IBD Surgical Outcome Registry

Q&A with ACPGBI President, Mr Graham Williams

Posted 28 June 2013 in

President of the ACPGBI, Mr Graham Williams

1. Why and when did you decide to pursue a career in medicine?

It’s difficult to pinpoint exactly when I decided to become a doctor, let alone a surgeon. The two must have come together because I no recollection of wanting to be anything other than a surgeon. My mother pin- points it to the time as a 7 year old I decided to open my teddy bear up and have a look inside (he still bears the terrible scar as this was pre-keyhole surgery and the wound has not healed well to this day, even though the silk stitches are still there – PBA score of 1). It made life easy in secondary school as I knew sciences were for me and English Literature was not (illustrated by an abysmal fail at O-level because the only quote I could remember from Lord of the Flies was about the conch emitting a low farting sound when blown – inevitable really). I scraped into Medical School in Cardiff, which at that time had a strong Anatomy department, and realised I had made the right decision, staying on for an extra year to do a BSc in anatomy. As a pre-clinical student, there was the opportunity for interested students to go into theatre in the main teaching hospital as observers. I remember the first time I went to see an operation and being fascinated by the whole set up. However, my abiding memory is of watching the surgeons (I think it was a nephrectomy) and thinking …”and they get paid for doing this!”

2. Who have been your greatest influences and why?

As a trainee, everyone I worked for influenced me in some way or other. Perhaps the two greatest influences were Les Hughes in Cardiff and Stan Goldberg in Minneapolis. Les Hughes was a renowned Australian Professor of Surgery and saw me through my formative years as a house surgeon, research registrar and surgical registrar. It was whilst working in his unit that I decided to become a colorectal surgeon, mainly because for the variety of colorectal conditions treated on the Unit. He was one of the first surgeons in the UK to embrace the idea of the multidisciplinary team both for cancer and inflammatory bowel diseases. Anyone who went through his unit left with a huge respect for him and tried to emulate his attention to detail. It was Les Hughes who engineered my 2 years with Stan Goldberg in Minneapolis. This was an incredible experience and totally different to surgical training in the UK at that time. Stan has a passion for colorectal surgery that shows no signs of diminishing, even in his 80s. I had never experienced so much one to one training before arriving in Minneapolis and learnt so much about techniques in colorectal surgery from him and his colleagues.

3. What experience in your training taught you the most valuable lesson?

It is hard to pinpoint a single lesson learnt during training. I worked for a variety of surgeons, each of whom taught me valuable lessons. These range from how to operate safely and effectively, through to how to manage patients rather than just treat them, to how not to do things. I have worked for one or two consultants who if they were working in current times would be spending a long time on gardening leave. Hugely entertaining to a junior trainee and very instructive in demonstrating how to create problems and get out of them. In the latter stages of training I worked for a prominent upper GI surgeon who was superb at getting himself out of trouble in the operating theatre, It reflected the varied training he had had as a trainee, something our current trainees are increasingly missing. In addition, he was never fazed by complications. There was always a plan for resolving the situation, which he had usually seen before. A valuable lesson here was never to apportion blame, concentrate on resolving the problem and getting the patient better.

4. What have been the most significant changes in coloproctology over the course of your career?

I have been fortunate to catch the rise of Colorectal Surgery as a specialty. When I qualified, most surgeons were General Surgeons with an interest in something. This may have been colorectal surgery, but this would have only formed a part of the work of these surgeons. Thirty years later, there are very few true General Surgeons left. What we have now have are Colorectal Surgeons with an interest in General Surgery, mainly acute surgical emergencies and abdominal wall hernias. This has been one of the major advances in our specialty and I have no doubt that the major developments have come as a consequence of surgeons concentrating on a specific area and giving it their undivided attention. This is not to say there are not problems with the move to specialisation and we still have not resolved the conflict between being a “generalist” on call and a “specialist” in the clinic. This is one of the training challenges we face, especially as it is linked to man-power planning for the future.

