E: Self-Help - Life Lessons from a Trauma Consultant - Mr Ansar Mahmood (Consultant Orthopaedic Trauma Surgeon)

Hear the extraordinary journey of a leading Trauma Consultant and how he struggled during his early life against all odds. Mr Ansar Mahmood shares life lessons that are applicable to all of us.

Key topics covered in this episode:

👉🏽 How to succeed even if you were labelled as deprived

👉🏽 Daily challenges of a Trauma Consultant

👉🏽 Importance of teamwork

👉🏽 Future of the medical profession and the impact of AI

Mr Ansar Mahmood, Consultant Orthopaedic Trauma Surgeon MB, ChB, MRCS Ed, FRCS (Tr&Orth), DABRM.

Mr Mahmood is a Consultant Orthopaedic Surgeon in one of the leading Major Trauma units in the UK. Fellowship Trained in Orthopaedic Trauma Surgery, with Specialist interests including Major Orthopaedic Trauma, Sports & Tendon injuries & post trauma reconstruction. He is the University Hospital Lead for Trauma Research. Research interests include Platelet Rich Plasma (PRP) and Ortho-biologics and their use in musculoskeletal conditions and wound healing. 

Mr Mahmood is a Senior Clinical Lecturer in the Institute of Inflammation & Ageing at the University of Birmingham and major trauma research lead at the Institute of Translational Medicine. He is one of the first and very few holders of the Diploma from the American Board of Regenerative Medicine awarded by the American Academy of Regenerative Medicine in the UK & Europe. He founded the UK based Academy of Regenerative Medicine which is the premier provider of education and accredited training in regenerative medicine in Europe. He is also one of the few Orthopaedic surgeons in the UK that is trained in Ultrasound and does all of his treatments under ultrasound guidance to enable a higher level of precision and improve patient outcomes from non-surgical or minimally invasive techniques. 

Currently the President of the British Trauma Society he also created the internationally recognised MISTT course which uniquely trains teams to plan and manage trauma in mass casualty situations and is accredited by the Royal College of Surgeons Ed. & recognised by the World Health Organisation. He is invited to lecture and train clinicians around the world on a regular basis. 

He is passionate about the scientific endeavour behind our practice of medicine and surgery and believes big data and machine learning/AI will be instrumental to our decision making for trauma and medicine in the future. He gave a lecture on AI in Trauma at the British Orthopaedic Association conference and is involved in research with the AI research group at the University of Birmingham. 

Links: 

Linked: https://www.linkedin.com/in/ansar-mahmood-ab465135

IG: @regenacademy @dransarmahmood

 Websites:

www.thearm.co.uk 

www.stemcellscience.co.uk

www.britishtrauma.com

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Transcription:

[00:01:02] Paddy Dhanda: Dear friend, thank you so much for listening in to the Superpower School podcast. And on today's episode, I have a childhood friend and when we think back to our friends, It's probably my best friend from school. Still great friends because he's the one person that I would probably turn to for any kind of life advice.

He's just an all around, genuinely smart guy. I thought I'd bring him onto the show today. He is a consultant trauma surgeon. He is a lecturer at the University of Birmingham. He works at the Queen Elizabeth Hospital in Birmingham and is the president of the British Trauma Society. And I'm sure there's a load of other accolades, but I just don't have time for them right now.

 I'd love to welcome Mr. Anal Maud. Hey, welcome to the show.

[00:01:52] Ansar Mahmood: Thanks, bud. Great to be on. Um, looking forward to the questions.

[00:01:57] Paddy Dhanda: We grew up together at high school, and I was gonna refer to you as Dr. An Mahmoud, and then you corrected me just before we started. Tell me more about that. Why am I not allowed to call

[00:02:07] Ansar Mahmood: you doctor? When you said that, do you want me to refer to you as doctor or Mister?

I said to you it's usually mister and the reason for Mister is there is a history behind it. So the Royal College of Surgeons in Edinburgh started just before the UK one. Both colleges, when they became College of Surgery that was over 500 years ago. At that time there weren't really any surgeons.

Because before anesthesia came along that an antibodies surgery was pretty difficult to do well and people, if they ended up reading a limb off or an abscess drain, it either happened naturally or they went to anybody to do it. But one of the people they went to do it, or the physicians would use physicians being the medic you and say something's wrong with you.

 If they needed a abscess draining or something chopping off, they were probably too prim and proper to do it. But they also didn't have the blade skills. They didn't have the practical skills to do it. So actually they used to instruct the local barber barb, as we all know how very good knife skills, uh generally, especially pre Gillette, razors, et cetera.

There are all the brands out there. People used to have to do with a sharp blade. And barbers had very good knife skills. So the physician would send for the barber who later they incorporated the The Barber Surgeon Society, which later became the Royal College of Barber Surgeon, which later became the Royal College of Surgeons.

So Barbaras are always mister, so the doctor would send for Mr. Smith, whoever the barber surgeon was, and the mister would turn up and that would differentiated. It was the physician and the surgeon. And one of the doctor one was Mr. And obviously being England, we keep our traditions going on for hundred and hundreds of years.

That's still the case that when you become a member, when you pass your memberships exams for Royal College of Surgeons, you now call yourself Mr. And in the hospital, it differentiates physicians from surgeons. Not that it really matters anymore.

As I said, when you go to the rest of the world, they don't understand this either. I have to do this whole explanation every time I go abroad as to why you missed that. Because all the other surgeons in the rest of the world tend to be doctor.

[00:04:05] Paddy Dhanda: So on this episode we're gonna be talking about some of your superpowers.

And I don't think there is one specific superpower that we can really pinpoint because there's just so much that you do, but you are a bit of a fixer of people. And as a trauma consultant, I'm sure that is a core part of your job. But before we get into that, I want to take you back to some of your childhood and my first memory of meeting you.

Was quite an interesting story. I dunno if you remember, but I had just moved from Warwick to Birmingham and I sometimes refer to it as moving from Harry Potter land because Warwick's a bit like Harry Potter land with Big Castle, and it's all lovely and friendly to a school in Birmingham, which was more like Jurassic Park.

You only the fittest survived. And I remember on my very first day, I sat at a particular desk, which happened to be your desk, and you were running a little bit late and the response I got from you was like, what you're doing at my desk? And it was like a very, one of those really sort of nightmare-ish meetings because I'm the new kid and I just had no idea like who you were, but you were a lot taller than I.

 Let's take you back to our days at high school. Like for the listeners, could you describe what kind of environment. What's that?

[00:05:34] Ansar Mahmood: Yeah, it's a difficult one cause I know when I went to medical school, I felt quite outta place and it's because about 80 to 85% of the medical school intake, certainly historically and going back 20 years ago, was predominantly 85%, grammar or private school.

 I came obviously from that other 15%. What I do remember is you and I were in like year, what they call year nine now. So like third year of high school and the league tables coming out for the very first time they produced a national league table of schools. I won't name the school, although I probably can actually cause it's gone.

 But I remember having the newspaper, we were all looking through it on the school field and we looked down and the worst borrower in the whole country for children's education was sandwell. We were in Sandwell and the worst performing school in Sandwell was Ley High School.

And I remember looking at this and thinking, does that make us like officially the worst school in the country? And what strange is you are when you are in that environment, you've grown up in that environment that's normal, so you actually have no perception. I remember reflecting back on that, that when someone was said, like with the worst school in the country, at no point did we look or feel or think that we were in the worst school in the country.

Not saying that it was the worst school in the country. Obviously those tables can be, there's lies and statistics whatever they're made from. We know that being the lowest in that borough doesn't mean you're the lowest in the country.

But it's nice extrapolation. It makes better headlines and it makes more interesting conversation when you're teenagers. So we went down with walking around for a couple of weeks telling everyone that I could meet that we were the worst school in the country. And that was slight badge of honor.

Um that was a kind of environment. And I remember government policy made that worse, in our later years because we were quite a small school compared to the surrounding three really big high schools that had over a thousand students in them. And we had about five or 600, but we had much larger fields.

And rather strangely, the high or schools around us were struggling with fields think, well, why can't we just absorb or take over that school? So our school was constantly under threat of being closed or absorbed into the other schools. And because of that, there was an active policy of accepting anybody.

So in our last couple of years of high school, all the kids have been excluded from all the other schools. And so had nowhere to go, suddenly arrived in our school. So we then had our onsite drug dealers and their relatives coming to the school. The gamblers. Yeah. Yeah, exactly.

