E103: Self-Help - Life Lessons from a Trauma Consultant - Mr Ansar Mahmood (Consultant Orthopaedic Trauma Surgeon)

Hear the extraordinary journey of a leading Trauma Consultant and how he struggled during his early life against all odds. Mr Ansar Mahmood shares life lessons that are applicable to all of us.

Key topics covered in this episode:

👉🏽 How to succeed even if you were labelled as deprived

👉🏽 Daily challenges of a Trauma Consultant

👉🏽 Importance of teamwork

👉🏽 Future of the medical profession and the impact of AI

Mr Ansar Mahmood, Consultant Orthopaedic Trauma Surgeon MB, ChB, MRCS Ed, FRCS (Tr&Orth), DABRM.

Mr Mahmood is a Consultant Orthopaedic Surgeon in one of the leading Major Trauma units in the UK. Fellowship Trained in Orthopaedic Trauma Surgery, with Specialist interests including Major Orthopaedic Trauma, Sports & Tendon injuries & post trauma reconstruction. He is the University Hospital Lead for Trauma Research. Research interests include Platelet Rich Plasma (PRP) and Ortho-biologics and their use in musculoskeletal conditions and wound healing. 

Mr Mahmood is a Senior Clinical Lecturer in the Institute of Inflammation & Ageing at the University of Birmingham and major trauma research lead at the Institute of Translational Medicine. He is one of the first and very few holders of the Diploma from the American Board of Regenerative Medicine awarded by the American Academy of Regenerative Medicine in the UK & Europe. He founded the UK based Academy of Regenerative Medicine which is the premier provider of education and accredited training in regenerative medicine in Europe. He is also one of the few Orthopaedic surgeons in the UK that is trained in Ultrasound and does all of his treatments under ultrasound guidance to enable a higher level of precision and improve patient outcomes from non-surgical or minimally invasive techniques. 

Currently the President of the British Trauma Society he also created the internationally recognised MISTT course which uniquely trains teams to plan and manage trauma in mass casualty situations and is accredited by the Royal College of Surgeons Ed. & recognised by the World Health Organisation. He is invited to lecture and train clinicians around the world on a regular basis. 

He is passionate about the scientific endeavour behind our practice of medicine and surgery and believes big data and machine learning/AI will be instrumental to our decision making for trauma and medicine in the future. He gave a lecture on AI in Trauma at the British Orthopaedic Association conference and is involved in research with the AI research group at the University of Birmingham. 

Links: 

Linked: https://www.linkedin.com/in/ansar-mahmood-ab465135

IG: @regenacademy @dransarmahmood

 Websites:

www.thearm.co.uk 

www.stemcellscience.co.uk

www.britishtrauma.com

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Transcription:

[00:01:02] Paddy Dhanda: Dear friend, thank you so much for listening in to the Superpower School podcast. And on today's episode, I have a childhood friend and when we think back to our friends, It's probably my best friend from school. Still great friends because he's the one person that I would probably turn to for any kind of life advice.

He's just an all around, genuinely smart guy. I thought I'd bring him onto the show today. He is a consultant trauma surgeon. He is a lecturer at the University of Birmingham. He works at the Queen Elizabeth Hospital in Birmingham and is the president of the British Trauma Society. And I'm sure there's a load of other accolades, but I just don't have time for them right now.

 I'd love to welcome Mr. Anal Maud. Hey, welcome to the show.

[00:01:52] Ansar Mahmood: Thanks, bud. Great to be on. Um, looking forward to the questions.

[00:01:57] Paddy Dhanda: We grew up together at high school, and I was gonna refer to you as Dr. An Mahmoud, and then you corrected me just before we started. Tell me more about that. Why am I not allowed to call

[00:02:07] Ansar Mahmood: you doctor? When you said that, do you want me to refer to you as doctor or Mister?

I said to you it's usually mister and the reason for Mister is there is a history behind it. So the Royal College of Surgeons in Edinburgh started just before the UK one. Both colleges, when they became College of Surgery that was over 500 years ago. At that time there weren't really any surgeons.

Because before anesthesia came along that an antibodies surgery was pretty difficult to do well and people, if they ended up reading a limb off or an abscess drain, it either happened naturally or they went to anybody to do it. But one of the people they went to do it, or the physicians would use physicians being the medic you and say something's wrong with you.

 If they needed a abscess draining or something chopping off, they were probably too prim and proper to do it. But they also didn't have the blade skills. They didn't have the practical skills to do it. So actually they used to instruct the local barber barb, as we all know how very good knife skills, uh generally, especially pre Gillette, razors, et cetera.

