February 3rd 2021 Mr Neil Pearce FRCS ‘Establishing a Laparoscopic Liver Unit in the Caribbean’.

The President took the chair and welcomed everyone to the Zoom meeting.  The minutes of the last meeting were approved. She introduced the evening’s speaker Mr Neil Pearce FRCS who spoke to the title ‘Establishing a Laparoscopic Liver Unit in the Caribbean’. Neil spoke about his career. He qualified at Southampton in 1990 and trained in surgery, with a special interest in patients with complex problems, at a number of surgical units in the UK. He was appointed a consultant in surgery in 2003. His interest in complex problems led him to specialise in liver, biliary and pancreatic surgery. He became especially interested in laparoscopic surgery and developed new techniques. He was invited to operate live, and demonstrate techniques, at European and Asian conferences and he has also been invited to stream operations around the world from Southampton. After a demonstration of laparoscopic hemihepatectomy in Edinburgh he was approached to consider opening a liver service in The West Indies. He was invited to Trinidad on a fact finding mission. In Trinidad there is a mix of government funded health care, private insurance and charity funded care. There were considerable problems to be overcome. There are no blood banks in Trinidad. In Southampton the average blood loss in hepatic surgery in 270ml but if something goes wrong much more could be needed. In Trinidad it is necessary to take 2 units before the operation, replace it with saline, and return it after the surgery is finished. Equipment was needed and In order to finance it it was necessary to have local ‘business partners’ who would provide the necessary investment. The business plan allowed for a mixture of second hand US equipment [apparently they discard equipment after a low number of operations in the US] for which they allowed £50000 and an additional £70000 for new equipment. Plus bribes to get it through customs. He also had to bring out instruments from the UK in his hand luggage on a number of occasions. The local media was interested in the new venture but for the first case there was to be no publicity. Indeed to make life difficult there was a bleed from the primary liver tumour. At which point the theatre began to fill up with a number of observers, which included the Minister of Health for Trinidad, whom someone had invited. There were other problems too - the stapler could not be found, the theatre sister went missing and was found asleep in the anaesthetic room. To top it all a Q and A session had been arranged on breakfast TV early next morning. The arrangements went better after that and the team began to gel. Neil also set about training the next generation of hepatic surgeons. There was one young trainee surgeon who was very promising and it was arranged to pay for him to come to Southampton as a trainee fellow. He is now the surgeon running the Trinidad hepatobiliary unit.

Neal developed MS in 2011 and had to give up operating.

The President thanked the speaker for his interesting and entertaining talk. There being no other business the meeting was closed.

January 13th 2021 New Young Doctors: Drs Yarrow Scantling-Birch, Lara Hyson and William Sherwood ‘Learning on the Job’.

The President took the chair and welcomed everyone to the Zoom meeting.  Dr Freeman started the meeting with two minutes silence in memory of Professor Glenn Neil-Dwyer and Dr Derek Browne of Brockenhurst. 

She introduced our speakers, Drs Yarrow Scantling-Birch, Lara Hyson and William Sherwood who spoke to the title ‘Learning on the Job’. They were former recipients of Foott Memorial Bursaries [Yarrow gave his report last year to a live audience]. Yarrow wanted to update the Society on the work experiences of young doctors during the SARS-CoV-2 pandemic and arranged this presentation with colleagues. 

Yarrow Scantling-Birch started the presentation. He said he became an F1 doctor with great expectations. The arrival of the pandemic changed everything. He described the life of an F1and F2 as ‘go to work, go home, not enough sleep and little social life’. A weekend on duty is not only seeing the tide of patients being admitted but also a lot of administration. Now that he has just started his F2 year in acute medicine the only illness he sees is Covid, which is very repetitive and at times miserable from the high number of deaths. But now he also has to be thinking of the other things he needs to be doing to become an ophthalmologist. He has to prepare for membership exams, arrange presentations, arrange to do research and earn enough points to get on the specialist ladder. Covid19 also saw an influx of retired doctors to be supervised as well. One of the most difficult things he has to do is dealing with phone calls from relatives who cannot see their very sick relations in hospital. He thinks these calls put a lot of pressure on young doctors. He also did a spell in obstetrics during his F1 year but he is not fond of this rather messy speciality.