Yeah. We ended up with a lot of the most interesting elements of society all at the school. Some people would argue that maybe they were always there. I remember one big story, which I still tell my kids, that onco pad, was taken aside of one of the teachers at school and told that he stopped hanging around with Ansar because Ansar was gonna end up in prison.

Yes. In prison. And he shouldn't end up in the same place. But yeah, I remember I said, I remember Paul coming out and telling me that this was, I thought, I can't believe That morning I'd actually helped part with his science homework, which I used to do.

I probably didn't have mine in, but I did his for him. It was a shock to me. So maybe I didn't have insight, but that was the kind of school we went to. I think you were a cheeky chappy in that kinda school. Either teachers loved you or hated you, and I suppose I was a little bit on the cheeky side.

Yeah.

[00:08:49] Paddy Dhanda: I just remember being the new kid, there was this constant sort of competition from many of the males around, they had a league table of who's the hardest in the year, the strongest, the toughest. And whenever anyone new came in, they was like where do they go in that league table?

So you either. Have to defend yourself and prove yourself to get on the table. Or like me who avoided violence. Just hope no one picks on you. The couple of times I did get picked on, luckily I had good friends around me who were always there to help support me, but God forbid some of the kids must have had a right difficult time there.

I know. I felt

[00:09:27] Ansar Mahmood: so sorry for him. It was a tough upbringing and I remember seeing some sort of cartoon or something. I don't spend all that much time on social media, but I saw something that said that there's a praise in that says that hard times generate hard men.

 Then hard men generate hard work. And then hard work generates good times and then good times generate soft men. And then soft men generate bad times. There's little cycle of life. And I worry about that now actually, I think cuz of the background I was from, there was quite a lot of adversity and we were probably used to facing it, but I do remember actually that wasn't the case and that was somewhat individual psychology.

 There's a few of us that pushed through and made it somewhere into a profession of some kind. I remember looking back and we had quite a small year and there's about 120 kids and I think only about 20 of that went on to do a levels or college of some kind. The other hundred literally just left high school and went looking for work or whatever other activity they felt they could earn money from.

And that's not a great statistic. Think of the 20 that went to college. Not that it's always a measure of success, but I think about seven or eight of us probably went to university. So if you take 120 and a success rate is less than 10% going into. Certainly the highest levels of education at university level.

 It's not a great statistic, but again, it didn't feel like that, I'd grown up at Langley Junior School, Langley High School, and although the junior school and the high school are not co-located there, two a mile and a half, two miles apart, so actually you don't ever see the high school or vice versa.

 Not that they weren't in the same building. So when I came to high school, it was a completely new building with a completely different set of people. It wasn't something I had any prewar or experience about. And I suppose being in a high school like ours, it was tough. Yeah.

We didn't realize it was that tough. We just thought that was normal and I certainly think there's lots of things that can break people, you know, a degree of physiological stress, but at the same time, some people thrive under stress maybe, you wanna push through or you wanna get beyond that.

And I think it really comes down, I was reading something or listening to a quick talk on David Goggins that chap ultra runner et cetera in America, the Navy Seal. Yeah. See that's what he talks about. He went through periods of his life where yeah, absolutely miserable.

Then he lost confidence and he gained loads of weight and did nothing else with his life and wasn't really progressing anyway. And it's only when he actually thought, I need to get over everything that's holding me back. Just accept all the bad that's happened. You need to accept it and move on.

Whereas you sit there bathing in it, you're never gonna move on. So lots of reasons why we wanted to get out of where we were. But I suppose I still accept that we were probably privileged, we had stable families and good families and parents that even though we didn't appreciate the time, were always looking out for us and trying to get us on the right path.

I know when I went to university, that's when I first met the first contract. So I met kids who had been to five years high school and two years of college, or seven years of higher education of some kind or secondary, and they'd never seen or been exposed to violence or a fight. Our school, there was a weekly, if not it's a main event, like every day.

 At least a weekly fight of some kind. Yes. So there would always be you, sometimes one a day or two a day. It was quite normal to expose that level of violence. When I reflect back on it, I realized perhaps why we're damaged in the way we're damaged. But,

[00:12:50] Paddy Dhanda: well, I was thinking about like some of experiences of adversity and how they helped us.

One example, I'm sure you remember this, we were in the football team and we were playing a local school called Bristol Hall who were like, way better than us at football. And you and I were in defense and we were losing 10 nil right in this match. And everybody in the team had literally given up hope.

There was no hope of us doing anything in that match. And I just remember for me personally, off the back of that match, I was made captain of the football team because I was the only one who was still encouraging everybody. I don't know why I was doing it. I was just like, come on, we can do it.

We can do it. And then I remember you grabbing hold of the ball on the halfway line and you booted it and you scored this amazing goal from the halfway line. I'm sure you remember that. You must be telling your kids to this day about that goal. And that was like our highlights of the match. But you know what?

Yeah, we lost ten one, who cares? But we walked away with great because I got made captain, you had scored this wonder goal and what a great experience.

[00:13:57] Ansar Mahmood: Yeah. That was an interesting day. Yeah, absolutely. It was the eighties, right? So eighties into the early nineties and what the UK culture was in a stage, we were trying to be American, right?

So whatever the Americans doing, about five years later it was coming into the uk and I think we were just in that period over that period, five years where like colors, gangs were over LA and New York. So Birmingham had this issue with like gangs everywhere, and sort of gang and culture.

School cultures have always been the same, I suppose to some extent there's always rivalry, et cetera. But I think we taken rivalry beyond that level of, we just don't like each other. Cause we play sports against each other. And it got to the point where everyone was like, you just disrespect my gang and my crew and my territory.

People had got this into their psyche and there were lots of gangs around Birmingham at the time that, and they wore colors. They wore orange or they wore blue and people from those different gangs couldn't go into different areas because they were then out their own territory.

That was quite a weird environment, but certainly a high school. We didn't really ever go to the other schools because the level of violence within our schools, it was the same in between the schools. There would be no qualms about putting fists or bats and having go at each other.

Thankfully, mostly always fists. I don't remember the mean much. Weapons, maybe weapons are worse now actually.

[00:15:11] Paddy Dhanda: Another story that sticks in my mind was when we were kids. I remember you telling me about your dad. He had a really good friend who was a gp and he once took you to the surgery and he explained to his friend that he was hoping that you would one day become a doctor.

Could you tell us about that story? Because for me, it still or sticks in my mind even to this day. We look back and we think. How did I end up on the path that I ended up on? And for many of us it's because we may have had some kind of point to prove to people. So could you

[00:15:47] Ansar Mahmood: share that me with us?

Absolutely. I'd come back from work experience at University of Birmingham. I went to be physicist. Remember I was a physics, not loved physics and space science. And so I was gonna go off and do space science and physics. That was my Plan eight university. And then long story, that's for another day.

 I had in the physics department, I had medical doctors coming. Cause we were doing some research on the first pet scanners in the country at the University of Birmingham, which are now in common use in the nhs. But at that time they weren't available in hospital.

We were testing them and we were playing around with these pository emission tomography scanners at the university. And the doctors were doing research on cancer using pet scanners to monitor cancer. But it wasn't proven at that time. But they would turn up in, I would be there, I'd have got there on the bus, the two postdoctoral PhD physics students, and the professor would arrive in a, 20 year old s SCORs, et cetera.

And then the orthopedic or the oncology doctor would arrive in his Porsche outside and park it next to our cars, come in, tell us what to do, tell us what he wanted, and then leave. And third or fourth time he came along, he said to me, what are you doing here? And then we ran into a conversation and ultimately what he said to me, he said, if you do physics, you're gonna be like, these guys, you're gonna be poor forever.

He said, you love what you do. I'm sure. But he said sooner or later, and he said, look, I'm doing physics, but I'm a doctor. I can do whatever I want. We can invent science, so actually do something that earns you some money. you'll be respected and then you can come and do science if you want.

You can be a researcher within medicine. And he gave me that idea. And obviously being relatively. Now they call them deprived kids, but certainly I wasn't well off one of six kids and a dad worked in a shop or a factory. It was challenging in a single income household.

 We were never flushed for cash. I'm not saying we ever went hungry. My dad was great and he worked really hard, and then we always had plenty of food. So I didn't really notice that we were plus for cash until I saw the people and that's when I realized that.

