Good day Prof and thanks for the opportunity to spend this moment with you
Hi Mary, It is a pleasure to converse with you.
*Please tell us about your background, what motivated you to specialise in Vascular Surgery and vein in particular
I come from a non-medical family but at school, was always fascinated by biology and regularly won the biology prize. I had an excellent training at St Bartholomew’s Hospital medical School and then went on to academic medicine through the University of Bath and then University of Oxford before becoming a consultant in Guildford. When I was training, the only two areas where research was moving fast was laparoscopic surgery or vascular surgery. At first I was doing a lot of laparoscopic surgery but, had an opportunity to work with Prof Michael Horrocks in Bath for my research. He was inspirational and I ended up doing my thesis with him for which I won the Norman Tanner medal at the Royal Society of medicine. From that I move to a lecturer’s post at the University of Oxford with another inspirational boss, Prof Sir Peter Morris. As part of my training, I worked with consultant Surgeon Mr Bob Galland who showed me that you could produce excellent research whilst still having a very active clinical practice.
My interest in vein surgery started very young in my medical career when I realise that although we were doing amazing operations in arterial surgery (vascular surgery) people were ignoring patients with varicose veins and both patients and doctors were accepting high recurrence rates and poor results. It was clear to me that the majority of the problems with vein surgery was a lack of understanding and also a lack of pressure from either doctors or patients to do the job better. I was fortunate that during my training, the new test colour flow duplex ultrasound scan was invented and became popular. This gave me the tools to be able to start my research into varicose veins and venous treatments. In 1999, I already had very good theories as to how to improve vein surgery when a new development, radiofrequency ablation, appeared in America. I was the first person to use this in the UK, got into the newspapers and then use the lessons that we learn from this to develop our protocol to use the new techniques that we now use – such as endovenous laser ablation, TRLOP closure of perforators and coil embolisation of pelvic veins.
I now regularly teach other doctors especially from abroad and frequently point out that you do not have to be very good to become an expert in vein surgery, as so many people currently allowed to perform vein surgery are so bad and artists interested in the subject.
*How have you managed to continue to innovate and to focus on Research, even in the present climate. These are two, time consuming but much-needed aspects of healthcare provision
My belief is that you cannot remain giving your patients the best treatments if you are not actively involved in innovation and research. As such, I sacrifice a lot of my spare time in evenings, weekends and holidays to make sure that I keep the innovation and research at The Whiteley Clinic as a priority, and ensure that we stay at the top of our subject.
Having financed this for years myself, I have now managed to build a team around me which has started attracting funding from commercial companies, research grants and recently a government based grant. It is the same with many things, success breeds success. The more successful your research and innovation is, the more people want to support you.
*What are the challenges/lessons for healthcare advancement through research
The biggest challenges are firstly to have the vision as to what research needs doing and secondly making sure that you realise how long it is going to take and how much resource it is going to take to do good research.
Many people believe they are doing “research” because they do a research project that is company based or they have been given. Innovative research comes from within the company. There has to be either someone or a team that can identify the areas that need to be improved, and then a will to solve the question through a research or innovation strategy. However this usually takes many years and an awful lot of time and money. It is essential not to get downhearted during this time and to make sure you see each project through to fruition.
*How far have we come regarding innovation in vein care and treatment since the VNUS closure and TRLOP technique
I performed the first endovenous surgery using VNUS closure (radiofrequency ablation) in the UK in March 1999. We invented the perforator vein closure technique (TRLOP) in 2001. In those days these were performed under general anaesthetic. When I look back at how we treated patients then, and the ultrasound that we had available to us in those days, it is like a completely different world.
Nowadays the venous duplex ultrasound scanners are immeasurably better allowing us to diagnose vein conditions we were not able to identify then. The old radiofrequency ablation has given way to several new endovenous laser devices, glue and mechanical ablation as well as coil embolisation of pelvic veins. It is not only the way we treat veins and the devices we use that has changed, our whole understanding of vein wall biology and the source of venous reflux has changed completely. This is the reason why the recurrence rates at The Whiteley Clinic are so very low and cannot be improved upon. Our recurrence rates are currently the same as the natural appearance of varicose veins, if you have never had veins before.
*I am keen on Educating/Training both Doctor’s and Nurses as a team to ensure excellence in healthcare provision, something you do at the Whiteley clinic – What impact have it had on patient care?
Although there are many doctors or nurses that can build a team around them, the only way to change the whole of a subject both nationally and internationally is to educate and train doctors and nurses so they can go out and build their own teams. As such, we not only do internal training for our doctors and nurses but we run external courses for doctors and nurses who want to learn the very best techniques for investigation and treatment of venous diseases. Interestingly, almost all of our trainees come from abroad. It is probably the old adage that a prophet in their own land is often ignored!
