Day 9: BORS and a (wee) Break

On Tuesday morning we awoke, had breakfast, and met Dominic in the lobby to take us to the morning session of the British Orthopaedic Research Society (BORS) meeting. This meeting was being held at the University Of Glasgow and Dominic was one of this year’s organizers. 

At the session we heard short scientific presentations on a variety of topics including metal wear in cervical disc replacements, influence of cup position on polyethylene wear, local effects of ceramic debris, kinesiotaping, adductor canal blocks, and more. In addition we had a longer talk on the science behind blast-related fractures from Professor Jon Clasper, a British military Orthopaedic surgeon. In addition, there was a small room of posters to peruse. 

After the morning session we had a break for lunch where we chatted with Mark Wilkinson from the University of Sheffield about his role in the larger Orthopaedic Research Society and the challenge they have faced getting active participation from clinicians. He genuinely seemed interested in our opinions about how to generate more active participation in the ORS. 

Following lunch we stopped by the Hunterian Art Museum at the University to see their current special exhibit: Skeletons! This exhibit displayed the skeletons of eight humans found buried in various places around the United Kingdom and go as far back as 3000 years ago. The skeletons were all carefully laid out in individual glass displays, and a small placard at each one pointed out interesting pathological features of each skeleton. The placards also included the assumed gender, approximate age at death, and sometimes even a cause of death. One skeleton showed a healed left tibia fracture and a severely arthritic right hip. 

From the museum we headed back to our hotel for a few hours of downtime before dinner. I took the opportunity to go for a run and ended up following a path along the river Kelvin through Glasgow’s West End. The light drizzle that seemed to never leave Glasgow helped keep me cool during the run. 

Dinner was at a local Thai restaurant and included a brief presentation about some newer surgical plates. Many registrars and consultants were there and Sanjeev Patil joined us again as well. It was a wonderful time and a great end to our time in Glasgow. The evening ended with hugs from Dominic and Sanjeev, and instructions on how and when to be at Glasgow airport next morning. 

Michael and I chatted briefly over a glass of scotch back at the hotel. We agreed that our hosts in Glasgow not only showed tremendous kindness, generosity, and hospitality, but also humbly demonstrated for us how we should be treating each other: as hosts to our guests, as doctors to our patients, and as people to each other. 

Day 8: Kilts, Haggis, and C√®ilidh

Mr. Sanjeev Patil picked us up on Monday morning to take us for a social tour. The rest of the faculty are busy with the British Orthopedic Research Society (BORS) meeting, and today was the basic science portion. They decided today would be a social day, and have us visit the meeting during the more clinical research that will be presented on Tuesday. So the plan was to take us for a hike of one of the local mountains, followed by a boat ride on Loch Lomond, and capping the afternoon with a tour of a local whiskey distillery.

Unfortunately, the weather was poor and the hiking conditions were not ideal. So instead, we drove around the Scottish country side until it was time for our boat ride. We boarded our boat and took a tour of the lake. Despite the fog and drizzle we had a great time and the lake was absolutely beautiful.

After our boat tour we took in lunch, and then made our way to Auchentoshan distillery. There we had a tour, and learned how scotch whiskey was made. Michael, who is the president of a scotch club, could hardly contain himself! At the end of the tour, we were both presented with complementary bottles of scotch. Much to our suprise the distillery had added custom labels with our names on them. We truly could not believe how wonderfully friendly and thoughtful the folks in Glasgow have been!

We arrived back at the hotel, with an hour to get ready before the BORS dinner meeting, to which we were invited. We were surprised to find a large plastic tub at the front desk waiting for us with our name on it. When we opened it, we found two garment bags with complete kilts inside! One had Michael’s name on it, and one had mine.

So Michael and I changed into our kilts (with the help of a YouTube video) and met Dominic Meek down in the lobby, ready to go to dinner. Thankfully, Dominic was also wearing his kilt! He told us we would not be the only people wearing kilts tonight, and it was important that we dress appropriately as there would be Cèilidh (pronounced KAY-lee) dancing!

At the dinner we had the chance to rub shoulders with some of the United Kingdom’s most preeminent orthopedic researchers. The conversation was incredible, and frequently came back to our choice of wardrobe. Clearly everyone was impressed with our kilts.¬†To round out our Scottish experience, dinner consisted of chicken, stuffed with haggis. They were truly going “all out” for us!