The second presentation was from Lara Hyson, who is an F1 doctor at St George's. She first served an assistantship to get a feel for practising medicine before her elective. She planned to spend her elective doing ophthalmology, in which she would like to specialise, first in Havana at the General Calixto Garcia Hospital and then in Guatemala. She spoke little Spanish at first but as the teaching was all in Spanish she had to learn the language quickly. Her boss presented Lara with a copy of her ophthalmology textbook, in Spanish, saying she would examine her on it before writing her report when she was due to leave. She gained a lot of experience in the more minor eye conditions working in outpatient clinics. She also attended daily teaching sessions, ward rounds and surgical operations. Covid struck the world half way through her term there. Not wanting to be trapped in Havana, and also because she felt she should be working in the UK at this time, she had to arrange a circuitous journey home as there were no longer direct flights from Havana. On return she was told ‘she was a doctor now’ and made an ‘interim F1’. She was attached to an F1 to learn the ropes. Being an F1, she said, was like being a ping pong ball bouncing between everyone and working 12 hour shifts 6 days a week. She was for a time in ICU where she had to know all the histories in detail of the 28 patients in her section. She said there will be brighter days ahead and that she was proud to be a member of the NHS. One thing she highlighted is the difficulty at present for F1 and F2s getting support to enrol on the right courses for future speciality training. She thanked the Society for the award which had made her trip possible.

Our third presentation was from William Sherwood who graduated unexpectedly, due to the pandemic. He was told by the University he could still travel to Vietnam and Nepal for his elective.  Just after his arrival in Vietnam the country locked down due to 5 cases of Covid being identified. The Vietnamese authorities were aggressive in their 4 layer contact tracing and he was expelled from his digs and spent a long time in Ho Chi Min airport. His supervisor in Southampton told him to go ahead with the Nepal section and he just managed to get the last flight out to Kathmandu. He said the Vietnamese lock down paid off. While GB has had 3.16 million cases and 83,000 deaths [at the time of his talk] Vietnam had 1520 cases and 35 deaths. In Pokhar in Nepal he joined the Nepal Ambulance service which is a pre-hospital service staffed by professionally trained medics to deliver medical services to patients especially in remote places. After this he was due to go to a hospital in Kathmandu but decided that it was too dangerous to work in a hospital there as Covid was becoming rife in towns. Nepal had 266,000 cases at that time and almost 2000 deaths. He managed to get on the last flight out to the UK. Once home he discovered on the TV news that medical students were being graduated early to work in hospitals. He therefore decided to offer his services to his local hospital in Poole to precede his prearranged F1 post. He served as an ‘interim’ F1 in a red zone elderly care ward. He found the support of the other F1 doctors very helpful. Due to severe restrictions of PPE only one doctor could visit the patients on a ward each day. One of the most difficult things, he found, was talking on the phone to relatives about patients he knew little or nothing about. After Poole he joined the West Middlesex Hospital as planned on the acute medical unit. Though quiet when he joined at the end of summer by November the beds began to fill steadily with cases of Covid and over Christmas there was a massive influx of patients. Operations were cancelled and the surgery wards turned into covid wards. The ICU was full. He said continuity of care was almost impossible. He was sent to different wards every day and patients were moved around so quickly the nurses did not know them. Often patients he was clerking could become so ill they would be moved on to a high care area almost before he had finished and all the time new patients kept arriving. He said flexibility and calmness were king as well as working together as a team. He was due to start surgery now but as all surgery was cancelled he was not sure what would happen. In the summer he will be joining the emergency medical unit as an F2. He thanked the Society for the bursary even though he could only complete part of his elective.

During a discussion with the audience afterwards a number of observations were made. There seemed to be little support for F1s from the Royal Colleges or the University Medical Schools. F1s and F2s could be redeployed without warning. Their experience was in-depth for Covid but nothing else. The juniors are concerned about their futures and the lack of training and supervision regarding their future careers. They all considered no-one had benefitted from the pandemic.

