Professor Neil Mortensen, President of the Royal College of Surgeons of England

AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.

Today, the subject is Professor Neil Mortensen, president of the Royal College of Surgeons of England and professor of colorectal surgery in Oxford. Professor Mortensen founded the first patients' association for those with ileoanal pouches, and set up Occtopus, a charity which supports education and research into colorectal disease.

A podcast of this interview is available here:

 

How did you get to where you are today?

I was at medical school in Birmingham, and then I worked in Bristol, teaching anatomy. I did a very early MD. I did my surgical training in Bristol and the south-west. I was an academic consultant in Bristol for a little while. 

Suddenly, somebody rang me up and said: 'Would you like to come and work in Oxford?' and I found that quite difficult to say no to! I then ended up, for most of my surgical career, on the staff in Oxford, and eventually became one of the professors of surgery in Oxford. I've had the most brilliant time becoming a surgeon.

 

What attracted you to surgery as a career?

One of the features of many careers is serendipity, or an element of luck, fortune, or taking the chances you get. Mine was that on my very first day at medical school, I was given a clinical tutor for the whole of my time there, and he happened to be the professor of surgery. 

Geoff Slaney was a great guy who I got on with, and he also eventually became a president of the College of Surgeons. During my first long vacation at medical school, he arranged for me to go with a colleague to one of the Harvard surgical services in Boston, USA. 

There we did a summer of operating on animals around transplantation research. We were trying to prolong graft life on all kinds of weird machines, so we were operating on dogs and pigs and baboons, when you were allowed to. 

We gave anaesthetics, we did the surgery, and we looked after the animals afterwards. It was absolutely brilliant, and I thought: ‘This is so wonderful, so cool. I want to be a surgeon’.

 

Tell us about your clinical and research interests.

At medical school I did, for a moment, think I might want to do obs and gynae. I did an elective in Ethiopia, which was really interesting. I did lots of breeches and triplets, and helped with caesarean sections. But I came back to the UK, and it wasn't quite as exciting. 

I also was very fortunate to do a term in Minneapolis in the United States, with the transplant team. That was in my last year at medical school. I did a whole term at the University of Minnesota, and I wondered about transplantation, since I'd done that research earlier. But I decided I wasn't the right kind of character for transplantation. 

I think you have to have a bit of a ‘hard skin’ to be a transplant surgeon. You have to be prepared for horrible things to happen to patients, and I'm too sensitive for that!  I decided that I liked the idea of gut surgery. There was a surgeon in Birmingham named John Alexander-Williams, who was very famous, and he made it seem really exciting. 

Those were the days when gut surgery was everything from the oesophagus to the anus, and there was not much specialisation. 

It was the early days of endoscopy. I did some early endoscopy research - when gastroscopy was first widely available - looking at biopsies of patients who'd already had a gastrectomy and what the changes were in the lining of the stomach. 

That then led to other projects around endocrine cells, which had been discovered in the lining of the gut just around then, so it was very new. We didn't know how they worked, and what effects they had - that was very exciting. I was a very early surgical trainee with an MD under my belt already - it was quite extraordinary. Again, I think this was about serendipity and luck. But you take your chances. 

So I got interested in the gut, and in terms of clinical practice, I was one of the pioneers of specialisation in colorectal surgery. I saw that there needed to be a focus on it. It was a bit of a ‘black art’ - nobody really cared about the colon much. Everybody was interested in the upper GI tract because of ulcers. Nobody really cared about the other end. It was a bit of a ‘Cinderella subject’ so there were lots of opportunities. 

I went to St Mark's Hospital, which was then the only place where you could get any kind of postgraduate special training in colorectal disease. For my surgical career I ended up doing colorectal cancer and colitis and Crohn's disease. Some of the functional problems related to the gut, and I have done lots of research in those areas too. 

I really love inflammatory bowel disease, Crohn's disease, and colitis management. I love being able to take a patient from the age of 16 and see them through their life with a series of interventions, keeping them going, making sure everything goes well, and that they still have confidence in the system - particularly in surgery - to get them right.

 

What are some of the biggest changes that you've seen within colorectal surgery?

People still talk a lot about the surgical firm - maybe with a degree of nostalgia, because certainly there were some surgical firms where the bosses weren't particularly nice, and there was bullying and favouritism. 

