BJS Bookshelf: Mastery
10 March 2023
26 May 2022
I have held the Chair of Surgery at the University of Adelaide for the past 30 years. I trained as an HPB surgeon, became involved in rural surgery coordination within South Australia, surgical management of public hospitals and assessment of new surgical techniques for the Royal Australasian College of Surgeons. For the past 20 years I have been Director of the Basil Hetzel Research Centre based at The Queen Elizabeth Hospital. I have been predominantly working within the South Australian public hospital and university system with a research focus on surgical innovation. I have held the Presidency of Health Technology Assessment international (HTAi) and chaired the International Network of Agencies for Health Technology Assessment (INAHTA) as well as serving on the Council of the Royal Australasian College of Surgeons for 9 years.
What made you decide to become a surgeon?
I grew up in a surgical household, my father was the first urologist in the city and I spent my early years accompanying him on weekend ward rounds as a young child and sitting in his consulting rooms after school before driving home talking about urology and football. I never imagined any other career.
Who were your influences?
The Professor of Surgery of the University of Adelaide, Glyn Jamieson, was my mentor who connected me to Professor Leslie Blumgart when he was working in Bern, Switzerland, and also Professor Bernard Launois in Rennes, France, all of whom set firm foundations for my subsequent academic career.
What were your training highlights?
Being supported to pursue a PhD with careful guidance but very little interference. It provided a template I have followed in my approach to Higher Degree supervision. Later, working overseas away from familiar systems and approaches and seeing excellence can be achieved by many different routes.
Tell me about a surgical triumph
Early in my consultant practice a patient who worked as a volunteer at the hospital was diagnosed with a gastric cancer and a CT was reported to demonstrate extensive metastatic disease throughout the liver. At the time, no treatment would have been offered. It was not a typical picture and I pushed for a biopsy of the “obvious” liver mets. He had extensive benign hamartomas, a gastric resection followed, and he lived for many years after. I still try not to accept opinions rather than evidence.
Tell me what your learned from a surgical disaster
As a Fellow in Switzerland with an experienced colleague, we stopped a torrential gastric ulcer bleed at 2 am. The patient seemed to recover well, at day 6 he was discharged, to return 4 days later with ongoing nausea. Plain x-ray show a pack had been left intra-gastrically. The count had been reported as correct, clearly I had left it behind. At the time in Switzerland it was not common that surgeons admitted mistakes. However, by reassuring the scrub nurse it was a shared responsibility and telling the patient exactly what had occurred (with removal of the pack by gastroscopy), the event turned into a positive, not a cover up. This approach was not considered “normal” practice at the time.
What was your proudest achievement?
Seeing my name as first author on my initial publication in what was, in fact, a high impact journal.
What are your hobbies outside surgery?
I enjoy collecting sculptures, both reproductions and original, usually of the human form. Some are over 3 metres in height and my house is littered with them, much to my wife’s horror. I also enjoy collecting early colonial prints and sketches, mainly from the first 50 years of white settlement in Australia.
What advice would you give a young surgeon?
Surgery will never stay still. Established procedures will disappear, new technologies and approaches will arrive: be open to change but honestly evaluate it, don’t blindly follow the herd. Support your colleagues and staff, it will ultimately lead to less mistakes and better care of the patients entrusted to us.
What would you be if you had not been a surgeon?
Very unfulfilled. However, if the possibility had not been available, I may have considered architecture, not that I have any artistic flare but I enjoy architectural form and solutions and have always been in awe of Frank Lloyd Wright and Rennie Mackintosh.
Not being around more for my children as they grew up. I allowed academic surgery to consume probably too much of my time and I never achieved a work/life balance. I found myself harvesting a donor liver when my twin daughters were christened and missed too many of my children’s weekend sporting triumphs. I hope they forgive me.
Guy Maddern, RP Jepson Professor of Surgery, University of Adelaide
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