The President thanked the speakers for their most enlightening talks and they were thanked for the trouble they had taken over their presentations. She said she would like the Society to keep in touch with them.

There being no other business the meeting was closed.

December 2nd 2020 Mr David Anderson, Consultant Ophthalmologist, Southampton, “The Development of Cataract Surgery and the Goal of 2020 Vision”.

An ordinary meeting of the Society was held on December 2nd 2020, on Zoom due to the continuing pandemic. The President was in the chair. She introduced the speaker Mr David Anderson, Consultant Ophthalmologist in Southampton, who spoke to the title “The Development of Cataract Surgery and the Goal of 2020 Vision”. David introduced his talk with a brief history of cataract surgery. It was not until the mid eighteenth century that the first controlled cataract extractions were performed and only after WW2 were modern techniques developed. Sir Harold Ridley developed the first intraocular lens that could be inserted into the eye, having observed during WW2 that injured pilots with intraocular shards of cockpit canopy did not develop an inflammatory reaction to the acrylic. A plastic lens was developed which he first inserted in 1949. The operation was very controversial at the time.  Many types of lens have since been developed. Monofocal lenses are the commonest. Toric lenses are used for patients with astigmatism. Corneal assessment is so accurate nowadays that most astigmatisms can be corrected. Multifocal and trifocal lenses are also available. The lenses can also have extended depth of focus for working with computers etc. Nowadays there is such a choice that consultants are asking patients what they think they would like to achieve from the operation. This is particularly helpful for people who need good close up vision for various occupations and even hobbies. He noted that colour perception changes after treatment and that artists in particular need to be aware of this. David said that laser treatments are very good for improving some eye injuries, postoperative changes, and curing corneal distortions. This year the pandemic has prevented a grand celebration of achievement in paediatric eye surgery - the ability to insert lenses into children. This obviates the need for very thick pebble glasses. David finished by saying that intraocular lenses do not degrade or wear out and are inserted very easily under local, or occasionally regional, anaesthetic. The patient can also have sedation if they wish. This, he thought, seemed to apply particularly to a modern less stoical generation!

The President thanked David for his excellent talk. 

The meeting then moved onto some other business. Mr Robert Jackson proposed that the Hon Secretary, Dr Alister Hutchin, should be granted an honorary membership for his services to the Society over some 40 years, This was seconded by Dr David Rowen. The proposal was carried. Dr Hutchin thanked the members for conferring this honour. 

There being no other business the meeting was closed. 

November 4th 2020 Brigadier Peter Fabricius, former Colonel Commander RAMC, ‘Duty Called and Called Me to Obey: the relevance today of two doctors and four VCs”.

An ordinary meeting of the Society was held on 4th November 2020 on Zoom. The President, Dr Alex Freeman, was in the chair. The minutes of the previous meeting were approved. The President then introduced the evening’s speaker Brigadier Peter Fabricius, former Colonel CommanderRAMC, who spoke to the title ‘Duty Called and Called Me to Obey, the relevance today of two doctors and four VCs”. 

Brig. Fabricius explained that the title was a quote from a letter, dictated on his deathbed, by Noel Chavasse one of the two double VC doctors he wished to tell us about. 