And you always know I was growing up that some people are a bit wealthier than you, and some people are. That's where you see their houses and their cars, the way they live. You're always appreciative of that. But I don't think we necessarily felt deprived until I got defined as deprived when I applied for the university.

 That was one of the things. I decided to apply for medicine. When I made the decision to apply for medicine, everyone just laughed. And that's actually what annoyed me the most. They knew I I wasn't a star student, you said I was pretty bright.

 I was never the one that stayed and did extra homework or got things in on time. You mentioned being at my desk cause I was late. That's cause I was awful late. That's unfortunately, I have to admit, even now as a doctor that stayed with me in life, I'm one of those people who always thinks, let me get this done.

And what's funny is that gives people the impression you're lazy. Anytime through my training being called by the old consultant or boss or training director as approached me and said, you must be lazy cause you've done less of the paperwork than your other colleagues.

I told them to do this. And you've done it, but you've done half as much as they have. So you either don't listen to. I remember one in my very first year of higher surgical training, at the end of the year, my program director, it was a nice chap actually. He had for the right intentions cause he explained it to me later.

 He said, you're either stupid. He said, I don't think you're stupid cause we hired you here as a higher surgical trainee or you're lazy. He said, those are the only two reasons why you haven't done what I asked you to do. And it was about sub updating your cv. And I remember being told off like that, about not updating my cv.

Cause he said you have to update your cv. And I thought, being the logical, pragmatic person, I usually am. I thought, I'm not applying for any jobs, right? So what? And all I'm gonna write is I've done one year more of training. Why bother? So I I didn't bother. I just said, it stayed as quo as far as I'm concerned, didn't bother objecting the CB.

 All he wanted to do was see that one line of the new place I'd worked in for the last year. That's all he wanted to see. And I didn't put it in. And he had this scope and he said, you are the stupid. Which I don't believe or you're lazy. I remember hearing that and I heard it a couple more times through my training and that, and I'm no, irrespective of anything else, I'm always the hardest per working person in the room.

Generally, in life, I've never really been the one who slacks. Once time I'm at work, I work twice as hard or three times the hardest as, yeah. I'm always the person trying to juggle three tasks at the same time and I overstretch myself. But I'm the one who say no and just gets on with it.

And if 20 patients are in clinic, or 40 patients in clinic, or 60 patients in clinic, just see them, , I don't sit, they're going, well, I'm supposed to see 10, whatever needs to be done, you get it done. That's always been one of my values.

More and more people shunt it to you. I sometimes get that problem now. I'm struggling to actually manage my own workload. Cause I'm spinning so many plates at the same time, and you then can't give the due attention you need to. So at the moment I'm in shrink wrap mode. I'm trying to shrink my life back into a more controllable box.

 I can dump some of these projects, but that story that you mentioned, sorry, I'm going through that probably 20 seconds. I had no friends who were, I had no relatives and no advice. We were the first generation to think of university. My sister had gone the year before me, but that was that first generation in this country that's gone to university.

So we had no contacts. My dad thought, if he's now thinking he wants to do medicine, let's get some advice. So he went to the local gp, who's a friend of his, cause that's same background, essentially Pakistani immigrants who came over. , this chap laughed at my dad slightly and not that he wasn't trying to be unhelpful.

He was actually, I think in his own head, trying to do my dad a favor and say, don't be unrealistic. What I remember him saying to my dad is that he said, look, my dad's name is Mohammed. Like most men of that generation and Mohamed don't carry these kind of hopes in your head, he said, because people like me who are highly educated and medical themselves, we worry, we don't think our kids will get into medical school.

He said, I want my kids to go to medical school, but I'm not sure they're gonna get in even though they're a private school. So he said, I've got my kid in a private school. I'm a doctor myself. I don't think my kid's gonna get into medical school. Your kid's got no chance. That's what he sort said to my dad, don't bother chasing these dreams, just go away and do something more realistic.

And that was the advice he gave. I said, I suspect with the right intentions, But he said that to my dad and my dad came back and tried of sock it a little bit, but that's what he'd said. And I thought, okay, but that's probably, yeah.

 I'm not somebody, I say this to my kids now, don't let anybody limit you. Don't let anybody say, if you're not passionate about something, that's fine. Yeah. You should just stop doing it. There's no point hanging on something you're not passionate about ultimately.

But if you think you are passionate about something and this is something you should be doing, don't let somebody say you can't do it. Because I was told that again and again. Even then when we were doing a Levels, my headmaster day and the headmaster of the school, cause he knew me as a slightly cheeky, turns up late lad.

 He actually refused to predict, give me the grades I needed to get into medical school. Even apply, he refused. He said your performance hasn't been at the level of a medical applicant. We've only had one per year for God knows how many years. It wasn't a high performing college particularly.

 And he said, we get very few kids that ever get into medical school and they would have to get sort of predictions, at least to be a's generally. And he said, and you are performing. I've spoken to your tutors and they're telling me maybe you B or C, and if I don't write a on the form, you can't even apply.

Which is the same saying, you haven't given me the grades I need to make the application. I did have my physics grades there as a backup. I actually knocked on the dogs cuz I remember initially thinking, should I just accept it? And I thought, no. I knocked on the door, spoke to him, and obviously he's a headmaster and he is a little bit annoyed at me.

Whereas you are telling me that you are gonna get better grades than this. And I remember saying to him, I now in retrospect I can see why he got so annoyed, but the time I didn't understand why he was so annoyed, because it sounds incredibly arrogant, because when I think back on him, but I said to him, that's because they think they know me, but they don't.

I know me. I know what I can do. And he got really annoyed. I didn't think that would trigger that. He got really annoyed. He asked me to leave the office and stop wasting his time. I walked out of the office. Cause that was a slight shock for me when he got angry and threw me out the office and I'm, whatever the 17 years old thinking I'm applying for college or university.

And I walked out the room and I remember walking outta the room out of the office and then standing in the corridor. And then I thought to myself, if I do nothing, this is my life. This guy's throwing my life or dictating where my life goes. And I wasn't happy with that. I thought, it's my life. At the end of the day.

If I don't fight for it, who's gonna? Why should they? And so I went back in, and I spoke to him and I said, sir, I gave you my explanation just saying that I will work really hard. I will show you that I can get this. I know I can do this. Maybe outta frustration or whatever it was, he said, look fine.

 He signed me off as a predicted for race. Which I know was a gamble. I think Mr. Harland, his name was so, I know Mr. Harland, cause he did change it. It was a gamble cause a lot of people wouldn't have done it. And I then applied to university and then on the application system, because of the postcodes we lived in, went to school in, we flanked as deprived.

I then went to this special interview or meeting when I went to the open at university, where they took me inside and I remember them asking me questions that I hadn't even thought about ever growing up. Do you have a desk to study on? Do you have your own bedroom? So you can have quiet and yeah, there was all these sort of questions.

We didn't have a desk in our house. Yes, I

[00:24:57] Paddy Dhanda: remember cuz you and I used to play on the computer in your bedroom and I think it was like on the actual bed or somewhere or on

[00:25:04] Ansar Mahmood: lamp. Yeah. There was no desk in our house. Again, I didn't know that was unusual that our house, everyone just had to fight for the coffee table or you put in your lap and you wrote on your books.

So I remember answering questions that the realization coming into my head, these guys think I'm really. Because they're asking me, do you have this? I'm like, no. Do you have this? No. How many siblings do you have? More than two. Yes. Do you any of your siblings share rooms? Yes. And this questionnaire just like making you feel poorer.

And I was like, I didn't realize I was in this bad a place until I applied to university and they're just telling me like the only advantage it gave me is they gave me a grade up or one lower. , to get into medical school there. I got through the interviews and at that time you had to be predicted three ass.

But most of the medics gave you a prediction of two As and a b or three ass. You. They would say something like that and they'd let you maybe slip 1 grade was the theory. But they gave me a one grade lower offer. They said we usually give a B, you're gonna get A, B, B. So that was it. After all this.

Soul searching and deprivation and background. You came to one grade, we're gonna drop you by one grade so that Cause you're poorer, you can come in if you get a B in something. I'm not sure those interviews are worth it, but go for it. And long story short, I ended up getting the grades I needed.

