February Update from The Campbell Clinic 

Most of us who work in healthcare spend a lot of our days in front of patients, trying to help, fix, advise, comfort, and understand. That is the role of the healthcare practitioner, but from time to time (and for some of us more frequently than that), the role becomes reversed and we become the patient.

That is a fascinating insight that all of us can use to reflect on our own practices and behaviours and the way that we try to look after the people we are given the privilege of having within our care.

And so, in February's monthly newsletter to our patients that I write after a break in January when I was away from work, I wanted to share a recent experience of becoming a patient myself and how that reflects on everything we try to do for our patients at The Campbell Clinic.

For almost 9 years, I've had significant knee problems with my left knee after a forced retirement from all running and triathlon when I saw an orthopaedic surgeon in 2016.

My knee deteriorated to become worse and worse, but I was desperately trying to avoid any intervention in this because I was always given the advice that you should look after your knees surgically late (look after your hips surgically early). 

At Christmas this year, it became more unmanageable, and my diagnosis is that I have some sort of previous injury to the outside of my left knee, which caused a problem with the cartilage and the disk in my left knee and has led to arthritis change.

One of my really good friends has suffered significant problems with their knee for many years due to sporting injuries from being a professional footballer and undergoing approximately 10 knee surgeries previously.

From my point of view, he has been the guy doing all the research for what is to come for me, so I've let him research and explore all possible surgical options and all possible surgeons.

In the end, it was time for me to see someone again about my knee almost 9 years after the first occasion, and I decided to pick the surgeon of my friends, a gentleman called Justin Cobb, who is a professor of orthopaedic surgery in London, who practices in the West End.

And so I travelled a couple of weeks ago to see Professor Cobb, wondering what it might be like having been a professional myself who has consulted with thousands and thousands of anxious, concerned, scared and worried patients. 

And so, as I turned up as one of those patients to the fancy hospital in the west end of London to see Professor Cobb, I wondered how it would be dealt with.

First visits and appointments with patients are absolutely fundamental and critical. We work extremely hard on this at The Campbell Clinic to make people feel welcome, at ease, and understood, as well as to take away the overwhelm that healthcare consultations can sometimes provide. What we also work very hard to do, though, is to provide time.

This is something which is massively overlooked in modern healthcare. So, as the world has changed, and the rules and guidance have changed about how we interact with people (more about that below if you're interested), what is clear is that we cannot fulfil the requirements that are put upon us by society and by the social contract with patients unless we have the time to do that.

This, of course, is a double-edged sword because to spend a whole day talking to one patient is to go bankrupt in any healthcare system, and therefore, the healthcare practitioner must balance the need to move along and the need to see multiple patients in a day with the requirements of individual patients and their own feelings, concerns and worries related to the treatment that they have.

And so it was with this in my mind and the concerns about what I might be told (I was bracing myself for the worst possible news because the last time I'd seen an orthopaedic surgeon, the news was so terrible I'd driven 30 minutes in the wrong direction). 

One of the things that Professor Cobb did for me was he called me in himself from the waiting room. In the large Clinic that I was at, the Cleveland Clinic in London, there were multiple consulting rooms and multiple people working simultaneously, and there was a very busy waiting room. 

To have the clinician call you in himself is a real statement, in my opinion, and it's something that we've done at The Campbell Clinic for many years.
Also, to introduce yourself by your first name is absolutely critical, and this is what Justin Cobb did for me.

One of the reasons Professor Cobb does this is so he can see you walking into the Clinic (he's a knee specialist), and so even before I'd reached the door, he was talking to me about how misshapen my leg was (that made me feel great!) but I told him that my children call me 'banana leg' and he told me that that was an 'expression of love'.

And so, in a very short time, he had massively reassured me that he was a caring practitioner who called me in himself, had very good eyes to see what was going wrong as quickly as possible, and was also able to be empathic and funny about the names my children called me. 

Not to put too fine a point on it, the consultation was exceptional, but it was quick. If I decided to deviate to try to enter into personal discussions, Professor Cobb would not really be bothered about that and would gently push me back into a professional conversation.

His consultation, in total, lasted 25 minutes (many of my consultations last an hour), so he has a different style of practice, but in no way did I feel undersold.