There are all the brands out there. People used to have to do with a sharp blade. And barbers had very good knife skills. So the physician would send for the barber who later they incorporated the The Barber Surgeon Society, which later became the Royal College of Barber Surgeon, which later became the Royal College of Surgeons.

So Barbaras are always mister, so the doctor would send for Mr. Smith, whoever the barber surgeon was, and the mister would turn up and that would differentiated. It was the physician and the surgeon. And one of the doctor one was Mr. And obviously being England, we keep our traditions going on for hundred and hundreds of years.

That's still the case that when you become a member, when you pass your memberships exams for Royal College of Surgeons, you now call yourself Mr. And in the hospital, it differentiates physicians from surgeons. Not that it really matters anymore.

As I said, when you go to the rest of the world, they don't understand this either. I have to do this whole explanation every time I go abroad as to why you missed that. Because all the other surgeons in the rest of the world tend to be doctor.

[00:04:05] Paddy Dhanda: So on this episode we're gonna be talking about some of your superpowers.

And I don't think there is one specific superpower that we can really pinpoint because there's just so much that you do, but you are a bit of a fixer of people. And as a trauma consultant, I'm sure that is a core part of your job. But before we get into that, I want to take you back to some of your childhood and my first memory of meeting you.

Was quite an interesting story. I dunno if you remember, but I had just moved from Warwick to Birmingham and I sometimes refer to it as moving from Harry Potter land because Warwick's a bit like Harry Potter land with Big Castle, and it's all lovely and friendly to a school in Birmingham, which was more like Jurassic Park.

You only the fittest survived. And I remember on my very first day, I sat at a particular desk, which happened to be your desk, and you were running a little bit late and the response I got from you was like, what you're doing at my desk? And it was like a very, one of those really sort of nightmare-ish meetings because I'm the new kid and I just had no idea like who you were, but you were a lot taller than I.

 Let's take you back to our days at high school. Like for the listeners, could you describe what kind of environment. What's that?

[00:05:34] Ansar Mahmood: Yeah, it's a difficult one cause I know when I went to medical school, I felt quite outta place and it's because about 80 to 85% of the medical school intake, certainly historically and going back 20 years ago, was predominantly 85%, grammar or private school.

 I came obviously from that other 15%. What I do remember is you and I were in like year, what they call year nine now. So like third year of high school and the league tables coming out for the very first time they produced a national league table of schools. I won't name the school, although I probably can actually cause it's gone.

 But I remember having the newspaper, we were all looking through it on the school field and we looked down and the worst borrower in the whole country for children's education was sandwell. We were in Sandwell and the worst performing school in Sandwell was Ley High School.

And I remember looking at this and thinking, does that make us like officially the worst school in the country? And what strange is you are when you are in that environment, you've grown up in that environment that's normal, so you actually have no perception. I remember reflecting back on that, that when someone was said, like with the worst school in the country, at no point did we look or feel or think that we were in the worst school in the country.

Not saying that it was the worst school in the country. Obviously those tables can be, there's lies and statistics whatever they're made from. We know that being the lowest in that borough doesn't mean you're the lowest in the country.

But it's nice extrapolation. It makes better headlines and it makes more interesting conversation when you're teenagers. So we went down with walking around for a couple of weeks telling everyone that I could meet that we were the worst school in the country. And that was slight badge of honor.

Um that was a kind of environment. And I remember government policy made that worse, in our later years because we were quite a small school compared to the surrounding three really big high schools that had over a thousand students in them. And we had about five or 600, but we had much larger fields.

And rather strangely, the high or schools around us were struggling with fields think, well, why can't we just absorb or take over that school? So our school was constantly under threat of being closed or absorbed into the other schools. And because of that, there was an active policy of accepting anybody.

So in our last couple of years of high school, all the kids have been excluded from all the other schools. And so had nowhere to go, suddenly arrived in our school. So we then had our onsite drug dealers and their relatives coming to the school. The gamblers. Yeah. Yeah, exactly.

Yeah. We ended up with a lot of the most interesting elements of society all at the school. Some people would argue that maybe they were always there. I remember one big story, which I still tell my kids, that onco pad, was taken aside of one of the teachers at school and told that he stopped hanging around with Ansar because Ansar was gonna end up in prison.

Yes. In prison. And he shouldn't end up in the same place. But yeah, I remember I said, I remember Paul coming out and telling me that this was, I thought, I can't believe That morning I'd actually helped part with his science homework, which I used to do.