I ended up in medical school. Medical school was funny. Kids I didn't really have any empathy or commonize with you tend to find your own eventually. So I ended up leaving medical school probably with five or 10 really good friends out of a year of 240. And I think the other 230, I have no idea what they did or where they went in life, other than the odd Facebook, thing that pings up maybe sometimes.

And that was it. I've always been someone who's, has five or 10. Yeah, a small group of very good friends and I don't feel I need hundreds of friends. Not one of those people never have been. To me quality is definitely better than quantity. Yeah,

[00:26:56] Paddy Dhanda: no, I can vouch for that. I was just thinking about a few things he was talking about there, especially about being late and all of those things.

 I think some of your lateness must have rubbed off on me because I'm always late now, always for meetings. The ironic thing is for this episode, you and I are both late. I said, oh, we're gonna be late. I'm just grabbing a tea. And you went, oh, likewise. And so we ended up starting late. So it's going back to your job, right?

So you've talked there about how you got into medicine and then the struggles that you went through. For anyone that doesn't know about trauma, can you explain, first of all what it is that you do? Because that'll be great for me as well. I have a vague idea, but I've never really spent that focus with you to understand it deeper and also, what are some of the challenges that you face on a day-to-day basis?

Could you give us a typical day in your life at work?

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[00:29:24] Shure MV7-2: Now let's get back to the.

[00:29:27] Ansar Mahmood: I do trauma. The hospital Birmingham was a major trauma center and about almost 15 years ago, they decided that centralizing big complex trauma cases into big hospitals, they could have all the specialties that could deal with them in the uk, was the best way forward So they created that model.

So we, in the UK we have something like 20 odd, mid twenties, high twenties, major trauma centers. Birmingham's a regional one, for the city metropolitan area is the qe. So all of the complex trauma, whatever, however it's caused, comes to us. That's the hospital that I work in.

 One of our key professors who's been the bit, a big name in trauma across the UK and in the Midlands region. He is Professor Keith Porter. Uh, well, professor Sir Keith Porter. He interviewed me and was one of the people that helped me come into the trust at University of Birmingham.

Him and Julian Cooper. Shout outs to both of them. For the job in my first choice hospital that I wanted to when I finished. So I've gotta give him that credit. But prof shaped. Porter shaped a model of care, which was the same actually makes sense in anything.

You're a specialist in something and as a specialist in a disease, you make differences to people. Cancer specialists, even cancer, are now, people who deal with lung cancer specifically. People deal with all the types of cancer, et cetera. So we know specialization is, tends to improve outcomes.

And he had the idea that trauma's a disease. It's not a broken bone plus a broken head. They link, they create a physiological response in the patient. So we need disease specialists who created a major trauma service. And myself as a trauma surgeon, what I do is if when I'm on call in the day, or available in the day for the hospital, I see everyone that comes with injuries.

And I do two layers of on call. I do a trauma orthopedic on call, which deals with broken bones, dislocate joints, associated with anything car crashes through to just falling over and twisting your ankle and breaking it. That. So it needs fixing. They come to us. And then in the major trauma side, I deal with undifferentiated trauma, but that means it can be anywhere.

Cuz trauma , it's not selective disease. You know, cancer may only effect one area of your body for trauma. If you get hit by a bus, you tend to get hurt everywhere. You end up with a bad brain, bad face, bad chest, bad belly sometimes, and broken arms or legs. So in those sort of higher energy crashes, we see patients with lots of different problems.

 What a trauma specialist does is resuscitate and deal with that early part of keeping the patient alive, stabilizing them, but then follow their care through and understand what their priorities are, physiologically, making them back to normal. What the priorities for.

Reconstruction or et cetera. So we have that knowledge where we understand the disease very well. We know how to resuscitate, keep people alive in the very early phase. And then following that we operate on them. And I, as an orthopedic surgeon from background, tend to pick the bone side. And we have sort the specialists who do with brain and chest, et cetera.

Although as a bone surgeon, I do pick root fractures as well at QE Birmingham. We offer that service. That's sort of day job of a trauma surgeon. Most doctors probably hate trauma, it's fair to say. And the reason is it's unpredictable.

The patients you're gonna see every day are different and challenging and sometimes very challenging. We lose patients. They're dying our resource if they're too severely injured. And so that very hyper acute, sharp decision making that's required and sometimes losing people, having the stress of that.

It's something that I think most people probably shy away from. And so a lot of doctors really dislike trauma because of that hyper acute side of it. But I never have, and I think, one of the things I firmly believe in, if people ask me for career advice, I said, what you need to have is some insight into your personality.

And I think possibly growing up, it may be cause of reading or it may be why I went into reading. Actually. I'm not necessarily super humble and intro. I'm certainly not introverted. I don't think, although on I, I've done one of those Myers Briggs things and one of the one time it did say I was introverted science.

 I thought that was interesting. Oh, that test's wrong. No, they don't know what, yeah. Yeah, probably. Cuz most of the time I sit on the other side, but I'm not really an introvert, but I do set, reflect on myself, on the actions. And I remember growing up, even at school, if I saw somebody being bullied, Or I'd done something to somebody, it would make me feel bad because I think sometimes peer pressure, you'll say something horrible to somebody if your friends have said something horrible to them.

I suppose that's gotta be probably some nurture, there's nurture element to that. You know, nurture nature. I don't know what makes somebody kind. But I didn't like ever beating or threatening younger kids for instance, or trying to take things off people.

It was something that just inherently felt bad to me. I would leave that encounter thinking I wish that had happened. Even if it ended up being that somebody, one of my friends or friends circle to ended up taking something off somebody that wasn't, that belonged to them or had bullied them or hit them.

You wouldn't have wear stop it because it was peer pressure. Although I think I got the confidence as I grew up became a bit bigger and taller. I did actually use a stop quite a lot of bullying, which I am still fairly proud of. Or at least I would divert it away and say to people, what do you get out of doing that to somebody?

Whatever situation they're in, you shouldn't get a kick out of being horrible to them. But you know that in a broey sandwell accent, black country accent as a teenager, I make it sound very eloquent now, probably, but it wasn't quite like that.

 I didn't see the point of bullying someone, I never understood that. That probably shapes that I sort of fit into medicine, but I realized very early on in my very first few months outta medical school for a period, I actually thought I might even do medicine.

I might leave and do something else. But once I started working in it, I found one, I had the sickest patients that I really had to fix. That's what stimulated me. My brain woke up. I wanted to fix them. I wanted to go and read. I wanted to investigate. I wanted to see what their tests were. I didn't wanna leave the hospital.

I wanted to make that patient better. Once you get the patient's story and you get the background, you realize a bit about them. They mother or father or brother or sister tells you that this is so and so. This is John, my brother, and he's usually really funny and he fought in the army and he died from whatever shrapnel injury.

You get that sort of background. Suddenly you are invested in the case. And I think those first few patients that had been shot, run over, were very sick, stimulating me in a way that I thought actually, this is what makes me like this job medicine. I like medicine because people come in super sick.

I have a period of time to try and get them better. And it's up to me to find out what's wrong with them and to try and fix it. And that for some reason stimulated me. I can't tell you what I said, what kind of adverse personality disorder that gives me, I thought that stimulated me.

And so I went into, right from the get-go, went into trauma surgery, wanted to be a trauma surgeon from then, and trained in surgery, went to the busiest trauma centers in the country, went to a fellowship training in trauma. So I'm fairly broadly trained. And, um, ended up, at QE Birmingham, which as I said was my first choice for both family reasons and professional reasons.

It's a royal center for defense medicine. We see a lot of casualty from all around the world, and it's a good place to work. Obviously famous prop portal was there, so I was quite keen to go there and work with the guys there to learn from them. So I ended up with QE as a traumatologist.

I still deal with very sick patients. I think devastating cases you see that do stay with you. I think particularly younger people. Also some of those people that you've spoken to and taken a whole background from and created a bit of a personal link to, and then they end up dying.

It's challenging. It's definitely not an easy job. I enjoy it. I enjoy the challenge of coming in every day, having a different set of patients, getting it called in an emergency. And again, I dunno what kind of personality that gives me. You're getting it called in to try and help someone when they're in serious trouble.

 And just doing your best for them. And as I said, it's something that I've always enjoyed. I enjoy being at work at night and that sounds really strange, cause I do like to sleep. But when you're at work at night, it feels very personal. It's you against the world.

