Surgeons work right on the frontline of healthcare. Delivering procedures that are very often life-changing or life-saving, they are responsible for delivering essential interventions in acute, critical and emergency care. And given the nature of their work, they also carry a major burden of responsibility for patient safety, before, during and after any operation.
Given all of these factors, plus the fact that surgery covers such a vast range of skills and disciplines, the role of the expert surgeon is pivotal in the safe delivery and effective management of surgical practice in all its forms.
Traditionally, appropriate experience and expertise have been formally built into surgical teams through clearly defined senior roles. In the general hierarchy, consultant surgeons sit above registrars and career-grade surgeons, who in turn sit above core training and foundation stage doctors. Not only does this reflect different levels of qualification, experience and specialist expertise at different career stages, it also provides a framework for management, oversight, quality assurance and professional development in all forms of surgical practice.
With the emergence of new technologies in healthcare, such as AR, VR, and remote networking, the possibilities for these relationships to become more fluid is emerging. Platforms like Proximie are opening up opportunities for mentoring, expert guidance in theatre and even consultancy work to take place virtually rather than in fixed teams in a set physical location, opening up opportunities for better knowledge-sharing and more flexible organisation of resources.
But the core principle remains – specialist expertise has critical importance in the planning, delivery, and management of surgical practice. Here we will outline five key reasons why, and how emerging technologies like Proximie are upholding the value of the medical expert in surgery.
1- Ensuring a successful operation
Surgical procedures range from the routine and straightforward to the highly complex and specialised. Likewise, the people carrying out surgery range from trainees making their first ‘live’ incision to expert practitioners who have pioneered a particular technique and may in some cases be the only person in the world offering it.
Expertise is critical at every stage. Whether it is a consultant or registrar offering ‘over the shoulder’ guidance to a junior team member, or a specialist performing a complex operation themselves, nothing can happen in theatre without the appropriate experience and knowledge.
For most of the history of surgery, this has depended on having a figure present in theatre with these attributes. Thanks to the advent of telemedicine, including AR platforms like Proximie, this is no longer the case. Junior and general practitioners can be guided from afar by specialists, boosting the availability of procedures when and where they are needed most, meaning more patients get access to the care they need.
2- Patient safety and reassurance
Whoever carries out an operation, and however the framework for oversight works, patient safety and wellbeing is the single most important consideration. This begins well before a patient enters operating theatre, starting with choosing the right procedures, and covering all steps along the way, including choices in anesthesia, medication, equipment, and aftercare.
Typically this is carried out by a senior figure such as a consultant, as these decisions are fundamental to patient safety. They carry a weight of responsibility, and it is also important from the patient’s point of view – they want to be reassured that these key decisions are being made by a senior figure with the appropriate level of expertise.
Again, telemedicine platforms open up the possibility for these decisions to be made remotely, even if there is no one in a local hospital with specialist experience in a particular procedure a patient needs. Advice can be sought from an expert in another city or even another country, offering guidance on every step to be taken. This also applies to consultations with the patients themselves, who may even be more reassured that one of the best surgeons available for the procedure is overseeing their care, even if they are not physically present.
3- Driving standards
With quality of care critical to guaranteeing patient safety and delivering positive outcomes, surgical practitioners are, like all medical professionals, under a continuous obligation to uphold and try to standards. While there are, for whatever reasons, patients who do not make a full recovery following surgical intervention, there is always scope for practices to be improved upon.
Taking responsibility for this bigger picture requires experience and broad knowledge of the profession. As as maintaining standards is also a matter of oversight and accountability, it is right that it falls to senior team members with managerial responsibilities.
4- Theatre management
The provision of surgical services extends far beyond the process of actually performing an operation in theatre. We have seen the importance of pre-operative diagnosis, treatment decisions, and patient reassurance, and the same applies to post-operative care. Then there is also the issue of preparing a theatre ready for a procedure, ensuring correct protocols are followed, the right equipment is clean and ready, the right people are present.
All of this is achieved by a team of people working in unison, from surgical nurses to the consultant. The need for hierarchy stems from the need to have someone responsible for managing all of this activity, combining the roles of director, facilitator, and overseer.
Management is an important function not just operationally but from a perspective of team morale, of everyone feeling confident in what they are doing. Again, there is nothing to say, in the modern work environment, a consultant or senior surgeon needs to be physically present in theatre for every procedure to fulfill this role.
5- Nurturing the next generation
Finally, those with highest levels of experience and expertise in surgery have a critical responsibility for ensuring the skills and knowledge they have, remain in the profession. Training new surgeons is critically important to healthcare as a whole, especially as student numbers have been falling.
Students need access to experts to learn from them. Until very recently, there have been obvious barriers to this. Surgical specialists tend to be scattered, creating an obligation for either the students or the expert to travel for training to take place. But of pressures of time and distance, there are only so many guest lectures a consultant or registrar can attend. Students can only move to study in one, two or perhaps three teaching hospitals, narrowing the exposure they get to different specialisms and techniques.
Thanks to platforms like Proximie, that is all changing. Now, expert surgeons do not have to travel to lecture or teach, they can do so from an iPad. It creates the opportunity for potentially thousands of students worldwide to gain the benefit of watching a specialist perform and talk through a single procedure, greatly increasing the flow of knowledge. And it gives students the excitement of being able to learn from the best surgeons in the world, in wide variety of disciplines, wherever it is they study.