I probably didn't have mine in, but I did his for him. It was a shock to me. So maybe I didn't have insight, but that was the kind of school we went to. I think you were a cheeky chappy in that kinda school. Either teachers loved you or hated you, and I suppose I was a little bit on the cheeky side.

Yeah.

[00:08:49] Paddy Dhanda: I just remember being the new kid, there was this constant sort of competition from many of the males around, they had a league table of who's the hardest in the year, the strongest, the toughest. And whenever anyone new came in, they was like where do they go in that league table?

So you either. Have to defend yourself and prove yourself to get on the table. Or like me who avoided violence. Just hope no one picks on you. The couple of times I did get picked on, luckily I had good friends around me who were always there to help support me, but God forbid some of the kids must have had a right difficult time there.

I know. I felt

[00:09:27] Ansar Mahmood: so sorry for him. It was a tough upbringing and I remember seeing some sort of cartoon or something. I don't spend all that much time on social media, but I saw something that said that there's a praise in that says that hard times generate hard men.

 Then hard men generate hard work. And then hard work generates good times and then good times generate soft men. And then soft men generate bad times. There's little cycle of life. And I worry about that now actually, I think cuz of the background I was from, there was quite a lot of adversity and we were probably used to facing it, but I do remember actually that wasn't the case and that was somewhat individual psychology.

 There's a few of us that pushed through and made it somewhere into a profession of some kind. I remember looking back and we had quite a small year and there's about 120 kids and I think only about 20 of that went on to do a levels or college of some kind. The other hundred literally just left high school and went looking for work or whatever other activity they felt they could earn money from.

And that's not a great statistic. Think of the 20 that went to college. Not that it's always a measure of success, but I think about seven or eight of us probably went to university. So if you take 120 and a success rate is less than 10% going into. Certainly the highest levels of education at university level.

 It's not a great statistic, but again, it didn't feel like that, I'd grown up at Langley Junior School, Langley High School, and although the junior school and the high school are not co-located there, two a mile and a half, two miles apart, so actually you don't ever see the high school or vice versa.

 Not that they weren't in the same building. So when I came to high school, it was a completely new building with a completely different set of people. It wasn't something I had any prewar or experience about. And I suppose being in a high school like ours, it was tough. Yeah.

We didn't realize it was that tough. We just thought that was normal and I certainly think there's lots of things that can break people, you know, a degree of physiological stress, but at the same time, some people thrive under stress maybe, you wanna push through or you wanna get beyond that.

And I think it really comes down, I was reading something or listening to a quick talk on David Goggins that chap ultra runner et cetera in America, the Navy Seal. Yeah. See that's what he talks about. He went through periods of his life where yeah, absolutely miserable.

Then he lost confidence and he gained loads of weight and did nothing else with his life and wasn't really progressing anyway. And it's only when he actually thought, I need to get over everything that's holding me back. Just accept all the bad that's happened. You need to accept it and move on.

Whereas you sit there bathing in it, you're never gonna move on. So lots of reasons why we wanted to get out of where we were. But I suppose I still accept that we were probably privileged, we had stable families and good families and parents that even though we didn't appreciate the time, were always looking out for us and trying to get us on the right path.

I know when I went to university, that's when I first met the first contract. So I met kids who had been to five years high school and two years of college, or seven years of higher education of some kind or secondary, and they'd never seen or been exposed to violence or a fight. Our school, there was a weekly, if not it's a main event, like every day.

 At least a weekly fight of some kind. Yes. So there would always be you, sometimes one a day or two a day. It was quite normal to expose that level of violence. When I reflect back on it, I realized perhaps why we're damaged in the way we're damaged. But,

[00:12:50] Paddy Dhanda: well, I was thinking about like some of experiences of adversity and how they helped us.

One example, I'm sure you remember this, we were in the football team and we were playing a local school called Bristol Hall who were like, way better than us at football. And you and I were in defense and we were losing 10 nil right in this match. And everybody in the team had literally given up hope.

There was no hope of us doing anything in that match. And I just remember for me personally, off the back of that match, I was made captain of the football team because I was the only one who was still encouraging everybody. I don't know why I was doing it. I was just like, come on, we can do it.

We can do it. And then I remember you grabbing hold of the ball on the halfway line and you booted it and you scored this amazing goal from the halfway line. I'm sure you remember that. You must be telling your kids to this day about that goal. And that was like our highlights of the match. But you know what?

Yeah, we lost ten one, who cares? But we walked away with great because I got made captain, you had scored this wonder goal and what a great experience.