After dinner, the dancing began. C√®ilidh dancing turns out to be an exceptionally fun group activity. There were circle dances, and paired dances and line-style dances. It was almost like being at a wedding! Everyone had a fantastic time, and I couldn’t believe how many researchers you could fit on a small dance floor!

Day 7: Derby to Glasgow

On Sunday morning we woke up, had our traditional English Breakfast, and met Peter Howard one last time while he insured we got safely in our hired car to go to the train station in Crewe. From there we boarded a train that would land us in Glasgow, Scotland in a little over three hours.

The train ride was very peaceful. We rode across the rolling English countryside through the Lake District and ultimately into Scotland. Glasgow from the train was an ultra-modern metropolis that had 18th century buildings side-by-side with modern architecture.

At the train station we were met by Mr. Dominic (RMD) Meek. He is a tall, pleasant gent with a lovely Scottish accent that is not so heavy that we can’t understand him. He picked us up in his car and drove us to our hotel, the Hotel du Vin & Bistro which is close to the University. Since we had been sitting all day he was kind enough to take us for a walk through the area by the University including the Botanical Gardens, and a stop at a local church that had been converted into a pub. Since it was Sunday (at least by our best recollection), we decided to go into Church, just to have a pint.

After our walk Michael and I went back to our rooms to settle in and freshen up. After that Dominic took us for dinner to meet the rest of the faculty. We ate at a restaurant called the Ubiquitous Chip where we were greeted with a drink, delicious food, and a personalized menu just for our visit!

Among the many faculty there I enjoyed talking to Mr. Sanjeev Patil, a hip surgeon from Glasgow who was going to be taking us around for our activities on Monday. Sanjeev has trained many places and taught me that the best way to learn something new is to “go to the source to learn it.” This is something he took away from his time with Dr. Daniel J. Berry, who mentored him while Sanjeev studied at the Mayo Clinic.

After the excellent dinner and hospitality, Michael and I went back to the hotel, had one glass of scotch to cap the night, and went to bed.

Day 6: Journey to “Jiseki”

Michael and I slept in a little bit on Saturday morning which was a welcome respite from the highly scheduled visit. We grabbed breakfast at 8:30am and were met outside by Peter Howard at 9:30. Though the weather was supposed to be nice in the morning, and turn to rain in the afternoon it looked cloudy. Peter decided to drive us around Derby to a lovely walking area called Dove Dale.

Dove Dale is a walk along the Dove River through some foothills (similar to the glacial drumlins we have in the Kettle Moraine area of Wisconsin). Here we walked the famous Dove Dale stepping-stones and chatted about the formation of the British National Joint Registry (among other things).

It was on this walk that Peter talked about people’s reaction to NJR and specifically used concepts from a lecture he had heard about the “Journey to Jiseki.”

“Jiseki,” he explained, is a Japanese concept that roughly translates to “acceptance of burden.” When people are faced with data about their performance they go through four distinct stages:

  1. “The data are wrong.” – This is akin to denial and is often the first stage on the journey to “jiseki.”
  2. “The data are right, but it’s not a problem.” – The idea behind this is that the data is accepted, but excuses are provided to resolve or minimize the implications.
  3. “The data are right, it’s a problem, but it’s not MY problem.” – This is best exemplified by the Japanese word “taseki” which roughly means: “The dog ate my homework.”
  4. Finally, “The data are right, it’s a problem, and it’s my problem.” – This is “jiseki” and is characterized by someone who feels this is now their responsiblity, their burden, and accepting no excuses.

We finished our walk in a traditional English countryside rain shower, and followed Peter back to his car. From there we stopped at the John Thompson Inn in Ingleby for lunch and a pint and then headed back to Peter’s house.

Once at Peter’s house he showed us the ins and outs of the NJR, including how to interpret funnel plots, spot outliers, and use the provider data to meaningfully determine if you were doing a good job or not. Over the course of 3-4 hours we sat in his den and asked him questions that we hoped the registry would answer. It was fascinating to see the ease with which he could conjur up the answers as well as provide deep, meaningful insight into where there were hidden answers in the data. All of this was done with a hot cup of tea and a warm smile. 

Before dinner we got to tour an old water tower that Peter’s wife, Mandy, had been renovating as a residence. It was an unbelievably cool project, and both Michael and I ended up in a bidding war for the property.

