Orthopaedic surgeons are a funny lot. Butt of numerous intra-hospital jokes (e.g. what’s two orthopods reviewing an ECG: double blind study) and not particularly known for their intellectual prowess, they pretty much go into medicine to actually ‘do’ things. The actual patient contact (you know, talking, reassuring) is more seen as a soft skills that is not particularly necessary, and a happy orthopod will always be an operating orthopod, where he doesn’t have to talk (apart from grunting to anaesthetits and junior doctors) and can let his manual skills shine by sawing bones, drilling holes and saving limbs. Pretty much the craftsmen of doctors.

Now one has resigned from his post at the trust that incorporates the Royal London Hospital and St Bartholomews’ Hospital with a surprisingly elaborate and thoughtful email, blaming the management of the trust for worsening outcomes for patients under his care. Some of his comments are strong stuff:

“We are regularly out of kit, out of nurses, out of ODPs [operating department practitioners, who plan care] and always out of beds. We have become so used to the situation, it is no longer seen as a crisis, it is the norm.”

“I did an operation last week on a calcaneal [heel bone] fracture that kept getting bumped by more urgent cases. It was three weeks down the line, and had healed in a bad position. There was nothing I could do about him.

“I fixed a compound tibia [leg bone] that was going to get a second look at 48 hours after the initial debridement; she got to theatre six days later,”

If this is even remotely true, managerial personnel should prepare themselves what I would carefully call a shitstorm, as this looks like patients’ outcomes were worsened by lack of resources. It’s bad enough when you problems in patients’ outcomes due to a rogue doctor, but if you have a systemic failure that forces a whole department to underperform then the time has come to have a long and hard look at the resources they habe been given to work with.

The BLT trust doesn’t have a particularly reputation for managerial excellence anyway, but this will be resulting in loads of patients to be voting with their feet to avoid non-urgent surgery at this particular department, much to the delight of the surrounding trusts.

Watch this space.