First Impressions

First Impressions

Published 03 June 2020

What is in a name?

You only get one chance at a first impression. It sets the starting point for any further adjustments that might be wanted. In the context of appearance and dress it is a familiar concept to which many pay attention; we dress for an exam, an interview, a first date, I even polished my shoes the first day of my consultant post. However, people pay less heed to first impressions when applied to language and concepts. The first to say a number in a negotiation on a price sets the scene, the boundaries are beginning to be defined. Terminology is the first impression we give of an idea so we should take as much care as on the first date. Once the wrong impression is given, no amount of explaining can retrieve the lost ground.

When are we to restart ‘elective’ work? I know what I mean by elective in this context but how do others understand it. Some words that we use in medicine tend not to be confused with their plain language counterparts, a good example is fascia. I recollect that as student when in the dissection room I asked an anatomy demonstrator what ‘fascia’ was as it did not bear much relationship to a car. It was explained that whilst difficult to describe, by the end of the year I would believe that I understood it. I did, and still do, I think? With a word like ‘elective’ there is a bigger problem in that everyone believes they understand it at the outset; sadly they just don’t all understand the same thing. Elective implies choice, in the context or surgery this can imply choice relating to necessity or timing. As a surgeon I have grown to understand that it predominantly refers to timing, but my understanding is no guide to the way the word is interpreted by others. We could do with another term, scheduled may be reasonable as it relates only to timing and not to need.

Why is this important? In the past we have all lamented the slow turnover in theatre as we take the opportunity for a more relaxed cup of tea. There was pressure but it was parochial within our own patch, we had our own theatre rights. However, take a look at the first chart in the ‘Charting the Progress’ it reflects the results of a survey of Clinical Directors. The findings suggest that to service the same number of Trauma patients now as pre-COVID-19 will take 60% more theatre time, 60% more surgeon’s time, 100% more anaesthetist’s time and 260% more scrub/anaesthetic assistant’s time. Should that be replicated across other areas of ‘urgent’ work then there will in effect be a resource famine. The presumption is that work will be done in order of priority, and indeed there is a prioritisation document to guide us here. This document is written for the equivalent of the ‘pleasant’ ATLS triage scenario when there is enough resource and it is just a matter of order. However, with resources as scarce as they may become there is the harsher triage scenario when not everyone will be treated and the overall societal benefit is considered. By labelling our patients as elective we have disadvantaged them in this negotiation should it occur. Pain relief, improved function and quality of life are the motivators for most of our work we and the patient organisations need to make sure they are adequately represented in and equitable distribution of resource.

There may be another first impression to correct. It is over two months since the Transient Journal of Trauma, Orthopaedic and the Coronavirus or TJTO&C first appeared. The word ‘Transient’ could have referred to the pandemic, the publication or just the title. Undoubtedly there is a change in the nature of these strange times, the lockdown is loosening, I can buy a new car and snooker has resumed but the pandemic is not over yet. We continue to receive an encouraging number of submissions for TJTO&C, so the concept of a rapid turnover online journal survives. However, perhaps it is time to change the name to something less Transient and more suitable to continue into the longer term.

The government’s COBRA is a great name, it seems to imply strength and cunning. A sense that when the going gets tough, the tough get going. It is a bit disappointing to find that it is named after the Cabinet Office Briefing Room A. Interestingly, the BBC described that Cobra meetings may occur for two reasons. The first is it (the government) is quickly getting to grips with a thorny issue of immediate national significance. The other is that something bad is happening and maybe they are to blame.

The BOA could use its own snake association for similar gravity in a new title for the online journal. Oddly we tend to read ‘BOA’ as three letters, whereas we could say it like the constrictor as ‘boa’. I suggest that we change TJTO&C to The BoaJ (The BOA Journal) but pronounced Boajay. Should anyone have a better idea then please let us know. First impressions count, the terminology is important. We must be wary of confusing timing with necessity when discussing surgery and when naming a journal it is best not to choose a title that will obviously go out of date.

Bob Handley