He started with the story of Dr Arthur Martin-Leake VC and bar. He qualified from UCH in 1893. At the outbreak of the second Boer War he resigned from his position at Hemel Hempstead Hospital and joined the Hertfordshire Yeomanry as a trooper. He survived his year of service and joined the South African Constabulary as a Surgeon Captain. He was attached to the 5th Field Ambulance RAMC. On 8th February 1902 he went out, under fire from 40 Boers only 100 yards away, to treat two wounded soldiers and whilst attending to the second was shot three times. He continued treatment until exhausted. Long term he suffered an ulnar nerve palsy and was discharged from the army. During his recovery he studied for and passed the FRCS and was appointed as a Chief Medical Officer in India. In1912 at the start of the Balkan War he joined the British Red Cross and was awarded the Order of the Montenegrin Red Cross for his services in battle and then returned to India. At the outbreak of the Great War in 1914 he knew he would not be able to rejoin the RAMC if he tried to do so in England, due to having been discharged as medically unfit due to the severity of his wounds in1902, so he decided to travel to a recruiting station in Paris where he assumed that recruitment would be less scrutinised. Indeed he was accepted into the RAMC there and posted to the 46th Field Ambulance. During the First Battle of Ypres he was awarded a bar to his VC for treating and rescuing a large number of wounded men whilst under heavy fire near to the enemy trenches. He became the first man to win a second VC. He was also mentioned in dispatches later in the war. He was a great leader and also a keen photographer producing a portfolio of war photos. He returned to India after the war and retired in 1937. He then served again in the Second World War. He died in 1953.

The second double VC was Noel Chavasse. He was the most highly decorated soldier in the First World War. He qualified with a first from Oxford and then winning the Derby Exhibition in his finals at Liverpool. He was an identical twin and came from a remarkable family. Amongst other achievements were 2 doctors, 2 bishops, and with his twin, 2 Oxford Blues and 2 Olympic athletes. In 1913 he joined the RAMC and at the start of the war was doing medicals on new recruits. Frustrated because he thought he should be helping the fighting soldiers he pulled strings to get an active post and was posted to the Kings Liverpool Regiment about to depart for France. Our speaker showed a regimental photo taken before departing for France and by the end of June of 1914 everyone in it was either killed or wounded. In 1915 he was awarded the MC. His first VC was in 1916 at Guillemont when he spent 2 nights and 2 days in view of the enemy lines searching for and tending the wounded. In one case he and a stretcher bearer carried a wounded man 500 yards back to the lines during which he received shrapnel wounds. He was always concerned for his men. If he thought someone was beginning to show signs of shell shock he would consign them to light barrack room duties until they improved. He organised 800 pairs of socks, primus stoves for the men to cook on and gramophone records to keep them content. He was strict about hygiene and sanitation and sharp on infectious diseases. Every night he would go out with the stretcher bearers to look for wounded men in Nomans Land. His twin brother, who was an army chaplain, was wounded at Passchendaele and never found. Noel was devastated. He was awarded his second VC in 1917 in Belgium when although severely wounded in the abdomen when the dugout he was in was hit directly, he continued to search and care for wounded soldiers.He had a large abdominal wound and insisted the soldiers were looked after first until he collapsed. He was taken to a nearby dressing station where he died of his wounds. It was in a letter he dictated to his fiancee that the quote in the title of the talk was written. The relevance to 2020 is to remember that the doctors in the Great War gave up their plans for the future and put their lives on the line for the soldiers they cared for. Leadership, team work and moral courage. Doctors have continued to risk their lives similarly in Korea, Iraq, Afghanistan, and also in the Ebola outbreak and now in the NHS in the pandemic. There have been 3 VCs awarded since 2005. Brigadier Fabricius said that Armistice Day is about remembering those who gave their lives but, he added, we must never forget those who also survived and never got over it. Finally he wanted to dedicate this talk to all the hospital staff who during the pandemic served the sick.

The President thanked the Brigadier for his inspiring and moving talk. There being no other business the meeting was closed.

October 7th 2020 The Florence Nightingale 200th Anniversary Lecture. Sophie Hacker, 'Remembering Florence Nightingale'.

An ordinary meeting of the Society, which was followed by the AGM, was held on Wednesday 7th October 2020 on Zoom. The President opened the meeting and introduced the speaker, Sophie Hacker, a well known artist, who delivered the Florence Nightingale 200th Anniversary Lecture with the title Remembering Florence Nightingale.