[00:13:57] Ansar Mahmood: Yeah. That was an interesting day. Yeah, absolutely. It was the eighties, right? So eighties into the early nineties and what the UK culture was in a stage, we were trying to be American, right?

So whatever the Americans doing, about five years later it was coming into the uk and I think we were just in that period over that period, five years where like colors, gangs were over LA and New York. So Birmingham had this issue with like gangs everywhere, and sort of gang and culture.

School cultures have always been the same, I suppose to some extent there's always rivalry, et cetera. But I think we taken rivalry beyond that level of, we just don't like each other. Cause we play sports against each other. And it got to the point where everyone was like, you just disrespect my gang and my crew and my territory.

People had got this into their psyche and there were lots of gangs around Birmingham at the time that, and they wore colors. They wore orange or they wore blue and people from those different gangs couldn't go into different areas because they were then out their own territory.

That was quite a weird environment, but certainly a high school. We didn't really ever go to the other schools because the level of violence within our schools, it was the same in between the schools. There would be no qualms about putting fists or bats and having go at each other.

Thankfully, mostly always fists. I don't remember the mean much. Weapons, maybe weapons are worse now actually.

[00:15:11] Paddy Dhanda: Another story that sticks in my mind was when we were kids. I remember you telling me about your dad. He had a really good friend who was a gp and he once took you to the surgery and he explained to his friend that he was hoping that you would one day become a doctor.

Could you tell us about that story? Because for me, it still or sticks in my mind even to this day. We look back and we think. How did I end up on the path that I ended up on? And for many of us it's because we may have had some kind of point to prove to people. So could you

[00:15:47] Ansar Mahmood: share that me with us?

Absolutely. I'd come back from work experience at University of Birmingham. I went to be physicist. Remember I was a physics, not loved physics and space science. And so I was gonna go off and do space science and physics. That was my Plan eight university. And then long story, that's for another day.

 I had in the physics department, I had medical doctors coming. Cause we were doing some research on the first pet scanners in the country at the University of Birmingham, which are now in common use in the nhs. But at that time they weren't available in hospital.

We were testing them and we were playing around with these pository emission tomography scanners at the university. And the doctors were doing research on cancer using pet scanners to monitor cancer. But it wasn't proven at that time. But they would turn up in, I would be there, I'd have got there on the bus, the two postdoctoral PhD physics students, and the professor would arrive in a, 20 year old s SCORs, et cetera.

And then the orthopedic or the oncology doctor would arrive in his Porsche outside and park it next to our cars, come in, tell us what to do, tell us what he wanted, and then leave. And third or fourth time he came along, he said to me, what are you doing here? And then we ran into a conversation and ultimately what he said to me, he said, if you do physics, you're gonna be like, these guys, you're gonna be poor forever.

He said, you love what you do. I'm sure. But he said sooner or later, and he said, look, I'm doing physics, but I'm a doctor. I can do whatever I want. We can invent science, so actually do something that earns you some money. you'll be respected and then you can come and do science if you want.

You can be a researcher within medicine. And he gave me that idea. And obviously being relatively. Now they call them deprived kids, but certainly I wasn't well off one of six kids and a dad worked in a shop or a factory. It was challenging in a single income household.

 We were never flushed for cash. I'm not saying we ever went hungry. My dad was great and he worked really hard, and then we always had plenty of food. So I didn't really notice that we were plus for cash until I saw the people and that's when I realized that.

And you always know I was growing up that some people are a bit wealthier than you, and some people are. That's where you see their houses and their cars, the way they live. You're always appreciative of that. But I don't think we necessarily felt deprived until I got defined as deprived when I applied for the university.

 That was one of the things. I decided to apply for medicine. When I made the decision to apply for medicine, everyone just laughed. And that's actually what annoyed me the most. They knew I I wasn't a star student, you said I was pretty bright.

 I was never the one that stayed and did extra homework or got things in on time. You mentioned being at my desk cause I was late. That's cause I was awful late. That's unfortunately, I have to admit, even now as a doctor that stayed with me in life, I'm one of those people who always thinks, let me get this done.

And what's funny is that gives people the impression you're lazy. Anytime through my training being called by the old consultant or boss or training director as approached me and said, you must be lazy cause you've done less of the paperwork than your other colleagues.

I told them to do this. And you've done it, but you've done half as much as they have. So you either don't listen to. I remember one in my very first year of higher surgical training, at the end of the year, my program director, it was a nice chap actually. He had for the right intentions cause he explained it to me later.

