.000 --> 42:24.000]  They're 10 and seven and they'll do Brazilian Jiu Jitsu one day.
[42:24.000 --> 42:31.000]  They do piano the next day, oboe the next day, saxophone the other day or they're doing some acting class for a bit as well.
[42:31.000 --> 42:35.000]  And you kind of look at them and you think that and they get so excited and sometimes they're not excited.
[42:36.000 --> 42:41.000]  I don't do anything, but it's a nice time of life to be where you can just pick up things and learn new things.
[42:41.000 --> 42:45.000]  And it's kind of normal. Like if I've told you these things, you're not surprised.
[42:45.000 --> 42:49.000]  But then we will lose as adults, don't we? We don't we don't kind of do stuff like that.
[42:49.000 --> 42:58.000]  So one of the things I am incorporating of late is as Jack knows, probably that I did do a course on standup comedy, which is really, really fun.
[42:58.000 --> 43:01.000]  Might do another just because I can.
[43:01.000 --> 43:06.000]  I was actually looking into getting chess lessons because I've always been terrible at chess, but I want to learn chess.
[43:06.000 --> 43:09.000]  And then recently my son was talking about maybe getting a drum kit.
[43:09.000 --> 43:11.000]  And I thought, actually, I've always want to learn the drums as well.
[43:11.000 --> 43:19.000]  So why don't we do that together? And so I think that's probably the quirkier side of me is that I guess I maybe it's a midlife crisis.
[43:19.000 --> 43:21.000]  It's not over yet. There's so many things to learn.
[43:21.000 --> 43:25.000]  There's so many things to do. And while I'm still relatively young, I'm trying to pick it up.
[43:25.000 --> 43:30.000]  And so, yeah, I guess maybe that's a quirky side of me.
[43:30.000 --> 43:37.000]  I just I keep finding more things to learn and more clubs to join and more groups to get involved with and stuff like that.
[43:37.000 --> 43:44.000]  Yeah, well, that's that's a good midlife crisis because my husband bought a motorbike for his midlife crisis.
[43:44.000 --> 43:49.000]  And he gave me kittens watching him drive up the road on it.
[43:49.000 --> 43:54.000]  I was thinking about this quirky thing myself and I was thinking, what's the quirky habit I've got?
[43:54.000 --> 44:01.000]  And when we set when I'm celebrating something, I tend to high five or fist pump.
[44:01.000 --> 44:05.000]  And as the CEO of my organization, it's probably not that professional.
[44:05.000 --> 44:08.000]  And I find myself doing it with members now.
[44:08.000 --> 44:17.000]  So I think that I need to just remember what setting I'm in when I'm kind of excited and pleased about something that I don't, you know,
[44:17.000 --> 44:21.000]  drop the guard, if you like. But people seem to quite like it.
[44:21.000 --> 44:27.000]  But, Jack, I'm going to ask you the same. What's the quirky habit or ritual you have that makes you happy?
[44:27.000 --> 44:36.000]  Well, I've written something down, but after Imran's very insightful quirky habit, I feel like mine's not strong anymore.
[44:36.000 --> 44:43.000]  So mine is very on trend for the supplier I work for. It's cable management.
[44:43.000 --> 44:49.000]  I can't walk past the desk without tidying up the cables, making sure everything's neat and tidy.
[44:49.000 --> 44:57.000]  And to the point where I do have cable ties in my bag, which I will carry around with me.
[44:57.000 --> 45:03.000]  And I must admit, I did forget to take them out when we went to a parliamentary address.
[45:03.000 --> 45:07.000]  And when I had my bag searched and said, why are you walking into the parliament with zip ties?
[45:07.000 --> 45:10.000]  I had to explain this is my quirky habit and why.
[45:10.000 --> 45:14.000]  Like I said, you're more than welcome to take them. I'm not looking to cause any trouble today.
[45:14.000 --> 45:18.000]  Please take my very small black zip ties away if you feel better.
[45:18.000 --> 45:24.000]  And unfortunately, the security guard did not see the quirky side of it and quite promptly put them in the bin.
[45:24.000 --> 45:29.000]  But yeah, that is my quirky habit is I will try to make every desk come past tidy and neat.
[45:29.000 --> 45:33.000]  And I can't stand cables dripping behind the desk.
[45:33.000 --> 45:39.000]  That sounds like OCD. That sounds like OCD to me, Jack. More than a habit.
[45:39.000 --> 45:43.000]  It makes me happy. A clean desk is a clean mindset.
[45:43.000 --> 45:45.000]  Very good.
[45:45.000 --> 45:49.000]  I should show you my desk right now. It's a complete tip.
[45:49.000 --> 45:55.000]  I keep saying every day and underneath my wife was actually trying to look for a professional service to come sort my cables out.
[45:55.000 --> 45:57.000]  So maybe I should get you.
[45:57.000 --> 46:00.000]  Yeah, I'll come round and round. I know we spoke about going for a run in the past.
[46:00.000 --> 46:06.000]  I'll come round and do a run. We'll talk about AI and I'll do some cable management for you.
[46:06.000 --> 46:09.000]  Yeah, let's do it.
[46:09.000 --> 46:11.000]  Thanks, guys. They were great answers.
[46:11.000 --> 46:19.000]  So it's been great to get to know more about you, Dr. Imran and get some further insights into fractures and musculoskeletal health.
[46:19.000 --> 46:25.000]  A big thank you to Dr. Imran for joining us and to Jack for guest presenting alongside me today.
[46:25.000 --> 46:28.000]  And thank you to all of our listeners.
[46:36.000 --> 46:38.000]  Thank you.