Sophie said she was asked to design and make a stained glass window for the South Transept of Romsey Abbey in memory of Florence Nightingale on the 200th anniversary of her birth. She said she wanted to reflect Florence’s personal beliefs and motivations in her design. She read a lot about Florence and, in particular, went to the FN Museum in St Thomas’ Hospital which she found very atmospheric and helpful and how some of the personal items displayed inspired her initial drawing. She also spoke to Florence’s great Nephew. When Florence was 16 she was seated in the garden of her home, Embley Park, when she felt she heard a call from God. Sophie in her design made this moment the centrepiece and around this central drawing put all the important references to her life. In the picture of her in the garden Florence is turning away from us to hear the call. Sophie then described the process of making a full size drawing to the size of the very large window and then described how she marked out on it the tiny pieces that would make up the stained glass window. This had to be done with 100% accuracy. Stained glass is very expensive and mistakes cannot be made! These templates are then sent to a stained glass firm to create the pieces and then have to be fixed together to make the window. She showed pictures of the window being put in place in the Abbey which was happening on the day of her talk having been delayed by the pandemic.. The window can now be seen in the South Transept of Romsey Abbey and a book explaining the complicated process of designing and making the window can be purchased at the Abbey.

The President thanked Sophie for her fascinating talk.

The meeting then moved onto the AGM the minutes of which are recorded separately and will be circulated prior to the next AGM

March 4th 2020. Dr Sam Allen, Consultant in Infectious Diseases, “Stuff Happens”

An ordinary meeting of the Society was held on March 4th 2020. The President was in the chair. A period of silence was held in memory of the late Mr Tony Chant. The President then introduced the speaker, Dr Sam Allen, a consultant in infectious diseases, who spoke to the title “Stuff Happens”. Dr Allen told us that being a medical officer to international exploration expeditions was a hobby of his. He first became involved when, as a medical student, he joined the Zaire River Expedition, run by Col. John Blashford Snell, as part of his elective. The experience of being on an expedition travelling the length of the Zaire River, and being a member of the medical team part of whose job was to treat River Blindness, had him hooked. He later became MO to an expedition searching for the lost city of Inca gold. His next trip was on Papyrus reed boats on John Blashford Snell’s Kota Mama Expeditions  which were trying  to prove the existence of trade links recorded 3000 years ago between Lake Titicaca in South America and West Africa. All these trips involve delivering medical attention to the locals as well as to the crew. The surgeries are always busy wherever they stop. He mentioned in particular a child with very severe cleft palate whom he managed to get treated in Great Ormond Street. He kept up with her and years later he said she also delivered a child with cleft palate. He showed us a terrifying video of one of the boats going through extreme rapids being capsized and the crew washed downstream in the violent water. They were lucky not to drown. They were saved by being washed onto a small island. 

By then he was a consultant in Infectious Diseases.He spent time in the Brazilian Instituto Evandro studying Zoonoses and he became especially interested in Chagas Disease and its consequences. He was part of the British Government team who went to deal with the outbreak of Ebola in Sierra Leone. In 2016 he was part of the team sent to Rio by the British Olympic Association before the Olympic Games to assess the risks from Zika virus infection.

He ended with a remarkable story about his return from an expedition in 2001. They landed at JFK airport in New York to refuel. On taxiing to the runway again could see through the window strange explosions on what seemed to be the Twin Towers in the distance. The airport was locked down and the flight aborted. Urgent requests for medics to come and help were broadcasting so  he travelled into New York and found himself treating the few survivors next to the fallen buildings. He later wrote a book about it.

The President thanked him for his talk and the speaker was soon surrounded by the medical students present eagerly wanting to know more about expedition medicine.

The 2020 Foott Memorial Lecture: Dr Shantanu Kar, Consultant Radiologist,Southampton University Hospitals, 'Prostate Imaging - The Lymington Experience.