 He said, you're either stupid. He said, I don't think you're stupid cause we hired you here as a higher surgical trainee or you're lazy. He said, those are the only two reasons why you haven't done what I asked you to do. And it was about sub updating your cv. And I remember being told off like that, about not updating my cv.

Cause he said you have to update your cv. And I thought, being the logical, pragmatic person, I usually am. I thought, I'm not applying for any jobs, right? So what? And all I'm gonna write is I've done one year more of training. Why bother? So I I didn't bother. I just said, it stayed as quo as far as I'm concerned, didn't bother objecting the CB.

 All he wanted to do was see that one line of the new place I'd worked in for the last year. That's all he wanted to see. And I didn't put it in. And he had this scope and he said, you are the stupid. Which I don't believe or you're lazy. I remember hearing that and I heard it a couple more times through my training and that, and I'm no, irrespective of anything else, I'm always the hardest per working person in the room.

Generally, in life, I've never really been the one who slacks. Once time I'm at work, I work twice as hard or three times the hardest as, yeah. I'm always the person trying to juggle three tasks at the same time and I overstretch myself. But I'm the one who say no and just gets on with it.

And if 20 patients are in clinic, or 40 patients in clinic, or 60 patients in clinic, just see them, , I don't sit, they're going, well, I'm supposed to see 10, whatever needs to be done, you get it done. That's always been one of my values.

More and more people shunt it to you. I sometimes get that problem now. I'm struggling to actually manage my own workload. Cause I'm spinning so many plates at the same time, and you then can't give the due attention you need to. So at the moment I'm in shrink wrap mode. I'm trying to shrink my life back into a more controllable box.

 I can dump some of these projects, but that story that you mentioned, sorry, I'm going through that probably 20 seconds. I had no friends who were, I had no relatives and no advice. We were the first generation to think of university. My sister had gone the year before me, but that was that first generation in this country that's gone to university.

So we had no contacts. My dad thought, if he's now thinking he wants to do medicine, let's get some advice. So he went to the local gp, who's a friend of his, cause that's same background, essentially Pakistani immigrants who came over. , this chap laughed at my dad slightly and not that he wasn't trying to be unhelpful.

He was actually, I think in his own head, trying to do my dad a favor and say, don't be unrealistic. What I remember him saying to my dad is that he said, look, my dad's name is Mohammed. Like most men of that generation and Mohamed don't carry these kind of hopes in your head, he said, because people like me who are highly educated and medical themselves, we worry, we don't think our kids will get into medical school.

He said, I want my kids to go to medical school, but I'm not sure they're gonna get in even though they're a private school. So he said, I've got my kid in a private school. I'm a doctor myself. I don't think my kid's gonna get into medical school. Your kid's got no chance. That's what he sort said to my dad, don't bother chasing these dreams, just go away and do something more realistic.

And that was the advice he gave. I said, I suspect with the right intentions, But he said that to my dad and my dad came back and tried of sock it a little bit, but that's what he'd said. And I thought, okay, but that's probably, yeah.

 I'm not somebody, I say this to my kids now, don't let anybody limit you. Don't let anybody say, if you're not passionate about something, that's fine. Yeah. You should just stop doing it. There's no point hanging on something you're not passionate about ultimately.

But if you think you are passionate about something and this is something you should be doing, don't let somebody say you can't do it. Because I was told that again and again. Even then when we were doing a Levels, my headmaster day and the headmaster of the school, cause he knew me as a slightly cheeky, turns up late lad.

 He actually refused to predict, give me the grades I needed to get into medical school. Even apply, he refused. He said your performance hasn't been at the level of a medical applicant. We've only had one per year for God knows how many years. It wasn't a high performing college particularly.

 And he said, we get very few kids that ever get into medical school and they would have to get sort of predictions, at least to be a's generally. And he said, and you are performing. I've spoken to your tutors and they're telling me maybe you B or C, and if I don't write a on the form, you can't even apply.

Which is the same saying, you haven't given me the grades I need to make the application. I did have my physics grades there as a backup. I actually knocked on the dogs cuz I remember initially thinking, should I just accept it? And I thought, no. I knocked on the door, spoke to him, and obviously he's a headmaster and he is a little bit annoyed at me.

Whereas you are telling me that you are gonna get better grades than this. And I remember saying to him, I now in retrospect I can see why he got so annoyed, but the time I didn't understand why he was so annoyed, because it sounds incredibly arrogant, because when I think back on him, but I said to him, that's because they think they know me, but they don't.

