A day in the life of the clinical director for orthopaedics

In the latest in our day in the life of series, we spent the day with Alan Middleton, clinical director for orthopaedics.

The day opens with the briefing, where the team discusses the morning’s list and any points of note for today’s cases. It’s a trainer day, so Alan is working closely with registrar Ali, who he’ll be supervising for the day’s theatre cases.

Most of today’s procedures can be carried out under local anaesthetic so the patient is awake during the operation. Doing procedures by nerve block or local anaesthetic has many benefits; it vastly improves recovery time from surgery and means that patients are often able to go home that same day, if not almost straight away.

Today marks the second week of the new computer system, a move from the old Theatreman software to the Trakcare theatre module, so Ben from the electronic patient recordsteam has been supporting the team and it’s clearly appreciated by everyone in the unit.

While Ali and the team’s advanced practitioner work on the second of the morning’s patients, Alan takes a few minutes to catch up with an ever-growing mass of emails and phone calls, as well as helping to prepare another patient in an adjoining room. She is scared, and needs a nerve block on her arm. It takes a while and some skill to prepare her for surgery.
The tumour on her hand will need to be cut out and sent to histology for analysis. After careful excision, it pops out like a shelled pea (albeit slightly larger and not as round). The patient is clearly relieved it’s over.

As clinical director for orthopaedics, Alan has been with the trust nine years and manages 17 consultants and represents the specialty to the medical director. His team works closely with the community Musculoskeletal (MSK) service, and their extended scope physiotherapists can directly book any patients they consider suitable for surgery straight onto his lists.

His medical secretary has dropped a package of documents, each with a detailed post-it query. While he deals with the pile, Ali joins him, bearing coffee. They discuss the next patient, a dupuytrens case where thickening in the palm contracts, so sufferers are unable to fully open their hand. When they take their places in theatre, Alan carefully plots out the procedure with Ali, talking through each stage with a pen before any incision is made.

The morning’s last elective patient is a DNA (Did Not Attend), so an early finish means lunch where his medical secretary Sarah (“my right hand”) finds him ten minutes later and they discuss the notes from her earlier package. As she leaves, she is replaced by theatre manager Lesley, who has queries of her own.

Seven flights of stairs later, Alan joins a 1pm meeting to discuss the potential role of Physician Associates in the trust. He’s interrupted once; his registrar is trying to deal with a difficult patient and needs some advice.

He stays behind afterwards to discuss staffing and service developments plans, a complex proposal requiring imagination, meticulousness and flexibility to find a potential solution.
Back in theatre, Belgian surgeon fellow Marta and registrar Ali, who are managing the afternoon’s trauma list, clearly have everything under control, so Alan withdraws to continue with emails and begin some of the jobs resulting from his lunchtime meetings.

A young man has sliced his little finger doing a bungee jump, and they thoroughly and carefully check the finger for damage, before ensuring everything is in place and neatly stitching up the wound. The finger is bandaged and the patient sent off with cheerful instructions to avoid washing up. Another sliced his hand cutting pizza, and small nick in the tendon is repaired with tiny, fine stitches before the wound is closed and dressed, and he’s despatched with similar instruction about the dishes.

Two further DNAs and the afternoon’s work is finished by 5.30pm. Alan and the team complete the daily debrief then he coordinates diaries with Ali to plan the coming weeks.

Alan says: “Operating is definitely the favourite. I am fortunate that on each operating list I will have a wide variety of operations and there is no risk of boredom. I do, however, also love the challenges that being clinical director brings, and enjoy organising and developing services.”

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