The Foott Memorial Lecture meeting of the Society took place at the Ampfield Golf Club on 5th February 2020. The President, Mr Robert Jackson, was in the chair. The minutes of the previous meeting were read and approved. The President then invited Dr Shantanu Kar, Consultant Radiologist to Southampton University Hospitals, to deliver the 2020 Foott Memorial Lecture entitled Prostate Imaging - the Lymington experience. Dr Kar introduced his lecture with more of Dr Foott’s history. He had found in the National Archives Dr Foott’s Naval Record and certificate of death which covered the period from when he joined the Navy in 1886 as Surgeon at the age of 25 until he retired as Fleet Surgeon in1911. He then became a GP in Southampton until his death in 1945. His death certificate recorded the cause as Uraemia due to enlargement of the Prostate. This was a fortuitous finding to introduce a lecture on prostate imaging. Prostate cancer is diagnosed in 47,000 people a year. The annual mortality is 11,700 which is greater than breast cancer. Eighty percent of cases will survive 10 years and in the 50 - 69 age group 95%. Dr Kar said that Lymington has just acquired the most modern of MRI scanners and that multi parametric MRI is the way forward. He showed a series of video sequences and explained about the zones of the prostate gland and P1RADS scoring of tumours. The clarity of the pictures is such that any cancer present can be accurately placed so subsequent biopsy can be aimed; and, more importantly, it will reduce the number of missed cancers. It can also distinguish between the cancers that are invasive and need treatment and those that can just be observed over time. He also considers it accurate enough to exclude cancer of the prostate. He said that TRUS biopsy has too many possible serious complications to be used to exclude cancer on all patients with a raised PSA and the introduction of this technique should reduce the number of biopsies performed. In 2016 Lymington recorded 3500 examinations a year but with the new scanner this is being greatly exceeded.

The President thanked Dr Kar for his most interesting lecture. There being no other business the meeting was closed at 9.55pm.

January 8th 2020. Dr Ben Chan PhD ‘From Stonehenge to Orkney - Understanding the Great Monuments of the 3rd Millennium BC

An ordinary meeting of the Society was held at the Ampfield Golf Club on Wednesday 8th January  2020. The President was in the chair. The meeting started with a minutes silence in the memory of Dr Richard Buckle. The President then introduced the speaker Dr Ben Chan PhD who spoke to the title ‘From Stonehenge to Orkney - Understanding the Great Monuments of the 3rd Millennium BC’. This is, he said, the middle Neolithic period when the first farming communities appeared in Europe and monuments started to be built.The monuments at first were long barrows for burials such as West Kennet and over the following 2000 years ceremonial monuments, which are round, were built such as at Windmill Hill. The late Neolithic period is the most interesting as the monuments became bigger and bigger and the end of this period overlapped with the introduction of copper metallurgy and the two cultures existed side by side from a time. Dr Chan discussed the functions of  monuments. Stonehenge is still the subject of lots of competing interpretations ranging from Mycenaean practices through astronomical calculations to a gathering place for exchange of livestock for breeding. Stonehenge has an avenue down to the river Avon and another to Durrington Walls the largest henge in the country. [Stonehenge is not a henge.] Durrington Walls has houses and probably 1000 people lived there. No-one lived at Stonehenge. He described the construction of Durrington Walls and what had been found there. The pottery and middens all suggest lots of feasting especially at midwinter and Stonehenge has a midwinter setting. Isotope studies have been done on the pig and cattle teeth found which indicate people came with their animals from all over Britain. The southern circle is massive, requiring 300 hundred trees, thirty thousand stakes and miles of watling for the houses - something never done before in our history until then. Dr Chan then discussed the Ness of Brodgar which is comparable to Stonehenge and was active between 3200 and 2300BC. Twenty three buildings have been identified so far but there may be over 100. Most are larger than domestic dwellings and the quality of the stonework is exceptional. The floor deposits suggest they were used for a long period of time and that many may have been workshops. The similarity of the pottery and stonework all over Britain suggests there was a considerable movement of people at this time.

The President thanked Dr Chan for his fascinating talk. There being no other business the meeting ended at 10.15pm.

