Professor Ashok Handa
Consultant vascular surgeon and associate professor in surgery at the University of Oxford, Ashok Handa, recounts what drew him to a 'very rewarding and technically challenging' profession.
How did you first get into medicine?
I was studying maths, further maths, physics and chemistry at A Level and really wanted to be a particle physicist. Then I realised that three of the other six people doing these four A Levels at my sixth form college were far cleverer than me and if I studied physics at university I would be in the bottom of the class!
Also, I liked the idea of a mix of science and working with people, and was brought up to think of working for the community as a worthy aim in life.
What inspired you to pursue vascular surgery as a specialty?
I trained in vascular and transplant surgery and worked as a consultant in both specialties for the first five years as a consultant. Both specialties require an excellent knowledge of medicine and need the clinician to think of the whole patient and their co-morbidity, as well as the immediate problem where a surgical solution is only part of the management.
Hence the old adage in vascular and transplant surgery: 'Think like a physician and behave like a surgeon'.
I also worked for some fantastic role models, like Richard Corbett, Rozanne Lord and Stephen Brearley.
How does vascular surgery differ from other surgical settings?
There is a lot of out-of-hours work and about 50% of our operative workload is generated from urgent or emergency presentations. A large amount of our outpatient work is non-operative management, initiating best medical therapy and managing expectations.
The other part of our elective work is very rewarding, with technically challenging surgery making a difference to the quality and duration of people's lives – carotid surgery in preventing stroke, abdominal aortic surgery in prolonging life, and treatment of peripheral arterial occlusive disease in improving quality of life or in limb salvage.
The variety of surgery is also an attraction – operating on all parts of the body – as well as the emergency operating for limb salvage (for acute limb ischaemia) and life saving for ruptured abdominal aortic aneurysms and multiple traumas.
What additional skills have you learned as a result?
I've learned mainly about the combination of best medical therapy, lifestyle modification and surgical interventions working in combination to get the best outcomes for patients.
I've also learned how important it is to work in teams to offer the best option for patients, as it sometimes means asking colleagues for help or to take over the care of your patient – most importantly in the use of meaningful dialogue with patients and their families to get shared decision making and hence shared responsibility for the outcomes of treatment and management of their condition.
The future of vascular surgery is bright.
What advice would you give to a student who is considering this specialty?
Vascular surgery has undergone a revolution in the last decade with advances in endovascular techniques, prosthetics and the centralisation of services to 80 centres in the UK.
There is an increasing workload from an ageing population, the epidemic of diabetes and obesity, so there is much work to do.
The future of vascular surgery is bright, but the future vascular specialist needs a mindset of being 'a physician who can operate' rather than a technical surgeon alone.
Professor Ashok Handa
MBBS FRCS FRCS(Ed)
Ashok Handa is a consultant vascular surgeon at the Oxford University Hospitals NHS Trust, based at the John Radcliffe Infirmary. His academic roles include Director of Surgical Education at the University of Oxford and he is Associate Professor in Surgery. He is a Fellow by Special Election in medicine at St Catherine's College and a co-director of the Collaborating Centre for Values-Based Practice in Health and Social Care. He is also a member of council of the MDU.
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