It's just you and the patient. I really like that interaction. When I'm on call, I like to see patients. I like to go and see people, find out what's wrong with 'em. It's one of the great frustrations I have when I see junior doctors complaining about being on call.

Cuz to me, that is what a doctor should love to do. Be on call, see patients, diagnose what's wrong with 'em, what you may be the first person who's actually gonna work out what's wrong with this person. See them, take that history, do the examination, find out what's wrong with 'em, then try and fix them.

That's what we were trained for. I always disagreed with how medical schools are vetted. I don't think it should be academic. Because we know the dropout rate people are now talking, it's really hot news at the moment.

But recruitment and retention, the nhs, that's why there's a, now the fifth junior adopt strike about to happen. And a consultant. Strike ballot in the N H s, which I don't think has happened in 40 years, has just been successfully validated for, so consultants will also go on strike in July, 2023, which is, like I said, almost unprecedented.

 This is the stress. The n h s currently under just a symptom of that stress. And I think post Covid, that stress, all the cracks that were already in the system have been completely exposed by Covid. The current global pandemic changed culture. It changes expectation, it changed the pressures in the nhs and people in the NHS realized how actually the job they do is quite special.

But not just specialists, it's specialized. So what they do, they do well. When you're trained in the nhs, you get fantastic training. Generally you've got far more patients than you can ever deal with. Mm-hmm. Which means you actually get a lot of, generally very good experience. Most of the trainers in the system are pretty good invested in training you.

Because that's the culture. That's one of the great positives of NHS culture. I'm not afraid to train people, whereas I've gone abroad and found people protect techniques because they don't wanna share it because private practice and people stealing their skills and it's actually a very, strange, when I go there and people are reluctant to let you come into theater to see what they're doing.

It's only happened a couple of times. I think most medics are very collegiate and want to show people what they do and how it benefits patients. Cause certainly if you're from abroad, you're not generally gonna threaten them, but in, they're very worried about their own environment or their own local surgeons finding out what they're doing.

That's not the NHS at all. I think almost nobody protects any of the intellectual property. We just give away knowledge and training. We expect wherever university hospital, you have medical students. It's been an interesting journey and I think still when I go to work, I enjoy being at work.

I think I'm lucky from that point of view and I think the consultant strikes are driven by frustration. The fact that they seem to be penalized for when the NHS off most consultants, it's common knowledge, earn extra money by doing extra work over time. An extra operating list or an extra clinic because the NHS is always behind.

There's a waiting list, right? So by definition we're always behind. Otherwise, there'd be no waiting list. You'd walk in and get your operation on the same day or the next day. There's a waiting list. Everyone knows that. So consultants are incentivized often to, well, can you do a bit extra work?

And then most people probably aren't aware. But in the last few years, the government created change in certain laws, which meant that if you do that over time, your tax burden suddenly accelerates because of a pension trap that they've created for doctors. It wasn't for doctors. They were trying to close a loophole and didn't analyze the unintended consequences of that.

Potentially, or maybe they did and really crafty and just thought, we'll get all these middle class people to pay billions of more tax by the time they've complained about it. It's taken a few years to sort it out. We have a few more deniros in the in the treasury being cynical now.

I dunno what drives politicians, it isn't what drives me. The NHS really is in a, so straight affairs, nothing unless somebody sorts that out we're gonna be in trouble. But I'm hugely loyal to nhs. It's one of the best things this country ever did, and it's a trauma traumatologist.

 You're not gonna see trauma anywhere else. There's no money in trauma or certainly not the doctors generally. But there's nothing in it for private hospitals. So nobody's interested in taking big, complicated patients that spend hundreds of hours of medical time and thousands of hours of nursing and therapy time.

The NHS takes on that burden, and so trauma would always be in the nhs and that's probably why I'll always be in the nhs.

[00:41:20] Paddy Dhanda: Yeah, at the moment, I think there's a big dilemma for many of us around what jobs are gonna continue in the future.

 Which sort of brings me on to some of the current themes around ai. And I know you are quite passionate about this as well. I heard there's a few countries doing kind of these tests at the moment where they're comparing doctors versus AI and who's managed to come up with the most accurate diagnosis in the most quickest speed.

From that perspective, are you afraid for your profession? And what's your opinion on ai? Where's it gonna go?

[00:41:58] Ansar Mahmood: I'm gonna say the same, everyone else's huge potential, possible danger. And I think the opportunity is certainly bigger than the threat in probably working life practice, but you're right, doctors, and certainly in my lifetime, you won't see surgeons going anywhere.

We may operate, do what we do differently, but there's nothing anywhere near on the horizon good enough to deal with the variations in human anatomy and the handling and the skills and the conceptual skills, what needs to be done in a controlled operation, but uncontrolled operation we saw in the case in trauma, cause we've tried to do simulated training, we've even tried to do computer based training, virtual training, and we just do not have the visuals or the haptics yet to replace bodies. We still train, we have to train through in trauma, in that heart decision making environment where you've gotta get in there and your hands get dirty and you've gotta actually do something to somebody to fix them immediately.

 That really can't be trained on anything else. I'm a big fan because of the data side. We know so much. We collect billions and billions of data points on patients, and yet the NHS doesn't have a clear way of analyzing this, and the NHS doesn't know our systems that talk to each other's.

It's crazy. We're not really a national health service, certainly from an infrastructure perspective. We don't share data anywhere near as well as we should. But if we analyze large bits of data, we've got it all. Now, if you think about it, if you had a sore hip from arthritis, and I've done an x-ray, knew you had arthritis, you know the, we've already got the technology, you're probably wearing a watch on your hand that measures your heart rate your steps, how long it took you to walk those steps.

So already this thing is already judging. Your fitness, your cadence, your walking rhythm, what your heart rate goes at, how fit you are, et cetera. And then we know you've got arthritis of the hip. We know how old you are. We've got millions of data points in the UK and around the world of people who have had joint replacements.

So like hip replacement before. We could literally be in a position and the tech that could put us there is already in existence. It's a pipe dream in the future. It's just the algorithm we have to get right software side of it. And that's something that we feed in.

But we already have the tech that if a patient comes to me for a hip replacement, as they walk into the clinic, they walk over a force meter and APL walking plate. We can have a 3D or 40 camera, which we already have, which assesses your gait as you walk. And on top of that, I've got all your wearable tech information.

When you're walking to clinic, I just need to look at an x-ray and say, your computer's already done all your maths. We know what you weigh. We know your fitness levels, we know how you walk, we know your gait pattern, we know your age, your Asian, your bone quality, et cetera, et cetera, et cetera. Based on all of these AI parameters and machine learning that we've gathered, this is the hip replacement you're gonna have, and this is the outcome you're likely to have.

And the computer says, go ahead and you can, and would this be in three weeks? It's that tech already exists where it will tell you specifically what your problem is compared to the other person, what the best solution may be. That's just looking at one aspect of orthopedics. If you step that into medicine, it goes on.

And the biggest threat, I always thought this when I first heard of AI, is radiology. Because radiologists with their eyes and all the experience they have ultimately are just rep doing pattern recognition all day long. They're just looking at pattern recognition. And anything that is 90% pattern recognition, the computer can do better than human.

 If you start to just feed trillions of pixels, Into a computer, say, pick out when you see certain patterns, it can do that beautifully. To some extent that's where it's been proven. Some of those headlines you're seeing are usually around radiologists being outperformed at looking at a CT scan or MRI scan by DeepMind or by a computer.

There's a couple of studies out there now where there's a few that computers have come out inferior. There is a few robust ones now showing that they can pick up certain things very quickly and you can see the rate that's gonna accelerate. We've seen what's happening cause you can just feed in scans for learning for a computer day and night, second by second.

 It would absorb hundreds of thousands of scans, which a radiologists will never, you don't live long enough to see that many and it will just absorb hundreds of thousands of scans. As long as you teach it correctly. It will start to become very accurate very quickly. And it's been shown to our perform humans.

Where that falls apart slightly is when there's something that's unusual. There's something unusual or there is something that is rare. You see something what a radiologist may only see five times in a career once they become a specialist or the rest of the guys from around the country send it to you as well.

So they may have seen 200 and everyone else has seen 10. You suddenly become the global national specialist. That's the word. You do something rare and you become a specialist very quickly. And I think they're certainly a threat. But in this country, no doctor feels a threat because when you look at comparative economies per head of population, we're the most depleted per head.