But that sense of teamwork in a firm was really good. I think it helped people feel that they were part of a family, and that they could, within that team, take on responsibility. It is more difficult with shifts and with cross-specialty working as a junior doctor. 

There were also opportunities to do practical surgery early on, and if you can possibly do that, you do then get the ‘buzz’. You get the ‘drug’ of surgery. You say: 'Wow, this is absolutely fantastic. I want to do this.' 

If you were told that you were going to be given permission to take another human being apart, and maybe take them quite near to the edge in terms of their physiology and their survival, and then bring them back and see them get better afterwards, on a one-to-one basis - that is the most incredible privilege to have in medicine. 

You've actually done that with your hands - helped by machines these days, no doubt. But whatever things were like then, it's still true now - being able to have that privilege is absolutely amazing.

 

Tell us about the two charities you founded: the Kangaroo Club, which is the first patients' association for ileoanal pouches, and Occtopus, which supports research and education for colorectal disease.  

Oxford was one of the places which did ileoanal pouches. If you have ulcerative colitis and you have to have all your colon and rectum taken out, you would otherwise have to have a permanent bag - an ileostomy. This operation recreates an internal reservoir out of the small intestine. 

It makes you continent, and not need to have a bag - another little miracle of surgery. It’s not quite as big a miracle as having your cataracts done or your hip replaced. But for these patients who are aged between sixteen to early twenties, or early thirties -  all of them absolutely dread having an ileostomy long term. 

Some of them come to terms with it, some don't, and for those who don't, having this ileoanal reservoir - which means you can be pretty normal and not have to wear a bag all the time - is a miracle and life changing. We did considerable numbers of those operations.

But as with all surgeries, surgeons need to listen to their patients and understand that once you've done the operation, that's only the beginning of the job, and that there are patient-related outcomes that we need to pay close attention to. 

There were lots of teething troubles and there were no ‘barn-door’ standard outcomes from this operation. Patients carried on needing help with the fine-tuning of the function of their ileoanal reservoir or their pouch.

I've long felt that patient power is really important, and that in medicine we don't mobilise it enough. We need patients to speak on our behalf to the government, because the government listens to them more than doctors. There's a sense in which we're seen to whinge a bit. I think if you have patient advocates that's fantastic. 

So we formed this little group, and it became very successful, and other centres around the country have formed similar patient help groups. We have meetings two or three times a year - patients talk about their problems. 

We raise money for research for those kinds of surgeries. It gives them a sense that they're not alone, and there are other people around who can help them and talk with them about their problems. It’s one of the best things I've done.

 

What makes an exceptional surgeon?

I don't think there's one recipe. There are people who have exceptional technical talent, but if you have exceptional technical talent and no common sense, you're dangerous. There is bound to be a bell-shaped curve, with surgeons one side of the median or the other. 

Within that variety of expertise and ability, there are some people who aren't such good technical surgeons, but they make very good judgements. There are some surgeons who are absolutely brilliant at doing operations and having good judgement but are completely hopeless at speaking to their patients. 

The absolutely ideal surgeon - and nobody's like this - would be somebody who was technically brilliant, had very good judgement and common sense, and was also a brilliant communicator. But of course nobody has all those talents under their hat. We have them to a greater or lesser degree. That's why it's really important to work in surgical teams.

Within a surgical team you can have some surgeons who are brilliant educators and trainers. You can have some who are brilliant researchers. You can have some surgeons within the team who are brilliant communicators, and you can have some who are brilliant at organising or managing things. 

That's why you need a team of all the talents. That's one of the things I've tried to do and say at the College of Surgeons - that we need people with all the talents from all sorts of backgrounds, because you need a team of varying abilities and interests. 

What you don't want is a team of super-alphas who are all absolutely brilliant technically, who are hopeless at getting on with their colleagues, and hopeless at speaking to their patients. You need a variety.

 

What advice would you give to medical students and junior doctors who are interested in surgery?

Plan ahead and be patient. It’s very easy in the current environment to get impatient and to think: ‘I'm not getting on, I'm not getting as much as I need, I need to do step X, Y and Z by date Y.’ 

