How did you first get into medicine?
I wanted to become a doctor from 10 years old but I’m not sure what really inspired the idea. No one in the family came from a medical background but my truly loving parents backed my every move. I just devoured finding out how our bodies worked.
In retrospect, my choice to become a medic is surprising since my most inspirational school teachers were in the humanities and art. Perhaps they drove me to the application of science in its most human form.
What inspired you to pursue your specialty?
Having spent a BSc intercalated year reading pure psychology, I hankered after a career in analytical psychiatry. But my innate love of tinkering with how things work drew me towards the endless fascination of fixing disorders with my hands. Surgery drew me in – and when one day as a general surgical registrar, the chief I most respected looked at a painstaking repair I’d made and remarked I ought to be a plastic surgeon, a seed was sown.
Two years into a middle grade registrar job, enjoying the diversity of general surgical work at that time, my wife and I responded to a long-held call to spend some time in less privileged parts of the world. I resigned my post and a delay getting a visa led to an unexpected senior house officer post with a London based plastic surgeon who was unique in many ways! This preparation was remarkable for the really ‘general’ work I was about to encounter in that mission post in a remote part of Tanzania.
I spent two years managing anything that needed surgical intervention, including the whole gamut of obstetrics and gynae, as well as delivering my second child – my son! It made me realise the one skill I lacked in surgery was how to recreate structures. I wrote my first, and in my eyes best, paper on the spectrum of plastic surgical cases I encountered.
Advice for budding students – don’t focus on CVs or career building steps. Instead, develop your personal skills and think about how you can contribute to each team you eventually join.
Once I came back, surgery was all I wanted to do. I hoovered up knowledge of the specialty as if it was going out of fashion, and found a senior house officer post at Mount Vernon Hospital in Hillingdon, soon moving onto a registrar training appointment. The die was cast.
How does your chosen specialty differ from other medical settings?
Plastic surgery is a remarkable specialty, acting as a problem solver for vast areas of disorder. Contemporary microsurgery has forged new paths, but the best plastic surgery remains determined by good planning, and the careful use of basic techniques and rarely sophisticated instrumentation. A lot can be done with some anaesthetic, a bright light, and a sharp knife.
It is a specialty most adept at pioneering novel surgical solutions to problems across congenital, cancer, and traumatic disorders, as well as enhancing quality of life – such as facial reanimation, or lymphoedema super-microsurgery.
What additional skills have you learned as a result?
Much plastic surgery involves planning multiple staged procedures (in my specialty of cleft care, over an entire childhood and into adulthood), so the ability to build mutually trusting lasting professional relationships is exceptionally rewarding. Perhaps akin to the enjoyment of developing a garden, the fulfilment of seeing surgical endeavour merge with the human body’s incredible ability to heal is inestimable.
No surgeon can work without decisiveness to consider every option (including doing nothing or referring), and impeccable integrity in presenting options and walking the walk with those we seek to serve is essential.
Finally, good plastic surgeons must be able to think three dimensionally. Not everyone does that well, and accepting that honestly at the outset might avoid unfortunate false starts along the career path.
What advice would you give to a student who is considering this specialty?
I can’t think of a better path for anyone who enjoys craft and working with your hands. Advice for budding students – don’t focus on CVs or career building steps. Instead, develop your personal skills and think about how you can contribute to each team you eventually join.
Whether it is making people better through exceptional skills, clever research, gifted teaching, insightful people management, team building, being an artist or poet, or simply the ability to make fellow colleagues and patients laugh! Bring something to the table that makes you what they want in their team and you’ll never look back.
Tim Goodacre is a recently NHS retired plastic surgeon with an honorary contract at the Oxford Radcliffe University Hospitals. He is past president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) 2011, and currently serves on the RCS (England) Council as BAPRAS elected representative. He is president of EBOPRAS and sits on the ExCo of the Plastic Surgery section of UEMS – the European advisory body.
He is on the council and cases committee of the MDU, Trustee of the Blonde McIndoe Research Foundation, and chair of Interface Uganda – a small charity supporting training and development of reconstructive services in east Africa. Tim is also a patron of the British Association of Skin Camouflage.
See more by Tim Goodacre