All of the English speaking countries, most of our European neighbors are something like three to four times as many doctors per head of population. That's why I don't think any of the medical force in the UK feels under threat at all by anything and probably won't need to for the next 10, 20 years.

But AI will certainly threaten some specialties more, but I think it's not necessarily a threat, it's simply a case of moving what you are good at. Cuz I don't think we're a very long way from AI replacing humans, even if it's just out to being a technician.

 20, 30 years maybe we'll be able to do radiological procedures better than a radiologist maybe sooner if people really do accelerate. But it comes outta the r and d. Most doctors do not feel threatened by AI other than perhaps, it still feels very far away, it feels like Terminator.

[00:47:35] Paddy Dhanda: It feels like it's a bit of a toy at the moment. I drew a visual on Instagram the other day, and I drew a little pet dinosaur and as humans we're petting it. It's a cute cuddly little thing. And then I drew another visual about.

30 years into the future and then like the dinosaurs got a chain around the human's neck and now wear the nice cuddly little thing. I'm obviously being quite negative and extreme about it, but I think some jobs will probably end up like that.

 One of the things I wanted to very quickly explore with you is in a lot of jobs that we do, it's about the team around you. I'm sure the same is the case for yourself, that having other humans around you are really there to support you and help you. And I guess we can't do the jobs we do without that support around us.

How does a team impact the work that you do and are there any techniques that you guys use to, for example, run your meetings or even reflect on if things are going well or not? Like how do you guys

[00:48:35] Ansar Mahmood: work as a team? I think surgeons have traditionally got a reputation where most people think they're a bit arrogant. They're shouty louder, taller and so they tend to tell people what they do, what to do, et cetera.

These are all sort of stereotypes around surgery, but I think surgeons are acutely aware that they're part of a team. So I almost can't do anything to most patients unless you are wide awake and low anesthetic surgery is really expanding. It is never gonna replace all types of surgery where you've gotta bit to sleep at the end of the day.

 You need people to help you. The equipment we use is increasingly complex and there's hundreds of bits of kit. So most surgeons now rely on scrub staff, theater staff, everybody to know all of this equipment, know where it is, make sure it's ready. you don't do it yourself.

You go about for 30, 40 years and surgeons have to look at stuff themselves and go, I need that, that, that, that. And if I don't have it, and we'll have to water it, it'll come in 48 hours or they'll, or next week even, somebody has to make it for you. That was a situation 40, 50 years ago.

So it was almost custom made and you ordered what you needed for that week on the Monday when you did round and it arrived on Wednesday and you did an operation. I remember seeing professors telling me that's the way you worked in the seventies and eighties. The world has certainly changed, but your team's crucial. And when you're dealing with complex trauma, a severely injured patients, the teams are massive. I mean, sometimes actually in what we call code red patients, those are people who are actively bleeding.

So they've got a life threatening bleeding, but it's ongoing. Those patients need an answer fairly quickly. And so what we tend to do is we do an even larger call out. There's a trauma alert that goes out, emergency beliefs, buzzers, phones for the doctors in the hospital and out of the hospital potentially.

And they will descend on that resuscitation room over the next few minutes, patient arrives and they sometimes have a team of forget five or 10. It can be 40 or 50 people in the room waiting for one patient to arrive. And that's something the NHS has, if you look at that response, it's enormous, the cost to it, the specialty in the nhs.

This is one of the beauties of it. You can arrive in hospital and have millions of pounds worth of care. See, we're leading specialists and it doesn't cost you a penny. It is quite incredible that you can get that sort of response. I appreciate that's probably the detriment of some of the poor patient who probably just needed something simple doing and all those teams instead turned up in a and e to deal with this very sick person.

But it depends which shoe you are wearing. I think the team working is crucial. We teach it. We set up our own course for the major instant surgical training, course for teams. It's a teams focused course. How to think about it. You do work in teams and I'm gonna do another shout out to a good colleague, a old friend of mine, Chris Turner, is an A&E consultant, actually here in the Midlands.

And we worked together in some tough times. We were juniors in training together. And he created a campaign called Civility Saves Lives. And Chris did some great work with a team of people. Where he gathered data on this and he actually found that For instance, if you shout at the people in the room with you, if you're the senior surgeon and your team aren't performing very well, you may shout at them and say you need to do this better. Also, same with junior doctors or same with a nurse.

 Anybody if you're disrespectful and you're not civil to them. What he did was he gathered data on this and what happened to their performance, how effective their psychology, how effective their turnover in theaters or efficiency of services to patients and effectively no surprise every parameter drops so that people don't get better.

if You shouted at them. You could argue lots of things in this area. Cause I've spoken to very senior surgeons around the world and they say no, if you don't do that, then they don't get better. If they get better, which we then don't measure, they get better steadily over time and they get better quicker.

It may be even a added shouting episode. So I know there's always two arguments to any coin. I've worked with very senior others in other centers in the uk The hierarchy's very flat now for people in hospital. Surgeons don't dictate what happens in theater. It's a team exercise and everybody decides, and if we don't have the runner available in theater and they're crucial to that operation, the operation doesn't happen.

It doesn't matter how the, or the anesthetist or anybody else wants it to happen. We have of. There are sort of mechanisms, if there's people you need them. Right? And there's no real hierarchy. And the NHS has flattered that off quite a lot. Obviously there's decision makers like the surgeon underneath this who will be deciding what happens to the patient.

But you need the whole team, without 'em you can't do a safe procedure sometimes. So the sort of team working is crucial. We build on that, we do training around it, but it's still, after all of that, it is the most difficult thing to do.

 Actually outside of the nhs, I run a small business where I've got employees and actually employees are the most difficult part of a business. It's not the business, it's actually the workers. The relationships, trust, all these sort of things. Hard work, what people want.

Remuneration getting a culture. That doesn't matter whether you got a team of two. A team of 20, or a team of 24,000, which the trust. I currently work in the biggest in the country. If culture's wrong, I remember I've been sat in quite a few meetings recently and I've heard this repeated many times, which is culture eats, strategy for breakfast and no matter how good your strategies delivered can change.

If the culture is wrong or people don't feel they're being adequately recognized, rewarded, whatever it might be, it creates a hostile or a toxic environment. It doesn't matter how good your strategy is, who you hire or fire. If you don't change that culture, the performance doesn't change.

And I'm unfortunate gonna say now that my beloved NHS is in that trap, the culture is wrong. The rewards are inadequate. I'm not even just talking about financial rewards. You just be wellbeing, wellness at work, people struggle to get food. If they come in for a night shift, they may be doing a 12, 13, 14 hour night shift.

There's not food at some of the hospitals or they're on a vending machine. That's the only thing available. The vending machine breaks down. And then you've got busy doctors, nurses trying to order pizza in from a takeaway in the middle of the night trying to get fed, and that's just a small example. No rest areas for doctors. And there's lots and lots of things that be taken away and no replacement has come in. And then it's all these little things and you think, you know what disgruntled people. What is interesting is you don't remember being in a position where you were without, once you've got what you've got.

I think that's something that people should reflect on. Cuz I now hear, and I'm one of them, I do it fairly regularly, but I see the junior doctors complain about their workloads and I think, oh God, you know what? Funny years ago when I was there, I worked three times as hard as you did.

There was no hours restrictions. I was working a hundred hours a week. I was. Day and night, whatever the patient or the doctor or my consultant needed, that was a different working ethic slash relationship. But then I also had free university. At Free university. I left university with lower debts.

We were in a generation where pay and conditions are generally improving over about 20 years. Over the last 15 to 20 years, the reverse has happened. We've now got a generation of people who are gonna be poorer than their parents for the first time since the Industrial Revolution are probably gonna drop life expectancy for the first time since the Industrial Revolution.

We're not in a equal place. And wherever there's that level of imbalance in society and lack of opportunity potentially. And again, we're talking about the UK here. We're talking about lack of opportunity. I don't think there is lack of opportunity in the uk.

I think there's plenty of it. I don't think the culture is there where people wanna harness it. We don't give people, we don't empower people with the tools and skills and simple things to have access to. Why should you have to get GCSEs or a levels to progress? Maybe your strengths are somewhere else ?

 I think the pendulum always swings too far, right? Nowadays I see lots of kids being diagnosed as a D H D or having some sort of a special educational need, uh, attention deficit disorder, whatever it might be. Borderline spectrum, Asperger's and there is a diagnostic criteria for giving people these labels, right?

