Gazing into the crystal ball

There is a great quotation, usually attributed to the Danish physicist Niels Bohr, that goes “Prediction is difficult, especially about the future”. Difficult it may be, but it’s also necessary.  As the name suggests, considering the future of surgery is what the RCS’s new Commission on the Future of Surgery will be trying to do as it looks forward to what surgery might look like in 5 years, what it could look like in 10 years and what it might be in 15 to 20 years. The Commission will try to identify innovations and begin to evaluate their possible relevance and value and their implications for patients, surgeons and for a whole range of issues that relate to possible changes in the surgical landscape.

All of this is of huge importance for patients as well as for surgeons and the whole surgical team.  Of course, patients stand to gain in many ways if surgery is set to become less invasive and more precisely tailored to the needs of individuals. But there are also several areas where patients and lay people will wish to be reassured that issues of potential concern will be addressed as well as looking at exciting  changes in the fields of technology, pharmacology, imaging and genetics, amongst others.

First, innovations in surgery will highlight more than ever the need to for surgeons to communicate clearly with individual patients. The pace of change is likely to be so rapid that while patients may have a degree of knowledge about what a traditional operation might mean for them, they may, at least initially, have less awareness of what risks and benefits may come with  new techniques and approaches. Judgment in the case of Montgomery v Lanarkshire Health Board  made it clear that doctors must ensure that patients are aware of any material risks involved in a proposed treatment, and of reasonable alternatives. A possible increase in alternative treatments may well make the process of communicating with patients to enable them to give informed consent all the more complex.

Second, communication and dialogue with the wider community, including politicians, will be essential in order to build support for possible changes in the configuration of services, as some future developments  may well accelerate the trend towards concentrating some hi-tech services in fewer locations.

Third, patients will want reassurance that there will be equality of access across the country and between different sections of the population where they stand to benefit from surgical innovations. If local commissioners and groups of commissioners go their own way,  change could be very uneven, and patients  may be at risk of differential access to  new approaches.

Finally, while the Commission is understandably focused on the future of surgery, patients also need to know that  the whole system beyond surgery will be able to keep pace with surgical developments. If patients can't access primary care promptly, or if GPs aren’t kept abreast of what’s new, or if social care is unavailable to support patients before and after surgery, then the scope of potential benefits to patients would be severely limited. Given what’s at stake, that can’t be allowed to happen.

Ros Levenson  is chair of  the RCS Patient and Lay Group, and member of the RCS's Commission on the Future of Surgery.