I know me. I know what I can do. And he got really annoyed. I didn't think that would trigger that. He got really annoyed. He asked me to leave the office and stop wasting his time. I walked out of the office. Cause that was a slight shock for me when he got angry and threw me out the office and I'm, whatever the 17 years old thinking I'm applying for college or university.

And I walked out the room and I remember walking outta the room out of the office and then standing in the corridor. And then I thought to myself, if I do nothing, this is my life. This guy's throwing my life or dictating where my life goes. And I wasn't happy with that. I thought, it's my life. At the end of the day.

If I don't fight for it, who's gonna? Why should they? And so I went back in, and I spoke to him and I said, sir, I gave you my explanation just saying that I will work really hard. I will show you that I can get this. I know I can do this. Maybe outta frustration or whatever it was, he said, look fine.

 He signed me off as a predicted for race. Which I know was a gamble. I think Mr. Harland, his name was so, I know Mr. Harland, cause he did change it. It was a gamble cause a lot of people wouldn't have done it. And I then applied to university and then on the application system, because of the postcodes we lived in, went to school in, we flanked as deprived.

I then went to this special interview or meeting when I went to the open at university, where they took me inside and I remember them asking me questions that I hadn't even thought about ever growing up. Do you have a desk to study on? Do you have your own bedroom? So you can have quiet and yeah, there was all these sort of questions.

We didn't have a desk in our house. Yes, I

[00:24:57] Paddy Dhanda: remember cuz you and I used to play on the computer in your bedroom and I think it was like on the actual bed or somewhere or on

[00:25:04] Ansar Mahmood: lamp. Yeah. There was no desk in our house. Again, I didn't know that was unusual that our house, everyone just had to fight for the coffee table or you put in your lap and you wrote on your books.

So I remember answering questions that the realization coming into my head, these guys think I'm really. Because they're asking me, do you have this? I'm like, no. Do you have this? No. How many siblings do you have? More than two. Yes. Do you any of your siblings share rooms? Yes. And this questionnaire just like making you feel poorer.

And I was like, I didn't realize I was in this bad a place until I applied to university and they're just telling me like the only advantage it gave me is they gave me a grade up or one lower. , to get into medical school there. I got through the interviews and at that time you had to be predicted three ass.

But most of the medics gave you a prediction of two As and a b or three ass. You. They would say something like that and they'd let you maybe slip 1 grade was the theory. But they gave me a one grade lower offer. They said we usually give a B, you're gonna get A, B, B. So that was it. After all this.

Soul searching and deprivation and background. You came to one grade, we're gonna drop you by one grade so that Cause you're poorer, you can come in if you get a B in something. I'm not sure those interviews are worth it, but go for it. And long story short, I ended up getting the grades I needed.

I ended up in medical school. Medical school was funny. Kids I didn't really have any empathy or commonize with you tend to find your own eventually. So I ended up leaving medical school probably with five or 10 really good friends out of a year of 240. And I think the other 230, I have no idea what they did or where they went in life, other than the odd Facebook, thing that pings up maybe sometimes.

And that was it. I've always been someone who's, has five or 10. Yeah, a small group of very good friends and I don't feel I need hundreds of friends. Not one of those people never have been. To me quality is definitely better than quantity. Yeah,

[00:26:56] Paddy Dhanda: no, I can vouch for that. I was just thinking about a few things he was talking about there, especially about being late and all of those things.

 I think some of your lateness must have rubbed off on me because I'm always late now, always for meetings. The ironic thing is for this episode, you and I are both late. I said, oh, we're gonna be late. I'm just grabbing a tea. And you went, oh, likewise. And so we ended up starting late. So it's going back to your job, right?

So you've talked there about how you got into medicine and then the struggles that you went through. For anyone that doesn't know about trauma, can you explain, first of all what it is that you do? Because that'll be great for me as well. I have a vague idea, but I've never really spent that focus with you to understand it deeper and also, what are some of the challenges that you face on a day-to-day basis?

Could you give us a typical day in your life at work?

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[00:29:24] Shure MV7-2: Now let's get back to the.

[00:29:27] Ansar Mahmood: I do trauma. The hospital Birmingham was a major trauma center and about almost 15 years ago, they decided that centralizing big complex trauma cases into big hospitals, they could have all the specialties that could deal with them in the uk, was the best way forward So they created that model.

So we, in the UK we have something like 20 odd, mid twenties, high twenties, major trauma centers. Birmingham's a regional one, for the city metropolitan area is the qe. So all of the complex trauma, whatever, however it's caused, comes to us. That's the hospital that I work in.