Be determined - know what you want to do. Plan ahead, but be patient, because once you get there and you're in a consultant post in a hospital, in a sense you're chained to the work. You have to get on and do the work because it is a sort of tidal wave, and you've got to get through it.

Along the way to getting there, it's really important to enjoy it - to have a variety of experiences in education, in research and in organisation management, so that when you do get there, you have all those skills and talents together. 

I was incredibly impatient, and on occasion it meant I didn't enjoy things quite so much. So I would say be determined, be organised, think of the next steps ahead, but be patient.

 

To those doctors applying for core surgical training, what tips can you offer about how to face their applications?

It's such a long time ago since I did anything like this. Obviously, I'm in lots of conversations with my colleagues around applications for core training, and the way in which the system is either favourable or not favourable at various times during your application process.  

All I would say is, just like when you apply to medical school, and when you've applied to anything else, put your best face forward. During your medical school training, you have been, as a potential surgeon, thinking ahead, and therefore you need to put together the kind of application which reflects that - so have seen some surgery, done some surgical audit, and have done some projects related to surgery. 

Make sure that it's absolutely clear on the application that you have that background and interest already, that you're not just coming at it from zero, and you're going to give it a try.

 

What made you decide to run for president of the Royal College of Surgeons?

As well as the Royal College of Surgeons of England, there is an Edinburgh college, a Glasgow college and an Irish college, and we do try and work really hard together. The London college has a lot of influence. One of the things that I didn't realise before I became president was just how much influence it does have. 

Like many people, I did my surgical exams, I got my fellowship, I got back into the working world, and I was too busy to ever take much notice of the college. I was a college tutor for quite a long time. I used to give lectures at the college. 

So it was there in the background. I realised that it was important for exam-setting, standard-setting, and leading the profession in terms of its views on a whole range of important subjects. But it really wasn't for me, because I was too busy doing all the other stuff - the research and looking after patients. 

I've been addicted to surgery and it's been a drug that's difficult to get off, but you get to a point where you realise that there are only so many more of a particular kind of operation you can do, and maybe you can have a bit more influence at a higher level. 

That maybe if you get into the position where you can actually change things across the profession, that's a good thing to do. And so I got elected to council. 

During my time on council, I began to understand how the college worked. I began to understand that actually it didn't have so much power - it was more that it was an influencer, a nudger, a persuader. I realised there was lots going on behind the scenes, which I had never cottoned on to before.

With the election to the presidency, the opportunity came for me to throw my hat in the ring. The college council votes for the president in the surgical colleges. Whereas in, for example, the Royal College of Physicians, the membership vote for the president, so that's different and controversial. 

One of the things I wanted to look at on becoming president was how we could maybe change some of the rather traditional things we've been doing in the past and bring them up to date, including how we select the president - so we're taking a look at that, and at the whole equality and diversity issue.

I asked for the Kennedy Report to be undertaken - an independent review into our equality, diversity and inclusion in the college, in the profession, and in surgery more widely. This has had a tremendous effect, I'm pleased to say, across all the specialties. 

Rather like dropping a pebble into a pond, the ripples still keep going out to everybody else. I hope it will make a big change to allow people from every kind of background and interest to come into surgery, because in the next 20 years one of the biggest challenges to UK medicine will be the surgical wait lists. 

They're not going to be solved in two or three years - it's going to take some time. We're going to be very fortunate as surgeons, because we're going to have lots of work to do. There's not going to be a problem about getting surgical experience and a surgical career.

 

Tell us about the findings of the Kennedy Report and what you plan to do with them.

In 2020, there were several things going on simultaneously: the pandemic, the George Floyd episode, and  ‘Black Lives Matter’. It was an opportunity, while more of the routine things were put on hold in the College of Surgeons, to be able to do something very strategic. 

I had heard lots of stories from colleagues about bullying, harassment and favouritism, about colleagues not having a fair opportunity to get on in surgery, and complaints. 

I thought it was a brilliant moment, when all this change was going on, to take a look at things. With the chief executive we had a long discussion: shall we have an internal review, or shall we have somebody outside to have a look at us? 

I thought it would have more standing and more effect - though it might actually be much more challenging and difficult too - if we had an external review by somebody from outside. So Baroness Helena Kennedy got together a team of surgeons and lay people, and they began to take evidence. 

