Mr Paterson-Brown started his talk by saying: "We have spent a lot of time over the past 10-20 years on training to ensure that most surgeons ‘fit’ into a specialist category." But he added that this can have the result that some people feel uncomfortable working on emergencies that are outside of their specialist area.
He also pointed out that a recent survey showed that around two-thirds of patients with acute cholcystitis didn’t have an operation on admission but rather were transferred to a specialist unit - so it may be that on-call surgeons needn’t worry too much about being asked to undertake this type of tricky operation on an emergency basis.
Mr Paterson-Brown gave examples of his work in the Lothian region, for example, on patients with peptic ulcers or colorectal cancer which supported the view that specialisation could lead to fewer post-operative problems and complications. He also highlighted some practical issues, for example, surgeons on split sites who have to travel to the patient to undertake surgery. But he concluded that this would have to be seen as part and parcel of the job in the future as hospital sites became more complex and surgical roles more specialised.
He was also concerned about the possibility of 'consultant de-skilling' if someone specialises in one small area for many years but he weighed this against the benefits of great achievements in specialist areas.