For dinner, Mandy served a delightful shrimp salad, main course of beef stroganoff and rice, and a dessert of strawberry meringue. As a treat after dinner, Peter took us into his “music room” to show us his guitars, including two that his brother had made for him. I got a chance to play all of his guitars before a taxi picked us up and brought us back to the hotel.

We leave tomorrow for Glasgow, and we look forward to the rest of our journey, but our hosts in Derby have been so wonderful, so thoughtful, and so open to welcoming us that we can’t help feeling a little sad to leave. At least we have one more breakfast at the Boot Inn before we move on.

Day 5: Finally a real English Cemented Total Hip!

Mr. Peter Howard joined us for breakfast at the Boot Inn on Friday morning, and then drove us to Derby Hospital in his 2013 Maserati Gran Cabrio Sport for a busy day in the operating theatres. Much to our delight, his first scheduled case of the day was a traditional English cemented total hip arthroplasty using an Exeter Cemented Stem and Cup. This is really what Michael and I have been waiting for. We came to the Land of Charnley to see the closest thing to a traditional fully cemented hip replacement as we could.

Peter invited us to a few colleagues, including Mr. Arthur Stephen who also had a hip replacement scheduled for the day. He invited us in to his operating theater as well. In addition, in between cases he showed us some new software he has been piloting to help reduce waste in the operating room and at the same time provide more surgeon-specific tools.

In the theatre I was amazed by how few instrument trays were open at the beginning of the case. As the case progressed more trays were opened, but the patient was not delayed from coming into the room until all trays were opened.

In addition, neither Michael nor I were disappointed seeing two consultants each put in cemented total hip arthroplasties. Both Mr. Howard and Mr. Stephen were great teachers and provided their own entertainment as well.

Following time in the theatre we had a quick chance to pop across to the pub with Mr. Howard before coming back for a complicated cases conference. A number of consultants put up cases and asked our opinion, which was an incredible opportunity. After this we were taken out to the¬†Anoki¬†Indian restaurant “for a curry” as the English say. The food was fantastic and only beaten by the company and conversation. So far, our time in Derby is¬†turning out to be a most excellent and welcoming¬†experience.

 

Day 4: Oxford and Derby

We awoke early Thursday morning to check out of our London hotel, and take a car to Oxford, about an hour and a half north of London. We took the car with Professor Haddad who was scheduled to talk later that morning at the European Bone and Joint Infection Society annual meeting.

In Oxford, we were brought to the Nuffield Orthopedic Centre, where we were introduced to Mr. Si√īn Glyn-Jones, a consultant, and Mr. Anthony Palmer, a registrar.

Mr. Glyn-Jones gave us a tour of the orthopedic center, including their unique bone infection unit. He apologized for the lack of cases in their operating theaters today, but many of their surgeons were down at the bone and joint infection Society meeting.

He also gave us a tour of the research facilities on that campus, which are impressive to say the least. They perform epidemiologic research, clinical trials, and laboratory research out of a single comprehensive research facility. According to Professor Haddad, it is the most well funded, and largest musculoskeletal research facility in all of the United Kingdom.

After this tour, we were brought to the center of Oxford by taxi, to view portions of the bone and joint infection society annual meeting. After hearing some stimulating talks about bone and joint infection, we were taken for a walking tour of The Oxford campus by Anthony Palmer. He was kind enough to show us many of the colleges around Oxford, as well as other interesting sites including “The bear” Oxford’s oldest pub, and “The Eagle and Child”, the Oxford-based pub that CS Lewis, JRR Tolkien, and other authors frequented.

By the time his tour was done, I was ready to sign up for college again, and enroll immediately at Oxford university.

After a few pints around Oxford, we got into a car and were driven to Derby, approximately two hours north of Oxford. We were driven to the lovely countryside home of Mr. Peter Howard. He and his lovely wife Mandy invited us into their home, and then took us to our hotel, the Boot Inn, for dinner, and drinks.

There Mr. Howard and I discovered a mutual admiration for the Electric Light Orchestra, which was based out of Birmingham, England, approximately 30 minutes away. We shared a fantastic meal, and great company. We also learned a bit about the National Joint Registry, which Mr. Howard has been instrumental in designing, and moving forward.

After another long day, we retired to our rooms for some much needed rest.