When I first saw the draft report in January 2022, I was pretty shocked with some of the personal testimonies of a number of the people who'd spoken to the panel. I guess we all live in silos, and think the world carries on in a way in which we see it, and we don't realise what's really going on in many other people's lives. 

When you find out what's going on in other people's lives, it makes you want to change the system so that it's better for them too. We heard lots of stories around racial prejudice, and around gender prejudice. In principle, we have largely accepted Baroness Kennedy’s recommendations, to change the college and change the face of surgery. We're working through the details at the moment. 

Essentially, I would like the Royal College of Surgeons of England to be the sort of place where everybody, from whatever background, feels at home, and that that is the loadstone for them in their surgical career - not a rather distant group of elderly white males, out of touch and not really listening. 

I would like the College of Surgeons to be where everybody, of whatever age and background, feels that it is the place that helps them from the beginning to the end of their surgical career. That's very difficult in the present environment because there are lots of voices out there. 

There are lots of ways of getting education,of getting advice, of being advised and told what to do. We have to compete with that, and if we're a rather distant, cold body, only interested in doing the examinations, I think we will lose touch and become irrelevant. So it's all about being absolutely relevant to the surgeons of the future.

 

What are your key priorities as president, going forward?

I like using the title of a book by John Mortimer, who wrote Rumpole of the Bailey. His autobiography is called ‘Clinging to the Wreckage’. That sounds a bit down. But in many ways, in these kinds of jobs, it is about survival, but being a bit more positive. Recovering from the pandemic is a massive issue. 

The college was very challenged by the pandemic. We've had a rebuilding programme going on, to get back to work after the pandemic in the college. To get into the new building and make that work for us and for everybody. 

To have as much influence as we can around equity and diversity with the Kennedy review, and to do as much as we possibly can to influence, nudge, and shape policy with the government around the recovery of planned surgery. 

One of the issues that's really key is that there will be enormous pressure to get the volume of surgical cases through so that the wait list disappears and becomes less politically unacceptable. 

The unintended consequence of that is that there is tremendous pressure on individual surgical organisations within hospitals and regions to get the volume done and ignore the real need for simultaneous training and surgical education. If we get that wrong, we don't have a surgical workforce for the future. It's absolutely essential that, somehow, we keep those two things hand in hand, and that is one of my big priorities.

 

The Royal College of Surgeons published the New Deal for Surgery report, which sets out a plan to deal with unprecedented waiting lists for elective surgery. What does that plan involve?

Back in January 2022, we began to think about the way in which we might message, at a very high level, what we want to have happen in surgery. The New Deal for Surgery report was published at the end of May,  following on F.D. Roosevelt's ‘New Deal’ in the United States during the American Depression. 

A need for investment and for organisation to allow things to recover. The things we asked for were onward, consistent funding every year for revenue for allowing surgical recovery to work. That is so there's more time for working in the evenings, and for paying for staff to work at weekends so that we increase capacity in that way. 

We also said that there weren't enough beds and pairs of hands, and that included not only surgeons, but surgical care practitioners, anaesthetists, and theatre staff. Mostly we have been campaigning for surgical hubs, and they come in all shapes and sizes. 

They can vary from a major cancer hospital like the Royal Marsden - which is effectively a surgical hub for cancer surgery, and is protected from COVID and all the other winter pressures - to a pop-up, three- or four-theatre complex in a car park, put up specially to deal with the recovery of elective surgical services. 

In some trusts you have two hospitals, and you can characterise one as the 'cold' site and the other as the 'hot' site. The whole strategy being to try and preserve ring-fenced, safe surgical sites, where operations aren't cancelled, and where the surgical beds aren't overwhelmed every winter by the surge of medical admissions. 

What happened, even in 2018 during a flu surge, was that surgery stopped for months. Every year prior to that, previous presidents have been in conversation with NHS England and the government over trying to do something about making surgery seasonal. 

In other words, every winter it would slow down big time, the waiting lists would whizz up, and then we'd try and recover during summer, often not very successfully, so the waiting lists got bigger and bigger, and they were already pretty big before the COVID pandemic struck. What we're trying to argue for is a method of securing safe elective surgery, whatever the pressures in the rest of the system. 