Medical Student Presentations 2nd October 2019

An ordinary meeting of the Society was held at the Ampfield Golf Club on Wednesday 2nd October 2019. The President was in the chair. The meeting started with a minutes silence in the memory of Dr Pamela Ashurst and Dr John Wales. The President then introduced the speaker Dr Iain Macintosh, Director of the Paediatric Intensive Care Unit in Southampton, who spoke to the title “Difficult Decisions in Paediatrics”. He started by showing extracts from a film on Channel 4 that followed 8 families that had a child with a life limiting illness. We saw the ethics committee discussing with one family the choice they had to make between their child, which was on life support, suffering for a longer time with intensive care or being allowed to die sooner. As the Mail-on-line put it next day ‘the devastating moment when parents decided turn off life support”. His team then analysed the social media reaction. They found that in general people were supportive. There were some comments about wasting clinician’s time and critical remarks about the financial cost. The team also searched a number of other headings such as  ‘Parental choice’ ‘Religious Objections’, ‘Benefits of Tracheostomy’, ‘Critical decisions by the bedside that the child can hear’ and ‘Alfie Evans’. In the latter case they found Facebook groups that excluded anyone that had an opposing view to theirs, to the extent of an extreme like-mindedness. In this type of group there was evidence-free blame attribution. They found the public in general were not judgemental and expressed surprise at the lengths the hospital go to to help parents make good and fair decisions; that there was trust in the trustworthiness of clinicians. For Alfie Evans the reaction was exceptional with the help of the press casting the medics as villains. Dr Macintosh said that of course these decisions won’t go away. It is not about the decision but about the process. It has to be a story-telling type process and we need to share this more widely. There needs to be more GP  involvement.The cost didn’t seem to be questioned: it is in fact about £250,000 a year to maintain a child on life support. The media do not help by highlighting only heroic results thus creating unrealistic expectations. Crowdfunding for treatment abroad, especially the USA where there is always someone who will take on a case, is a common consequence and unfortunately the press rarely report the outcomes of those cases and the child is forgotten.

The President thanked the speaker for his interesting talk. The meeting was closed at 10.00pm.

Dr Iain Macintosh, Director of the Paediatric Intensive Care Unit in Southampton, on “Difficult Decisions in Paediatrics”.

An ordinary meeting of the Society was held at the Ampfield Golf Club on Wednesday 2nd October 2019. The President was in the chair. The meeting started with a minutes silence in the memory of Dr Pamela Ashurst and Dr John Wales. The President then introduced the speaker Dr Iain Macintosh, Director of the Paediatric Intensive Care Unit in Southampton, who spoke to the title “Difficult Decisions in Paediatrics”. He started by showing extracts from a film on Channel 4 that followed 8 families that had a child with a life limiting illness. We saw the ethics committee discussing with one family the choice they had to make between their child, which was on life support, suffering for a longer time with intensive care or being allowed to die sooner. As the Mail-on-line put it next day ‘the devastating moment when parents decided turn off life support”. His team then analysed the social media reaction. They found that in general people were supportive. There were some comments about wasting clinician’s time and critical remarks about the financial cost. The team also searched a number of other headings such as  ‘Parental choice’ ‘Religious Objections’, ‘Benefits of Tracheostomy’, ‘Critical decisions by the bedside that the child can hear’ and ‘Alfie Evans’. In the latter case they found Facebook groups that excluded anyone that had an opposing view to theirs, to the extent of an extreme like-mindedness. In this type of group there was evidence-free blame attribution. They found the public in general were not judgemental and expressed surprise at the lengths the hospital go to to help parents make good and fair decisions; that there was trust in the trustworthiness of clinicians. For Alfie Evans the reaction was exceptional with the help of the press casting the medics as villains. Dr Macintosh said that of course these decisions won’t go away. It is not about the decision but about the process. It has to be a story-telling type process and we need to share this more widely. There needs to be more GP  involvement.The cost didn’t seem to be questioned: it is in fact about £250,000 a year to maintain a child on life support. The media do not help by highlighting only heroic results thus creating unrealistic expectations. Crowdfunding for treatment abroad, especially the USA where there is always someone who will take on a case, is a common consequence and unfortunately the press rarely report the outcomes of those cases and the child is forgotten.

The President thanked the speaker for his interesting talk. The meeting was closed at 10.00pm.