 One of our key professors who's been the bit, a big name in trauma across the UK and in the Midlands region. He is Professor Keith Porter. Uh, well, professor Sir Keith Porter. He interviewed me and was one of the people that helped me come into the trust at University of Birmingham.

Him and Julian Cooper. Shout outs to both of them. For the job in my first choice hospital that I wanted to when I finished. So I've gotta give him that credit. But prof shaped. Porter shaped a model of care, which was the same actually makes sense in anything.

You're a specialist in something and as a specialist in a disease, you make differences to people. Cancer specialists, even cancer, are now, people who deal with lung cancer specifically. People deal with all the types of cancer, et cetera. So we know specialization is, tends to improve outcomes.

And he had the idea that trauma's a disease. It's not a broken bone plus a broken head. They link, they create a physiological response in the patient. So we need disease specialists who created a major trauma service. And myself as a trauma surgeon, what I do is if when I'm on call in the day, or available in the day for the hospital, I see everyone that comes with injuries.

And I do two layers of on call. I do a trauma orthopedic on call, which deals with broken bones, dislocate joints, associated with anything car crashes through to just falling over and twisting your ankle and breaking it. That. So it needs fixing. They come to us. And then in the major trauma side, I deal with undifferentiated trauma, but that means it can be anywhere.

Cuz trauma , it's not selective disease. You know, cancer may only effect one area of your body for trauma. If you get hit by a bus, you tend to get hurt everywhere. You end up with a bad brain, bad face, bad chest, bad belly sometimes, and broken arms or legs. So in those sort of higher energy crashes, we see patients with lots of different problems.

 What a trauma specialist does is resuscitate and deal with that early part of keeping the patient alive, stabilizing them, but then follow their care through and understand what their priorities are, physiologically, making them back to normal. What the priorities for.

Reconstruction or et cetera. So we have that knowledge where we understand the disease very well. We know how to resuscitate, keep people alive in the very early phase. And then following that we operate on them. And I, as an orthopedic surgeon from background, tend to pick the bone side. And we have sort the specialists who do with brain and chest, et cetera.

Although as a bone surgeon, I do pick root fractures as well at QE Birmingham. We offer that service. That's sort of day job of a trauma surgeon. Most doctors probably hate trauma, it's fair to say. And the reason is it's unpredictable.

The patients you're gonna see every day are different and challenging and sometimes very challenging. We lose patients. They're dying our resource if they're too severely injured. And so that very hyper acute, sharp decision making that's required and sometimes losing people, having the stress of that.

It's something that I think most people probably shy away from. And so a lot of doctors really dislike trauma because of that hyper acute side of it. But I never have, and I think, one of the things I firmly believe in, if people ask me for career advice, I said, what you need to have is some insight into your personality.

And I think possibly growing up, it may be cause of reading or it may be why I went into reading. Actually. I'm not necessarily super humble and intro. I'm certainly not introverted. I don't think, although on I, I've done one of those Myers Briggs things and one of the one time it did say I was introverted science.

 I thought that was interesting. Oh, that test's wrong. No, they don't know what, yeah. Yeah, probably. Cuz most of the time I sit on the other side, but I'm not really an introvert, but I do set, reflect on myself, on the actions. And I remember growing up, even at school, if I saw somebody being bullied, Or I'd done something to somebody, it would make me feel bad because I think sometimes peer pressure, you'll say something horrible to somebody if your friends have said something horrible to them.

I suppose that's gotta be probably some nurture, there's nurture element to that. You know, nurture nature. I don't know what makes somebody kind. But I didn't like ever beating or threatening younger kids for instance, or trying to take things off people.

It was something that just inherently felt bad to me. I would leave that encounter thinking I wish that had happened. Even if it ended up being that somebody, one of my friends or friends circle to ended up taking something off somebody that wasn't, that belonged to them or had bullied them or hit them.

You wouldn't have wear stop it because it was peer pressure. Although I think I got the confidence as I grew up became a bit bigger and taller. I did actually use a stop quite a lot of bullying, which I am still fairly proud of. Or at least I would divert it away and say to people, what do you get out of doing that to somebody?

Whatever situation they're in, you shouldn't get a kick out of being horrible to them. But you know that in a broey sandwell accent, black country accent as a teenager, I make it sound very eloquent now, probably, but it wasn't quite like that.

 I didn't see the point of bullying someone, I never understood that. That probably shapes that I sort of fit into medicine, but I realized very early on in my very first few months outta medical school for a period, I actually thought I might even do medicine.

