Samuel Morganabout 3 years ago
Welcome back our faithful readers to another instalment from the scalpels' edge.
Over the coming weeks and months, there will be many similar interviews with equally focused questions on pathways and progress in addition to specific questions relative to each surgical specialty. We hope to add questions from you the reader and encourage your input/feedback on our Facebook page.
In this episode, we have the pleasure of hearing the thoughts and journey of orthopaedic surgeon, Dr David Morgan.
After graduating from UQ in the 1970's he has enjoyed a full career of ups, downs and incredible stories, some of which he has shared below.
We hope you enjoy:
Where did it all begin for you – what started your interest in surgery?
Well, several places. I was involved in a MVA when I was in Year 12 at school and had a number of Orthopaedic injuries. That did stimulate an interest in Medicine in general.
Whilst at Medical School I was attracted to Haematology, General Surgery and O+ G. When I was an un accredited Registrar, I did a bit of Orthopaedics and met a bloke, Duncan Farquhar. He was first class in so many respects and I think this sealed it for me. In addition, surgery had the additional attractions of manual skills, the ability to direct a team and was well remunerated. All important factors.
Can you tell us a bit more about your pathway after you finished your tertiary studies, where did you spend time working and sharpening your skills?
I did a year at the Royal Brisbane. I was assigned to EVERY Professorial unit... Surgery, O+G , Medicine, Paediatrics, Psychiatry and Neurology.
In my second year, I was the Medical Superintendent at the Proserpine District Hospital. Imagine being the only Doctor, running a 60 bed hospital, handling all comers for 24 hours a day, every day for 3 weeks, and then having 4 days off. There was an old GP in town and another oldish GP at Airlie Beach. I was pretty much it though. I lasted 2 years.
Then back to the RBH and was a relieving surgical Registrar for 2 years before getting onto the National Orthopaedic Training programme in 1981.
Took the RACS Fellowship exam in 1984.
Off to Oxford as a Menzies Scholar for 2 years ('85 and '86).
Back to PAH in January 1987 as the Director of Orthopaedics.
Went into Private Practice in Oct 1988.
Associate Professor UQ in 1994.
Will cease operating in October 2017.
Talking laterally for a moment, what are some invaluable skills and experiences outside of medicine that have made you the surgeon you are today?
Stable marriage, family and home life. Healthy, active recreational interests. A few good dogs. Experiencing Orthopaedic problems of my own... TKR/Ankle Fusion/Cellulitis/Foot Drop/ Lymphoedema/DVT and PTE etc.
When times got tough during the long rotations, what was the drive that kept you going?
The end goal of being a Consultant Orthopaedic Surgeon. Determination not to be beaten or quit. Intellectual stimulation. Financial reward.
Who or what was your biggest support during your training years?
My wife, Noeleen.
If you could change one thing about the Australian surgical pathway, what would it be and why?
Greater access to the Private Sector, and earlier in the training programme. In the 1980's , most of the 'big' surgery was done in the Public Hospitals. That is no longer the case. Great training and mentoring opportunities are being under-utilised.
What do you wish you knew before you entered into the surgical pathway and your specific field?
That I would be a success, no matter what happened. I would have spent less time worrying, have been less competitive and would have enjoyed the journey a lot more. I wish I had a mentor who believed in my capacity, could reassure me when I had doubts and smooth the path ahead when necessary.
What advice can you give to the next generation of budding surgeons as they prepare in their penultimate or ultimate years study?
Work hard, remain focussed, establish a healthy work/family/play balance and never cut corners. Be in pursuit of excellence and enjoy every step of the journey.
A hypothetical: You’re a registrar on call over the weekend and an emergency orthopaedic case has just presented to the hospital. You’re the most senior surgeon in the field available and you are about to scrub in after a long day or intense surgery. How do you mentally and physically prepare yourself for what is coming next?
Revert to the simple, solid basics. Identify the goal. Search for pitfalls, problems and potential complications. Plan methodically and visualize the pathway .. every step. Banish negative thoughts such as fear, fatigue and failure. Accept the challenge, control it and succeed. An older colleague, (a professor and a patient) , used to assist a now retired cardiac surgeon. He referred to the cardiac surgeon as always appearing to have "stacks in reserve". That's how I'd like to be viewed when 'the chips are down'.
Tell us about your ideal consult call.
"Hello Dr Morgan. It's 2 am and I just wanted to call and say all of your patients are excellent!"
Something personal, tell us about your best and worst surgeries, the highlights and the ones that have kept you up all night.
The best .. all of them really. The worst .. every one that experiences a complication. I still call half a dozen every Xmas Day to tell them I love them.
As I understand it, you played an integral role in setting up the Queensland Bone Bank which was based on an existing system in Canada. With regard to today’s orthopaedic practices, how do you see the development of similar innovations occurring here and abroad?
You are correct. I worked in Canada in the mid 1980’s. This was a time when total hip replacement surgery had been relatively common for two decades and total knee replacement surgery had been similarly readily available for 15 years.
Unfortunately, not all of these arthroplasty operations were successful. Some failed prematurely. There were many reasons for failure but one was osteolysis as a result of aseptic loosening.
Patients requiring revision often faced complex operative interventions because of the major loss of pelvic, femoral or tibial bone.
Rather than filling these spaces with metal, cement or plastic, the use of allograft bone became very popular. Allograft bone is retrieved from donors (living donors undergoing a total hip replacement and therefore donating their femoral heads, or cadaveric donors who can donate all of their long bones).
Very special processes are required for retrieval, processing, storage and subsequent distribution. These are all quite distinctly separate from the actual operative use of the materials.
Those four functions are an integral part of what a “Bone Bank” does.
The North Americans were the first to set up larger bone banks and I worked in the Toronto area with Professor Allan Gross.
I returned to Australia in 1987 and was the Director of Orthopaedics at the Princess Alexandra Hospital. We started the Bone Bank there. It was quite an inauspicious start. I purchased a freezer from Errol Stewart’s and plonked it at the end of the Outpatients Department. We would deposit femoral heads into the freezer and then use them in an ad hoc fashion as required. You can imagine that this was quite a primitive exchange programme.
Over the subsequent decades, the procedures have developed enormously. We now have Therapeutic Goods Administration codes for Good Manufacturing Practice (TGA cGMP), stringent regulations to follow, almost overwhelming quality control restraints and a network that spreads all across the country.
We retrieve about 1500 femoral heads per year, have 100 cadaveric donors per year and can assist three or four thousand patients every year.
In 2004 the Queensland Government gave us a grant for $12.2million. We built a state-of-the-art facility at Coopers Plains. This is a world-leading structure.
Future horizons include developing special products such as demineralised bone, manufacturing specifically shaped allografts which would fill the spaces in cages for vertebral column fusions and also, 3-D mapping such that we can accurately replace segments of bone removed during ablative tumour surgery.
The horizons are particularly exciting and broad. Bone banking will be with us for some decades hence.
Internationally, for profit organisations synthesise artificial bone substitutes. They are exceedingly expensive and less effective. They impose unreasonable financial loads upon our health systems. Supporting allograft bone banks will provide greater benefits for our patients and concomitantly reduce our health cost base.