Surgery in the UK by numbers

An interesting view of surgery in the UK by numbers.  The four largest specialities are Trauma & Orthopaedics, General surgery, Obstetrics & Gynaecology (though the Royal College of Surgeons for some reason don't include those!), and ENT.

A more detailed source of these can be found on the HSCIC website LINK (2015):

• Even more common than the hernia, hip, knee, gall bladder and tonsil surgeries listed above are 
• Skin lesion excision
• Colon lesion extirpation (removal/ablation)
• Joint aspiration
• Caesarean section
• Tooth extraction
• ~500 types of operation are carried out at least 1,000 times each year in the UK
• 60 types of operation are carried out at least 30,000 times each year in the UK
• I'm aiming to see as many of these as I can while I've the capacity in medical school - have seen 30 of the top 60 so far!

Insights from global health conversations

Some global health actors

Have had the good fortune of meeting some people engaged in global health over the last few months.  Some insights:

EB (European health policy).  Indicated some important things that Europe offers us:

• Professional qualifications directive (2005 & 2013): ensures that certification of equivalence is possible for doctors working around Europe.  "Doctors, dentists, pharmacists, nurses, midwives, veterinary surgeons and architects benefit from the automatic recognition of their qualifications, on the basis of harmonised minimum training requirements."
• Working time directive (2003): provides a limit to working hours, which must not exceed 48 hours per week on average. 

SM (WHO, Ebola communications)

• WHO is undergoing a significant restructuring recently in the wake of the Ebola crisis; due to limitations in their logistical capacity to respond effectively to the epidemic.  Improving disease surveillance an important feature.

PF (ILO, disability advocacy)

• Maintains a disability blog - some good core messaging, in that access, rehabilitative therapy, and supported employment are some of the main topics advocated on; these being important topics both in the UK as well as in Bangladesh where much of his recent work has been
• Suggests that getting disabled people into work in developing countries is (1) difficult for many reasons, but (2) possible & going on, and (3) can be developed further through small initiatives rather than the huge investment one might anticipate

EO (Orthopaedic surgeon, Kenya)

• Took the view that any international exposure to different functioning healthcare systems is valuable.  
• Particularly helpful to look up and down the chain of how healthcare is delivered with more resources (and hence some of the latest technology), as well as with less resources (and hence using autoclaves, reusable drapes, etc., and cutting out expensive tech like laminar flow in orthopaedic theatres.
• Indicated that some orthopaedic trainees from Kenya when visiting Europe to train find that they have to relearn a lot of the knowledge - it can be demoralising to be taught badly and have to relearn techniques, although satisfying to bring best practice back

CR (MSF, midwife)

• While wealth levels may vary, the same stories play out in communities all over the world - love, children, infidelity, backscratching, festivities.

Samreen (Indian, FY3)

• The social-care delays on hospital discharge in the UK seem almost inexplicable - in India family will take in dischargeable patients, and middle class Indians can recruit cheap labour to their homes to care for ailing relatives - typically by providing them board & lodgings, and making them one of the family

Hand surgery inspiration

Hand surgery

I've been talking to people about hands.  Here are some of the nuggets that have turned up:

Musicians
- JP Ekins - Piano players' hands have wider reach as the thumb and little finger are sufficiently stretched apart to make a straight line.  Stretching a 9th is a normal reach.  Left hands apparently usually have a larger reach
- Liam Waddle - worried about arthritis.  Seemed to have a hyperextended thumb and middle finger on his right hand
- Dom Pipkin (& the Iko's) - noticeable broadened finger pads; apparently painful after a session of hammering the notes.  Amazing pianist tho
- Patrick (drummer with the Iko's): natural finger cadence is used as a guide when teaching drumming pupils to pick up their sticks

Sports
- Climbers' hands have denser bones, stratified relating to pressures used in their climbing - seen on a Sheffield example BBC documentary about anatomy.  Link to a related paper - one of the authors has surname 'Carpi'

General arts
- Carlo Maria Mariani - "The hand submits to the intellect" - representing the postmodernist 'meta-art' critique: a picture of two men painting each other, indicating that art is self-generated and hermetically sealed.
- Robert / Patrick Scott - Hands are one of the hardest things to get right when painting -> and occasionally palmed off onto the artist's assistant.  The size of hand from distal wrist crease to fingertip is approximately that from chin to hairline.

Medical lectures
- Morgan X / Louise Hickey - greater density of nerve fibres in fingertips enables more effective tactile discrimination.  Morgan (as an architect) talked of being able to 'grasp' a design - only engaging with a building design once he had physically felt it.  Haptic object recognition (stereognosis) enables us to generate a virtual image of an object without seeing it.
- Hand transplants: 80% of tactile function may be achievable with appropriate patient concordance with physiotherapy (from Blood and Guts, the History of Surgery).  Choosing an appropriately hairy / sized / gendered hand is important.  Immunosuppressant anti-rejection drugs may reduce patient lifespan.
- Carer: massive functional loss that occurred when his wife finally lost the ability to move both hands.  Even the basics like television remote and panic button use.  Preserving hand function is v important (perhaps a point for voice control).  Story was told by a 70+ y/o carer who's part of the MS society.


[To be added to]