But in our days, what was that? It was just a slightly naughty kid, wasn't it?

[00:56:29] Paddy Dhanda: Oh, problem child. Yeah. That

[00:56:30] Ansar Mahmood: was like, yeah, problem child tell you, difficult control, poor behavior won't concentrate is immature. All these sort of labels were given, and I think now we've over medicalized. You and I see kids who are a perfectly normal child.

They're likely attentive. They're a bit cheeky and they wanna run around a lot, but now they've got a diagnosis instead of just being, well, you'll grow out of that, which they will. I've seen some of those young kids that were given all these labels. I've seen 'em three years later and they're completely different.

 I think if you give someone a label, they should have that generally, and they may adapt for it. But if you've got d adhd, I think that impacts you mostly of your life. It doesn't just switch off. And I think a lot of these kids that get these labels, you see them five or 10 years later, they don't seem to have that adhd.

So I suspect I never had it in the first place, or maybe it's a transient thing, but I'm going into a specialism that I don't really understand. But I think kids is wrong. I think schools actually, I'm going off on tangent slightly, but are slightly better now overall, I think, than they ever used to be.

That, I dunno what your feelings are on that, but I get that impression. One thing that I remember hearing very recently on a radio show or a podcast, was that we've now currently got the safest generation who ever lived in history, okay? According to all statistics, whether it comes to disease and malice and violence and death by whatever, a violent ending, safest generation ever lived in history.

Yet, if you look at all the anxiety indexes and the depression scores and the societal indexes, we've got the most afraid generation ever lived in history, coupled with that, them being the safest ever. And so what is it that's creating that level of societal global angst. I don't think we've really got a handle on that.

And I think if we don't have a handle on that, we don't know what's. Driving wellness in our communities society, you're only gonna see a downward spiral. I don't wanna be negative about it, but we saw a reduction in interpersonal violence in the trauma world for 30 years until 2018. And then 2018, it started spiraling back over 7%, 10% growth year on year.

What led to that? What was the trigger? We don't know. That's what I'm saying. Actually, we don't know. I've asked police officers, I've asked social workers, I've asked all the trauma docs, people don't really know. I've got my own hypothesis. So I've spoken to lots of people, seen lots of things over many years.

And what I do remember is around 2008 when the financial crisis happened, kids at that age were bystanders. And one thing I've learned about kids and having my own kids is that they pick up and absorb far more than you ever give them credit for. Okay. So we think they're not really listening or understanding what's happening around them.

They prove us long wrong all the time. And I think that in terms of an eight, myself and my wife, and my wife is a lawyer and I'm a trauma surgeon, so we tend to deal with that echelon of society that's challenged a lot of the time and we both went, oh, we're gonna get really busy.

We're gonna get really busy over the next few years with this financial crisis. And we could see this recession looming, and the banking problems and the housing issues. We thought, God, there's gonna be people unemployed and poverty. And interestingly that did happen. Everything got stretched and we went into this period of austerity that everybody talks about.

 But they didn't happen, right? The crime rate didn't go up. Violence didn't happen. And I think there's two elements that, one is fairness. The bank, I say everybody. In fact, it's one of those rare crises that sometimes the riches got hit even more than the pool. So actually everyone looked around at everybody and went, everybody's screwed.

Right? Everybody's screwed. And that's fair. That's fair. I think if society feels something's fair, it just writes it. Everyone's taking a hit. So nothing happened. We looked at the crime rates for the next five years. No crime rates went up. Trauma didn't go up. The trauma steadily goes up a little bit each year anyway, usually cause of the elderly, we get aging population.

 But nothing happened until 2018. What happened in 2018 was the kids who were eight or nine or 10 or 12 were absorbing uncertainty, stressed parents, marriage breakdowns, mortgage, repossessions of houses, whatever it may be. They were hearing all of this uncertainty in the world that they were children in.

And that went on for years and years and years. Being told your opportunities lower, your jobs are lower, your prospects are lower. We can't afford this, we can't afford that. We can't afford this. All the services across society, were sort of cut back that I think that's the generation we're facing now.

Cause those 10 or 12 or 80 year olds are now 18, 20 and 22. They've grown up in a slightly different environment with different expectations and I don't think we ever really analyzed that psychologically. We've got the power of social media, the internet, and all the other things that we can see.

So I think people, what they see and what they want from their lives can often be stratospherically different. And I think people's tolerance of accepting that is lower than it ever was previously. Their coping ex mechanisms are probably poorer cause society hasn't given it to them. We've isolated our kids and teenagers more than they ever have been because they can disappear off into a virtual world.

Onto a Facebook or platform or an Instagram. You don't even have to interact with people ever. And we allow that to happen. Our kids on their devices 6, 7, 8 hours a day, they certainly aren't seeing relatives or talking to adults that period. They're usually not talking to their friends.

They're just often I just see them sitting there and they're just absorbing. They're just watching again and again and again. Your audiovisual learning is most powerful at that age. I do think we're letting our kids down slightly. We need to give them different coping mechanisms.

 We need to tell them that life's tough and good. Most people put their best photos, what holiday they're on. You know how amazing their family is.

Look at the family meal we're having. They don't do what happened to me yesterday in a restaurant. Went to lovely family meal. And my older teenager bothered. My younger teenager, reached out, drink, went onto a lap, he responded by slapping the source out of my daughter's hand.

That, and you pull over a dress, so then there's a fire. And I was crying and I'm shouting at people, you're embarrassing me in a restaurant. You know, that's the real world, right? That's what happens. And I should have put down on Instagram with all my kids crying around me at a eat.

I think that would've gone viral as

[01:02:42] Paddy Dhanda: that, that sort of thing is like what people wanna see that's relatable.

[01:02:46] Ansar Mahmood: The Coke medicines deal with the fact that their life may be poorer, cheaper, less so than what appears to be the case for other people. The grass is always green on the other side, isn't it? I think there's a huge world out there. Deprivation is increasing, not decreasing just in the volume of people probably cuz the population's expanded so quickly.

But it's incredible that we're traveling more probably, although again, that's reduced in the last number of years since the pandemic. But we've got kids who are interestingly more aware of the world because of the internet and the global space, and are probably less racist misogynistic than the previous generations.

 And are more accepting. So there's a lot of kindness in them. Actually they don't really have the social skills graces and practice to get what they need from that. And that's where the adults are letting them down. Maybe our adults let us down. We're not teaching us, we're not teaching our kids now, but it is an unprecedented world.

I still remember my oldest boy growing up before the first iPhone came, and I remember Google being launched while you and I were at university. It was MSN and Yahoo Messenger or something. And that's all you had? Yeah, AOL and net. Yeah, aol. Yeah. And you searched on that.

Suddenly this silly little thing called Google came along, that just sounded like an interesting name and nobody really understood it. And then look where they are now . It's become a term of actors use, just Google it, it's the brand name in every house in the world. I think the way lives have changed, it's been unprecedented.

No generations had to see that sort of accelerated. Parents should be kind to themselves as well, but what they do need to do is, get slightly old fashioned about discipline. Might sound very old like that. Yeah. But discipline and set expectations.

If your kids want, rights, you remind them of the responsibilities before they get their rights to pocket money or whatever else it might be that they want. Well, I'm having that

[01:04:39] Paddy Dhanda: dilemma right now. As we brought ourselves a little puppy and it was because the kids were badgering us for probably the last two years.

And I finally gave in and my daughter's okay. She seems to do her little chores with the dog. She brushes him, she brushes his teeth, all that kind of stuff. But my boy, he's slacking a bit at the moment, so I need to have a word. He promised me, as they all do that, he would take it outta walks.

He would pick up the potty stuff, like all of the things that I was dreading. None of it's come true yet, but we'll see. We'll figure that one out. We're fast running out of time and this episode we have explored so many avenues and so many insights, so thank you for that.

My one big question for you, having gone through the experiences that you've been through and being on that journey, looking back at your younger self, maybe at the age of 20, what would you tell yourself now that

[01:05:37] Ansar Mahmood: you know what you know?

That's a good question. That's somebody that maybe should have insight into that, but I actually what I say to everyone is do what suits your personality. I've always gone with that philosophy. The problem with that is you can make someone really difficult to live with.