He is extraordinarily experienced and skilled in his approach, and also the news from my consultation was much better than I could have imagined (despite the fact that I'm now booked to undergo surgery on my knee). 

And so, throughout the process, he was able to talk me through things, to explain things to me and to take me through a process. He made me feel at ease.

However, this is an interesting consideration because I am a specific type of patient. I am what we call in the Clinic, the CEO personality.

We believe there are many different personalities for patients who come to see us, and in fact, we now teach this principle all over the world in different places to try to help people understand how to understand their own patients.

So, to be clear, the CEO personality is not necessarily a CEO (in the same way that the accountant personality need not be an accountant), but the CEO personality is someone who trusts or does not trust very quickly. That would be me.

Professor Cobb calling me in from the waiting room and having an interchange with me on the way to the room made it very easy for me to trust him quickly.

Secondly, the CEO, after they trust, is happy to defer to the knowledge and expertise of the individual that they're speaking to quite quickly and also is happy just to move along as quickly as possible with solutions that are suggested but that is not the same for every patient, and to treat every patient as a CEO personality is to make the gravest mistake.

Consent in healthcare was very simple before 2015, effectively we did what the doctor said. If the doctor got it wrong, as long as it wasn't too wrong, they were protected by the law, and the patient was not.

Then entered the most extraordinary young woman called Nadine Montgomery, who had been working as a young geneticist in the NHS when she fell pregnant. As a diabetic, she was not given the correct information about the choices that she had to deliver her baby, and her son Sam was born with birth injuries, which would never have occurred had Nadine been given the information that she was required to be given to make the choices she could have made herself. 

This amazing young woman with a young son with significant difficulties following birth took the next 20 years to change the law, becoming a solicitor in the interim and going all the way to the Supreme Court to change the law, which has now become known as Montgomery consent to be more in line with patients' needs, wishes, and understanding.

I had the opportunity to meet Nadine Montgomery in 2021 and spend a little bit of time with her and find out what an extraordinary person she is but what she did changed the law in healthcare so that it is now the responsibility of the clinician to understand what the patient needs and to discuss and explain and negotiate with them their treatment in a way that is best for them (not just for a massive group of them). 

This is now the law and is known as Montgomery consent, but the problem is that it takes time.

Professor Cobb was able to do that for me in the absolute shortest timescale available. I'm not sure his approach would work with every single patient, but it may be he had me 'clocked' and understood what I needed; it certainly worked for me.

In other circumstances, it wouldn't work, and as healthcare professionals, we need to take longer to understand our patients and to be able to discuss with them possible options.

In some cases for us, it's important to say, "This is what I think you should have". We lost this approach in healthcare because we were worried about litigation and complaints, but at other times, it's really important to explain everything to patients and ask them what they want.

In my consultation with Professor Cobb, I was happy to be told what to have. I'm not an orthopaedic surgeon with thousands and thousands of knees under my belt; I didn't invent the robotic surgery machine, and I don't speak at international conferences on these almost every week. Why would I not take his advice? But the circumstances change for every patient.

In all of the new things that we offer at the Clinic and the ways that we change the practice that we provide in our relatively new Total Care Club general dental service or, our orthodontics and braces service for children and adults, or the dental implants that have been the fundamental basis of our life for 25 years will continue the process of 'using modern technology to make us more human'. 

The way we will do this is it will allow us more time to spend talking to and understanding our patients and less time spent on the administrative tasks, which are so burdensome that they take away from the real work, which is looking the individual in the eyes and understanding what they need.

Thanks very much for reading my February ramble.

If you have any comments, please hit reply; I'd be delighted to hear from you.

I will provide another update on things that are happening in the Clinic, the Academy and our social legacy projects in my March newsletter. 

Thanks to all patients who have been bringing in their dental recycling for the Philips Dental Care Recycling scheme through TerraCycle. Sadly, this scheme has closed nationally. 

There is not a scheme replacing it currently, but we have done some research for you and you can use this website https://www.recyclenow.com/recycling-locator?rlw-initial-path=local-authority/search which will let you search for the nearest collection point to you – for example electric toothbrush heads can be recycled at many (but not all so check on this website) Boots branches.