I might leave and do something else. But once I started working in it, I found one, I had the sickest patients that I really had to fix. That's what stimulated me. My brain woke up. I wanted to fix them. I wanted to go and read. I wanted to investigate. I wanted to see what their tests were. I didn't wanna leave the hospital.

I wanted to make that patient better. Once you get the patient's story and you get the background, you realize a bit about them. They mother or father or brother or sister tells you that this is so and so. This is John, my brother, and he's usually really funny and he fought in the army and he died from whatever shrapnel injury.

You get that sort of background. Suddenly you are invested in the case. And I think those first few patients that had been shot, run over, were very sick, stimulating me in a way that I thought actually, this is what makes me like this job medicine. I like medicine because people come in super sick.

I have a period of time to try and get them better. And it's up to me to find out what's wrong with them and to try and fix it. And that for some reason stimulated me. I can't tell you what I said, what kind of adverse personality disorder that gives me, I thought that stimulated me.

And so I went into, right from the get-go, went into trauma surgery, wanted to be a trauma surgeon from then, and trained in surgery, went to the busiest trauma centers in the country, went to a fellowship training in trauma. So I'm fairly broadly trained. And, um, ended up, at QE Birmingham, which as I said was my first choice for both family reasons and professional reasons.

It's a royal center for defense medicine. We see a lot of casualty from all around the world, and it's a good place to work. Obviously famous prop portal was there, so I was quite keen to go there and work with the guys there to learn from them. So I ended up with QE as a traumatologist.

I still deal with very sick patients. I think devastating cases you see that do stay with you. I think particularly younger people. Also some of those people that you've spoken to and taken a whole background from and created a bit of a personal link to, and then they end up dying.

It's challenging. It's definitely not an easy job. I enjoy it. I enjoy the challenge of coming in every day, having a different set of patients, getting it called in an emergency. And again, I dunno what kind of personality that gives me. You're getting it called in to try and help someone when they're in serious trouble.

 And just doing your best for them. And as I said, it's something that I've always enjoyed. I enjoy being at work at night and that sounds really strange, cause I do like to sleep. But when you're at work at night, it feels very personal. It's you against the world.

It's just you and the patient. I really like that interaction. When I'm on call, I like to see patients. I like to go and see people, find out what's wrong with 'em. It's one of the great frustrations I have when I see junior doctors complaining about being on call.

Cuz to me, that is what a doctor should love to do. Be on call, see patients, diagnose what's wrong with 'em, what you may be the first person who's actually gonna work out what's wrong with this person. See them, take that history, do the examination, find out what's wrong with 'em, then try and fix them.

That's what we were trained for. I always disagreed with how medical schools are vetted. I don't think it should be academic. Because we know the dropout rate people are now talking, it's really hot news at the moment.

But recruitment and retention, the nhs, that's why there's a, now the fifth junior adopt strike about to happen. And a consultant. Strike ballot in the N H s, which I don't think has happened in 40 years, has just been successfully validated for, so consultants will also go on strike in July, 2023, which is, like I said, almost unprecedented.

 This is the stress. The n h s currently under just a symptom of that stress. And I think post Covid, that stress, all the cracks that were already in the system have been completely exposed by Covid. The current global pandemic changed culture. It changes expectation, it changed the pressures in the nhs and people in the NHS realized how actually the job they do is quite special.

But not just specialists, it's specialized. So what they do, they do well. When you're trained in the nhs, you get fantastic training. Generally you've got far more patients than you can ever deal with. Mm-hmm. Which means you actually get a lot of, generally very good experience. Most of the trainers in the system are pretty good invested in training you.

Because that's the culture. That's one of the great positives of NHS culture. I'm not afraid to train people, whereas I've gone abroad and found people protect techniques because they don't wanna share it because private practice and people stealing their skills and it's actually a very, strange, when I go there and people are reluctant to let you come into theater to see what they're doing.

It's only happened a couple of times. I think most medics are very collegiate and want to show people what they do and how it benefits patients. Cause certainly if you're from abroad, you're not generally gonna threaten them, but in, they're very worried about their own environment or their own local surgeons finding out what they're doing.

That's not the NHS at all. I think almost nobody protects any of the intellectual property. We just give away knowledge and training. We expect wherever university hospital, you have medical students. It's been an interesting journey and I think still when I go to work, I enjoy being at work.

I think I'm lucky from that point of view and I think the consultant strikes are driven by frustration. The fact that they seem to be penalized for when the NHS off most consultants, it's common knowledge, ea