In thirty years there have been huge technological changes in colorectal surgery. Some of these have evolved following changes to techniques or equipment; others have been a complete change in approach: laparoscopic colorectal surgery is a case in point. The pace of change has been astounding and even over the last 5 years major changes have occurred. I think in another 5 years we will look back on current laparoscopic practices and wonder what all the fuss was about. I suspect much more surgery will be performed down endoscopes yet to emerge from the research laboratories. However, despite all these advances the challenges of treating patients with colorectal diseases will remain and keep surgeons awake as they worry about their patients.

5. What has been the biggest challenge you have faced as President?

I think all Presidents of the Association worry about keeping the various projects moving forward and they rely on their colleagues on the Executive, especially the major committee Chairmen, to make things happen. I am pleased that there has been progress with the Curriculum and the input of the Association has received due credit. Whilst not achieving sub-specialty recognition for Colorectal Surgery from the GMC, it will become easier for trainees to demonstrate that their training equips them for appointment as a Colorectal Surgeon. The new Website has been running for a while and proved very popular, at the moment it is only working on “low power” and I hope that next year will see the full potential of the Website released and the benefits for the membership as well as the public are realised.

Undoubtedly my biggest challenge this year has been the Department of Health initiative to publish surgeon specific outcomes for colorectal cancer. This initiative was launched in February and we realised fairly early on that the NBOCA data set was not designed for accurate surgeon specific outcome reporting, even though there is a huge amount of data available. It is in the last few weeks that the real headache has emerged after anomalous results were thrown up for many surgeons, causing much distress. It could not have come at a worse time in the lead up to the Annual Meeting and I am still not certain what will be the overall conclusion of the matter. However, we have learnt a lot and if nothing else it has got surgeons much more engaged, which bodes well for the future of the Audit. It is a tough problem to hand on to Karen Nugent.

6. As President of the ACPGBI, what have you achieved and do you believe the role of the Association will change over the next decade?

This is a hard question to answer and one I suspect all Presidents of the Association do not like to dwell on. The Association still maintains an annual presidency, unlike many specialty organisations which opt for two years. However, we have a two year lead-in and a collegiate style of running the organisation, such that the incoming President has been involved in most matters before they take up the position. I still think it would be a difficult post to do for 2 years, especially as it is getting harder for surgeons to be away from the coal face on external business. For this reason, I struggle to point out individual achievements. I think altering the Council Meeting format to give more time for discussion has been beneficial and has helped clarify the role of Council. I in addition, I hope the initiative to bring our Multidisciplinary Co-ordinators to the Annual meeting will be successful and they will leave with better understanding of what we do and why, as well as with an embryonic network of colorectal cancer MDM co-ordinators. Please make them feel welcome as I want to see the Association broaden its horizons for the future.

I think the Association will become more relevant in future. It is clear that our importance is recognised by the Department of Health and we have been attending regular meetings to discuss endoscopic services and our role in outcome reporting will strengthen our position. Commissioning within the NHS will have a big impact on our working lives and it will be important that ACPGBI plays a major part in developing commissioning guidance. This work has started and will gain momentum as people understand the changes more.

7. Outside of surgery, how do you relax?

I am able to switch off and am fortunate in working with in a team of excellent colleagues. We all have confidence in each other and have a good system for covering the service. This means that when you are off at weekends or on holiday you don’t have to worry about your patients as you know they are being looked after.

I gain great pleasure from annoying my wife and daughters, although it is getting harder as they just tend to ignore me. I have always enjoyed fiddling about making things and when we moved into our current house this hobby took off as it has a large workshop with light and power. I am a self-taught woodworker who started small. A bit like drugs, you start on the light stuff and soon escalate to hard stuff and before you know it you are smoking crack. I can remember being at a party and admiring a radiator cabinet. The host told me he has made it from MDF using a small router. It seemed easy enough and I bought my first router 12 years ago. Within weeks I was hooked but realised that if I only had this or that bit of kit I could do more and before you know it there is all sort of machinery in the workshop. One of the advantages of living in Wolverhampton is the ready access to machine companies for sharpening blades etc. and timber merchants for wood supplies. My wife knows when I have had a bad day at work as I will head outside for a bit of “shed”. I can easily lose myself concentrating on working planks of wood through machines and how to put things together.