But if you're in a district general hospital, and loads of patients come through the front door, through the emergency department, and those medical admissions have to go somewhere, and there are empty surgical beds, it's completely understandable that the patients have to go in those surgical beds. Those operations get cancelled. 

So we need to have a different way of doing things to try and keep some ring-fenced surgical capacity. I'm pleased to say that after the publication of our New Deal for Surgery report, it has had terrific traction. The Department of Health likes the idea of surgical hubs, the current Secretary of State himself has talked about surgical hubs. The budget promised another £1.5 billion, particularly for surgical recovery and particularly around the whole idea of surgical hubs.

You might ask: 'What on earth is the Royal College of Surgeons doing all the time?' Well, I can tell you that there is a brilliant example of us, behind the scenes, lobbying, nudging, persuading, and now there is money, and there is going to be increased capital spending on surgical facilities. 

One of the things that drives me crazy is to hear colleagues saying: 'We've only got one day a week in the operating theatre, and the rest of the time we can't get into theatre.' Surgeons love doing surgery, and we've got to find a way of increasing capacity in the UK. Allow surgeons to be in surgery two or three days a week like they are in many European countries. 

It's completely ridiculous that you have these brilliantly trained people who desperately want to do the work, as in they want to get into theatre and do surgery, and not give them the ability to do so. It's a big waste of a highly trained and expensive workforce.

 

COVID's been awful for so many reasons, but are there any positives that we can take away as a profession?

I think there are. Many of us have got used to digital forms of communication very quickly and the tech's improved very quickly too. I can remember MDTs, where we tried to have other people beaming in, and the technology was completely hopeless, and it made things very difficult. Suddenly, now we can do it. 

That's great, and that helps with communication and with managing surgical departments really well, in a way in which it wasn't possible before.  During the COVID crisis there were many surgical teams who became brilliantly creative and found solutions to problems without the pressure of maybe too top-heavy management. 

They were able to find solutions to problems, and that gave everybody a tremendous sense of achievement and spirit, a sense that they were working together to solve problems that otherwise they wouldn't have been allowed to. 

One of the things we're really hoping for is that that sense of entrepreneurship and creativity isn't crushed once more by the heavy hand of bureaucracy and management, and that teams are still allowed to think outside of the box and come up with creative ways of doing things. 

That is one of the biggest dividends of the COVID pandemic - that it has allowed us to think and do things in new ways and think outside of the box. There is still a spirit of that in the air at the moment. It is a fantastic opportunity to think about what we're doing, and think about doing it in a different way, and I just hope that we don't lose that too quickly - that we keep that for a good four or five years while we're trying to solve the elective surgical wait list, and the surgical provision problem across the piece.

 

Where do you see surgery heading in the next ten to fifteen years?

We published a document in 2018/19 called the Future of Surgery, which pointed out a number of things. Surgery's going to be provided in teams. The ‘big surgical I-am boss’ - as in surgery has the primacy over everything else - will have to change, because surgery becomes part of treatment, and is not the only treatment. 

For example, in cancer treatment, patients will have chemotherapy or radiotherapy first, then they'll have surgery, and they may have some more chemotherapy afterwards, so there will be a package of treatment, which will include other teams to optimise it. 

The advent of robotically assisted surgery is going to make a big difference. Genomics will help us choose which patients will be suitable for what treatment - so the individualisation of surgical treatment. I think there'll be much better predictive models for helping decide who should have surgery in what situation. 

One of the issues around surgical hubs is that the right kind of patient has to be fit enough for the right kind of venue for their surgery. If you have a relatively 'light' surgical facility, you can't have very comorbid patients having their surgery there. You have to have the right patient in the right place, so we'll have better algorithms, and artificial intelligence means of deciding who should go where. 

All those things are going to change the face of surgery very much, and it will become more minimalist. We will be not destroying organs - we will be preserving organs and we'll be doing that in a much more clever way. It's very exciting. 

All the technologies coming through look very promising, and to all those who might be thinking about a career in surgery, I'm incredibly jealous, because I'd love to be playing with all those new technologies too. 

