Interview: Linda de Cossart, surgeon, director of medical education

01 November 2013

"The passion of doctors has been quashed by the tyrannical NHS bureaucracy"

Fewer than ten per cent of women doctors are surgeons. Perhaps it's a lack of role-models, the unpredictable working patterns, and fewer part-time working opportunities.

I retired as a practising surgeon in 2009. I was one of only five women to be vice-president of the Royal College of Surgeons of England - there is yet to be a woman president - and was awarded a CBE.

My speciality was peripheral vascular surgery: plumbing. If it gets blocked, unblock it or bypass it; if it bursts, replace it.

As well as being a consultant and professor, I'm also the new president of the Liverpool Medical Institution, a Fellow of the Academy of Medical Educators and the Royal Society of Medicine, a member of the Travelling Surgical Society, trustee of the British Institute of Radiology, and I serve on the research committee of the Healing Foundation charity. 

I was appointed in 1988 to the Countess of Chester Hospital, as a consultant general surgeon with the specific aim to set up a peripheral vascular speciality service at the Trust. The hospital is only the second endovascular surgery site in Merseyside. 

I operated on patients with abdominal aortic aneurysms, people with limbs threatened with amputation owing to poor blood supply, and patients with transient strokes who required unblocking of the artery in the neck. 

My special interests were reconstructive surgery for patients with life-, limb-, or brain-threatening vascular disease, and developing new vascular techniques which minimise harm to the body when carrying out complex procedures.

It is a very people-orientated job. I liked that. I liked the fact that sometimes you could do something to relieve a person's problem - even save a life.

There's an apocryphal survey about the difference between surgeons and physicians. It claims that there isn't much difference, actually, except that surgeons are more religious. It might be true - because they deal with life and death all the time.

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The thing I miss most is the clinic, where I really enjoyed meeting patients and trying to sort out their problems. Some cheered me up after a difficult day - and sometimes these were the patients with problems I couldn't make better.

I work now at the Countess of Chester Hospital NHS Foundation Trust as director of medical education (every hospital has one). Also, with my colleague, Della Fish, and the University of Chester, I'm championing the development of the teachers of postgraduate doctors. 

We influence doctors and the surgical team by who we are, how we respond to our responsibilities as clinical practitioners, and the efforts we make as clinical teachers. I want to encourage well-supported but open-ended development that allows the best clinicians to fly, the more steady to grow proportionately, and the more needy to review, recover, and remediate their difficulties.

Wise doctors know themselves, and are prepared to do what is best for the patient, or student doctor, in front of them - even if it is not necessarily what others might think is the right thing. You help to develop one another by exploring the values and expectations of a learner, and building their character. I wrote Cultivating a Thinking Surgeon in 2005, and Developing the Wise Doctor in 2007, with Della. 

Just because people have passed exams, they're not necessarily a good doctor. Part of doing the job is getting on with patients and colleagues in a frenetic hospital environment.

The thing that is often forgotten is that doctors who qualify don't actually reach a status when they can practise as a consultant independently for many years; so they remain in training in their specialty for quite a long time. The Royal College of Surgeons set out to write a special post-graduate curriculum for surgeons. Della and I wrote this, and she's very interested in the values, which had got lost in the mire of competencies, targets, and contracts.

Our rather more values-based approach to postgraduate medical education doesn't fit with the current mindset of "tips for teachers" and "training on the run".

The passion of doctors for the work has been quashed by the control laid on them by the rather tyrannical bureaucracy which the NHS now is. Our young doctors have become very oppressed by managers. "I can't do that. My manager won't let me."

Della and I set up a Master's programme focusing on a moral mode of practice, trying to develop the person, with the moral responsibility on the teacher. It has resonated very well, and the doctors who have taken it said that looking at medicine in this way has changed the way they teach, and also practise, medicine.

A colleague's putting their own interests above that of a medical student was what last made me angry.

Since young doctors are working fewer hours, the way they're taught and developed is different. There's been a resistance to making education a significant part of the process. Managers see it as a tiresome add-on, not intrinsic to how people's care is given in hospital.

That's my one wish for the NHS - that our leaders would realise how important teaching is. If I could have a second wish, it would be for a courageous leader who believes that we can afford the NHS, and that we must protect it from the wiles of political and financial exploitation - though we mustn't rest on our laurels: there's appropriate competition and innovation.

I feel very strongly that people are important - that's what I've enjoyed most in medicine.

Much of the space in hospital is now taken over by management offices. Consultants are told they don't need offices now - or can share them. Sometimes it's very difficult to find a place that's quiet. Thank goodness for the chapel - if there still is one. The idea that you should sit quietly and think has been eroded out of practice - a moment of not having to respond to the noisy environment.

I say to my young doctors: "You are on a course: come to the education centre: we'll find you a quiet room where you can read and think." It's not something they come to naturally. If they are not encouraged to do it, they don't develop any habits.

The phrase I hate most is "work-life balance". This has separated medicine from you as a person - rather than saying that you need to seek balance within your work.

Your soul shapes your character and your body - if you listen to it. The real person you are is inside your body, and your body is responsible for looking after your soul in its earthly form. I think there is a spiritual being in all people - how much they see it is the difference. Talking about these important matters among doctors doesn't happen as much as it used to. They don't find it easy.

Family and close friends are fundamentally important to my well-being now, and have always been.

My biggest regret was missing my first godson's christening. I was on call, and my husband stood in. I've made a pact with myself not to miss funerals.

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Professor Averil Mansfield influenced me greatly. She was a vascular consultant in Liverpool, where I worked with her, and then professor of surgery (the first woman in the UK) at Imperial College. She developed excellent rapport with her patients, made wise decisions about whether an operation was the right thing, and at the end of each major procedure would call the next of kin on the telephone from the tea room in theatre, and tell them how it had gone. She never lost that feeling for patients.

I'd like to be remembered for caring. I wasn't able to live up to the telephone conversation in my practice, but I made a very big effort to be available to families and next of kin.

I love The Little Prince by Antoine de Saint-Exupéry, and The Courage to Teach by Parker Palmer.

My favourite place is at home in the garden, and I'm happiest when I'm cooking for people.

Favourite Bible passage: "The Lord is my shepherd: I shall not want." It never fails. I like less the book of Leviticus with protocols and laws, and the rather vengeful God portrayed in the Old Testament.

My most reassuring sound? The pulse in the foot of a patient at the end of a bypass operation.

I pray for the strength to see things through. I often pray for people, friends, and acquaintances when it seems they need a bit of extra help.

I'd like to get locked in a church with Pope Francis. He seems to have come into the Catholic Church with a completely different idea of what being a pope is, and I'd like to know how he is going to deal with the politics. He seems to be right on the ground, and I can't help believing that he'll be driving everyone in the Vatican completely barmy. I'm interested to learn what his game plan is.

Professor de Cossart was talking to Terence Handley MacMath.

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