And I think you have to accept that. I have a long suffering wife and kids and one of the reasons they don't wanna be doctors is cuz I can do seven days a week or sometimes weeks on end and it's not always just medicine, it's cuz of my other positions and lectures and conferences and other things I go to.

If I accept, go into these things, I can be. Away a lot and busy doing seven day weeks where I'm not around doing all the kind of things. I spend time with family, birthdays, anniversaries, weddings. And I usually make time, we're always try and do whatever I can, but I am getting to a point where I definitely need to shrink wrap that life and that box.

And so what I would probably tell my younger myself is give them that advice. Just say, focus on what's important. Probably get more focused. I think again, what drives your personality through experience. And I'm somebody that likes opportunity. I make my own opportunity. But then what I probably don't do is, so I want to do everything.

I'm not somebody who likes to drop something. I wanna do everything. I want to go everywhere. I wanna see everything. I think at some point you've gotta talk to yourself and think, what is it that's important to you? And people don't wanna be surgeons now because it takes 10 years of training.

 When I remember looking back in it, I'd committed. That's the way surgery works. And you had to accept that. Because surgeons had that reputation even as trainees then it's hard work. And you get, it's a craft specialty. The only way you get good at it is by doing lots of practice. You are seeing patients and you've gotta do your procedures and that's how you get good at surgery and be well trained and all the rest of it. Cause that reputation is a lot of competition to get into medical school. There's a lot of competition to get into surgical training and then even more competition to get into higher surgical training specialist. Then you become a consultant and by the time I became a consultant, I'd been studying medicine for 20 years, if you include my medical school days.

 I've now finished my last exam 20 years after I entered medical school to become a consultant surgeon, which is what I'm doing. It is a long haul journey and I think That puts people off. But I think it is potentially hugely rewarding because my wife always asked me, if they didn't pay you, what would you do?

And I said, I'd as in if the country ran outta money. You've gotta earn money. So I'd have to find another job. But the skills you have, I think in medicine isn't just all about money. I think it's sounds really old-fashioned, but the vocational element to what we do, you have to be willing to do it anyway.

And I couldn't see somebody injured and I've got the skills to do something and not treat them. It's one of the reasons I didn't do many fellowships or go abroad very often to the healthcare economies. Cause I believe what the NHS does and I think we do it as well as anywhere else. And when I have been abroad I've troubled quite a lot now.

I don't see anything better happening anywhere else is the honest answer. There's some better systems, there's more efficiency, there's all those sort of business aspect things. The NS needs to do much better. But we're as good as many other countries when it comes to what we actually do to patients.

The way we work, collaborative, the complex surgeries we do, and were as well practiced as most of the surgeons. The first time I went to the US I was expecting these guys to be brilliant. Because they do so much more experience and cutting. But you realize the training's much shorter.

The training is much shorter in the US than the uk. It's a post-grad course. Some mature people come in, learn what they need to learn and then become surgeons and they're very good at talking. And some of them are excellent surgeons. I'm not saying that they're not any good, but what I was surprised at is I thought all US surgeons would be a step above, say the UK surgeons.

What I actually found is almost the reverse, because most of our surgeons would do several hundred of any procedure. Cause there's so many patients and there's big waiting list and there's less competition and there's less doctors. We see a lot. We do a lot. And some of these guys only do 10 20 of those big procedures a year.

But there's a big differential in quality. I don't know whether I'd do anything differently. That's really difficult and it'd be a challenging question. I think for me, I'd have to really reflect on that, beyond the length of this interview.

But I think I would probably just give myself some of those advices and maybe give my wife a heads up cuz she might have changed her mind rather than my mind. And she does certainly says to my kids, don't marry a surgeon because, but I always say to them, it's not about surgeon, I'm just slightly different to most surgeons as well.

Cause I think all of my colleagues, I certainly do too much and take on too much. But I'm somebody that won't accept the status quo. And I dunno what drives that from me. I can't accept where I am. And I think somebody who sets their goals, As being, I'm happy where I am. I know there's a lot of happiness in that, but I never am, I always think there's a way to be better.

You can do this, you can do this, you can do this. I don't believe in being stagnant. I don't wanna be doing the same thing this year as next year. So I'm always thinking, well, what else can I do? What else can I develop? If there's more skills, whether it's in surgery or without surgery, I'm always trying to do something new.

 I was just telling you about exams for 20 years. I'm actually sitting in a university course again at the moment, people crazy with how busy I am, and I'm still sitting in an exam course at the moment and I've just done a US board exam last week. Stuff that a lot of people would say, what are you doing it for?

It's voluntary, right? So you don't need to do it. But to move on and learn. I do enjoy learning. I got that feeling. But,

[01:10:51] Paddy Dhanda: but, and thank you so much. From my perspective, there's so many things in there that I had no idea about. And I think that's a really good way to finish off is that constant learning, constant upgrading of our knowledge.

 Even we touched upon ai, but the fact is we've gotta constantly adapt. There are gonna be tweaks to our day jobs. There are gonna be tweaks to our careers. We've gotta be prepared to feel a little bit uncomfortable. In the intro of the podcast, I always say to people, sit back and get very uncomfortable because for me, whenever I felt uncomfortable, yes, it's scary, but.

Afterwards you feel great. Like when sometimes you're asked to present in front of tons of people. Yes, that's a scary thought. But once you've done it, that dopamine hit, you get, it just makes you want more. Obviously we can always improve and do better for next time, but I think just having that mindset is fantastic.

You were probably the one person who introduced me to reading a lot early on in life. You were just a bookworm. You read so much I never used to read. And this podcast has reinvigorated that hunger for reading. And I can't say I'm still the most avid reader, but I certainly spend a lot more effort trying to read now.

I just wish I'd done it back then when you and I were were growing up because I remember you used to recommend these books. David Gemmel was the author.

 Anyway, just before we go, just really for you to give a shout out to any other great work that you are doing. I know you mentioned you've got some other work that you do as well. Anything you'd like to share with the listeners on that?

[01:12:22] Ansar Mahmood: I teach around the world now. But most of the teaching I do know is either trauma related, which makes sense. But actually I do a lot of what we call regenerative medicine.

Regenerative medicine, I got really interested in from a trauma background, you know, healing people using their natural growth factors, doing sometimes things to wounds, to bones to get them to heal without big surgery. So it is something I got interested in, like most things you geek out running for a number of years.

At what point do you realize, and I've thought this, cuz now I'm seen as I get a lot of people saying, you they give you titles like he's Mr. P R P, whereas he is the regen guru. I've been, or recently when somebody introduced me to someone and I thought, you can't speak like imposter syndrome.

I sit there thinking, yeah, I know quite a lot about this stuff or because I've studied it for a long time. But the difference I think is that people appreciate is there's not many people in the world that know the science, know how to do it, and then actually do it to patients and then have that live sort of cycle of feedback where you're a researcher, you're a practitioner and you are the translational person in between those two things as well.

 I think that's quite unique and that's what's given me a perspective where I, from end to end know the business. Cause I stand in conferences where you've got very senior professors, world famous scientists, but they've never treated a patient. So they don't actually know what happened when you do this procedure to somebody.

 That doesn't damage their credibility in science. But certainly to me, when they're telling me what to do with patients, that doesn't give me any, I. Particular credibility in what they've got to say. When I treated hundreds of thousands of patients with various things and seen the results, sometimes they gone on for years.

So people will tell you it might be a placebo effect, right? Cause that's quite powerful in science. But actually placebo effects don't tend to make people better for years and years and years in my experience. It's an interesting area and again, you've established before that I like change and I like development and it's the fastest developing area of medicine.

Probably genomic therapy and regenerative medicine. They're changing all the time. There's something new coming around the corner all the time. There's lots to study, lots to learn. Huge amount of potential. We haven't all harness even we're only just getting the start of this really, and what it can potentially deliver to us.

Cuz gen medicine is the art, it's a science of modifying the way disease progresses. We're also turning it off potentially, you can turn off disease, you can turn the clock back on disease. You can literally make people a bit younger. I say a bit at the moment cause that's where the evidence is, but with the aging medicine, inflammation medicine and regenerative medicine, all coming combining, that's where we're heading.

[01:14:55] Paddy Dhanda: Oh, wow. That's a whole episode in its own right. We'll do a deep dive on that, maybe another time when I get the opportunity to speak to you again. Thank you so much. It's been a pleasure. Good luck and thank you for everything you're doing.