All of these areas of medicine change all the time, and that's what's so exciting about it - it doesn't stand still. You don't start doing the same thing you did 25 years ago, and carry on doing exactly the same thing for the next 25 years. 

It's changing, changing, changing. It is a life of perpetual education, of perpetual readjustment to new technologies and, at the same time, being kind and caring for our patients who, in the middle of it all, are the most important people in the whole framework of the surgical team and providing an operation. Why are we doing it? We're doing it for the best possible outcomes for our patients.

 

To what extent do you think hierarchy remains a problem in surgery, and what ways would you suggest surgeons combat its negative effects?

Hierarchy gets a bad press, in the sense that some hierarchies are good. You have to have somebody in charge. I think it's the way in which they're in charge which matters. I've travelled widely around the world, and I can tell you there are surgical hierarchies, for example, in Germany, which are changing but which are much more tough and hierarchical than in the UK. 

The big boss decides what all the other consultant surgeons on the staff do during the operating list that day.  In the UK we have a much different system, which is that you become a consultant and effectively - although this is changing - you are able to decide what you do with every individual patient, and nobody tells you what to do. 

So hierarchies are different in different health economies. If you're talking about the hierarchy within surgical training and within a hospital organisation, it's really important that leaders are accessible, listen, and regularly discuss what's going on with the whole of their team. I think that kind of cold, aloof, 'I'm too busy' kind of approach is completely unproductive and unhelpful.

It is also important that within leadership teams you have succession planning - you need to share the jobs around, you need to have everybody have a chance to take part in the various jobs and responsibilities of leadership. 

I think hierarchies can be flatter, but to a degree you still need some kind of leadership arrangement, and it's really important that particular posts are shared around. That there are opportunities for everybody to become the lead in whatever particular area within the hospital or surgical provision it is, so that they can get experience not only of leading, but also listening and seeing what the problems are. 

It 's easy to criticise other people in different levels of the hierarchy without really realising what it is they're trying to both achieve, and what they have to deal with. So yes to flatter hierarchies, but there has to be some leadership, and somebody ultimately has to take responsibility for the show.

 

What can surgeons who are working in a bullying environment do to change that culture?

The first thing to say is: it's not easy. And the second thing to say is: share the issue with your colleagues. All of us will have either a senior colleague or a contemporary who we feel we can talk to honestly. Sometimes we feel we're being bullied, and we may not actually be right. It may be that it's our misperception. 

So it's really important to talk to colleagues, both more senior and contemporaries. Once you have decided that what's happening is absolutely inappropriate, you have to speak to the relevant person in the clinical leadership. It might be the clinical lead in that area, or a divisional director, or it could even be the medical director. 

It takes a lot of ‘brass’, a lot of courage, to escalate it that far. The problem begins if it's the clinical director of the service who is doing the bullying. Then you have to get a coalition of the other senior consultants - let's say surgeons in this case - in the team, to talk about it with you, and then confront that clinical director or leader with the issue. 

If you are in a real fix and none of the people within your organisation can help, then you can speak outside the organisation - for example, if you're in a particular specialty, the leadership within your specialty have arrangements to help. If it's really bad, and you can't find anybody to speak to, then you can speak to the college. 

We have a helpline that deals with both professional, psychological, emotional, and health issues, in two separate streams. If you want professional help around bullying, and there is no other way of finding a potential solution to the problem, you can also get in touch with the college. 

As to changing culture, that's really difficult. Part of the Kennedy review recommendations is that we try to do just that. If, in the College of Surgeons, we give a successful candidate a fellowship, in the past we've taken the view that, apart from sending them some news updates every now and then, telling them what we're at, we effectively leave them to get on with it, and I don't think that's right. 

What we need to do in the future is to bring back people every five years to reaffirm their vows to the highest possible standards of ethical surgery, and also encourage them to look again at the culture in their own organisation. The NHS is trying really hard. Many trusts are trying really hard.

It takes a long time to change culture, but if there is a whole generation of you coming through the system, who can see the problems and want to change the culture, and make it easier for the next generation coming on, it will slowly change. But it's difficult. It won't change instantly. It takes time.

 

What have you've learnt about leadership from your experience as president so far?

They have been the most extraordinary times to be doing the job - being elected and in position during the height of the pandemic. For anybody in these kinds of jobs, it's all about - as far as you can - communication. It's about hearing and listening and talking to your colleagues. 

