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Changing times, changing risks

Dr Robin Tattersall is a surgeon (and Olympic team doctor) who left the UK for the British Virgin Islands in 1965 – and has practised there ever since. Here, he talks to Dr Nancy Boodhoo about working with limited resources, the value of good communication and how the medicolegal risks have changed over the years

Dr Tattersall was born in Cheshire in the UK in 1930 and, after a brief spell as a male model that saw him on the front page of Vogue and Harpers – and which helped him fund his medical studies – qualified as a doctor through St George’s Hospital Medical School. An article in the British Medical Journal then inspired him to spend some time working abroad.
It is in medicine where Dr Tattersall is most at home and where he has established a name and local reputation
Arriving in Tortola, in the British Virgin Islands (BVI), in October 1965, Dr Tattersall has lived in Brewers Bay since 1996. Since his arrival in the BVI, Dr Tattersall has enjoyed an eventful life and has become fully immersed in his adopted homeland. In between meetings with the Queen in an operating theatre (the only place in the hospital with air-conditioning), and later her son the Prince of Wales, Dr Tattersall found the time to represent the BVI twice at the Olympics, in sailing. He was the BVI team doctor at the recent Olympics held in London.
But it is in medicine where Dr Tattersall is most at home and where he has established a name and local reputation. In the early days of working in the BVI, dealing with basic equipment and low staff numbers were just some of the challenges that greeted him – here he looks back on half a century of change.

Changing standards

“There was very little here when I first arrived – I was working in a very small cottage hospital, which had two thirds the number of beds it has now. There was a matron, a staff nurse, an assistant matron and eight junior local nurses. I had to make do with what was there.

“Coming from the London scene, one tried to practise as one would back home, given the limitations – I just tried to give the patients what they needed. But care in England in 1965 wasn’t that complex either – a chest x-ray was about as complex as it got. In those days, you relied on your clinical acumen more: clinical standards, therefore, were high, even though resources were low – it is amazing what you can get by on.

In those days, you relied on your clinical acumen more: clinical standards, therefore, were high, even though resources were low

“We only considered disposable items to be disposable when they fell apart! Things were continually sterilised; needles were sharpened when blunt; gloves were patched. We never encountered any significant problems with infection rates. I think my own standards have more or less remained the same throughout my career; I probably order more investigations now, but that is the only real change.”

MPS frequently takes calls from members who are concerned about their own exposure to risks due to working with limited resources. This is particularly pertinent today, with the global economic problems necessitating cutbacks across a range of industries – and medicine has not escaped this.

MPS advises that while you should do your best with the resources you have – as Dr Tattersall says – you should resist the temptation to work around resource limitations by working harder and longer, as this will burn you out and risk serious harm to patients. It is also important to be open and honest with patients about any decisions that have been made. Patients have their own expectations about what level of access they should have to clinical resources; something that Dr Tattersall also feels has changed over the years.

“In the old days, there was not much communication with the wider world – no internet, and not much television. As a result, expectations were lower. But people also relied on their doctor for their medical advice, and accepted what the doctor said. [In terms of your position of influence] it was a case of God came first, then the doctor next. You could pretty well do no wrong – you had absolute trust from your patients.”

MPS advises that while you should do your best with the resources you have, you should resist the temptation to work around resource limitations by working harder and longer, as this will burn you out

Communication

Dr Tattersall has treated the same patients, and increasingly more members of the same families, for decades. It is probably safe to assume that, over time, this familiarity and intimacy has led to some strong doctor–patient relationships, where communication has been good.

“Part of being a doctor is finding out everything about the patient. I’ve always maintained this approach – this ‘goodwill’ of communicating well with patients – and this has prevented any new risks in my practice. The relationship between doctor and patient is absolutely vital. Your interest in them as people, and in their families, their lives – it’s why people keep coming back to see me.”

It is probably also why some doctors reduce their medicolegal risk. MPS has campaigned exhaustively through its publications, workshops and conferences about the value of good communication, and our own figures have justified this by showing how poor communication is consistently among the top risks for those working in healthcare. Patients are unlikely to be equipped to assess the technical competency of a doctor, so will frequently judge the quality of clinical competence by their experience or their interpersonal interactions.

Such factors as your body language – eye contact, turning your body to face the patient – play their part in establishing a strong rapport
Such factors as your body language – eye contact, turning your body to face the patient – play their part in establishing a strong rapport and therefore an effective line of communication with your patient. Allowing the patient to speak, without interrupting them, is another factor – and is even more vital when one considers that patients are unlikely to present their information in order of clinical relevance.

Too close to call

A flipside of long-standing relationships with patients is providing treatment to friends or those close to you, which MPS generally advises against. When treating those close to you, it can be easy to make assumptions, eg, regarding the way a patient is feeling if a doctor knows them already. A doctor may not ask the relevant questions or lose objectivity. It is not a situation that Dr Tattersall has encountered problems with, although he acknowledges how it could create a degree of discomfort.

For the first 12 years, Dr Tattersall was the only surgeon of any kind in the country. “I’ve operated on most of my family, delivered my last child – and operated on him – operated on my wife, operated on friends. An aesthetic procedure that fails to match the patient’s expectations would be an uncomfortable experience, if you know the patient well.”

In retrospect

Dr Tattersall’s story shows how many common medicolegal risks are still prevalent today, no matter how much the clinical environment changes around you. It also demonstrates how acute awareness of issues such as resource limitations, and a degree of skill in communicating with patients, can help to ensure longevity in your career and one that is largely free of disciplinary or litigation-related issues.

Words by Gareth Gillespie

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