So that means talking to people on the council of the College of Surgeons and finding out what's going on in their locality. Talking to all the regional directors we have up and down the country, and finding out what's actually going on in their hospital or their trust or their region. 

Within the organisation itself, the college employs around 240 people, so speaking to them, and their managers, about what their aspirations, hopes and fears are. Then in the wider context, finding out what's happening in the world, and what other medical colleges are managing to do in tough times. 

How they actually run their surgical colleges and run their leadership. So listening, talking, observing, and hearing, and seeing what other people do. There are always going to be problems. There are always going to be people who disagree with you. 

There are always going to be people who make life difficult for you. In big jobs like this, it's always the case, and learning how to manage that in a way which keeps colleagues civil and on good terms and respectful is the most important part of the job.

 

What are some of your proudest achievements?

Many people who get to be in some kind of leadership position, whether it's prime minister or president of the College of Surgeons - and I'm not equating those two things at all! But just as an example, people talk about: ‘What will be your legacy?’ 

I'd like to suggest that for all of us, the most important legacy is the surgeons who you have personally helped to bring on for the next generation. Degrees, positions, qualifications, awards mean nothing. The most important thing is securing the future of the next generation of surgeons. 

What makes me most proud is seeing some of my disciples, some of my little ‘chickling’ surgeons, develop into proper, grown, huge, forceful, successful surgeons themselves - male, female, from every racial background. That is the most important achievement ever - it's the succession planning in bringing on the next generation of surgeons.

 

What are some important lessons that you've learnt that have shaped you as a surgeon or a leader?

If you're offered an opportunity, grasp it. If the door is ajar, push it open - even if you don't feel up to it. I've had lots of moments as president of the College of Surgeons when I've felt not up to the job - imposter syndrome plus plus. 

It's really important to challenge yourself, to put yourself in a position where you are made to be uncomfortable. During a surgical career, if you are offered leadership positions in an organisation, in a specialty, doing a job on behalf of your colleagues in the hospital, taking a management role, taking a role in education, training, or examinations - think about it very carefully. 

Don't take it on if you're already super over-committed. Don't take it on if your family is going to find you're never, ever at home. But think really carefully about saying no to an opportunity if it's offered.

 

Have there been any key role models for you that have shaped you?

There have been two completely different kinds of role models. Professor Geoffrey Slaney, who subsequently became president of the College of Surgeons, helped me decide to become a surgeon. 

Although all the advice he gave me I often completely disagreed with, and didn't follow, he was there if ever I wanted to ask: 'What should I do next?' He would say: 'You do A’, and often I went off and did B, but nonetheless, he was there to bounce things off, so that was great. 

It is also really important to have a partner who understands your business, and can help you be grounded and bring you down to earth, even when you're feeling a bit pompous or over-successful in your surgery. 

So for me, I would say my wife, who happens to be a doctor too. She is a great source of common sense, of grounding, a person I can talk to about all kinds of issues. To have somebody like that at home in your life is really important.

 

What's your favourite book?

I am an avid reader. I read three books simultaneously. I'm completely obsessed with military history, particularly the military history of the Second World War. When I was a schoolboy, I failed some of my ‘O’ levels. I was in a fast stream for getting to university quickly, and there were several of us who were rather naughty boys and enjoyed having fun rather than studying, and we had to go into the fifth form to do our ‘O’ levels again. 

It was very shaming, but it was also absolutely fantastic, because in a year I did the history of the inter-war period, which included the rise of communism, the rise of fascism, and the Great Depression. All those issues which still have echoes today. 

So, I can't tell you about one book. But reading about that period, as I do obsessionally, gives lots of echoes around what's happening today. The world is becoming a more fractious, divided, difficult place. 

Even in the UK we've had Brexit, and two completely opposing points of view. There are lots of echoes from that period in world history. We can learn from it, and sometimes find some of the solutions, but also look forward to some of the potential problems we might have.  

I'm not going to give you the name of a novel. I'm not going to give you the name of a medical history book. I'm just going to say my favourite reading is all around that inter-war period and the development of the Second World War, which was a huge catastrophe for humankind.

 

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.