In this latest installment in our Day in the Life series, we expand our scope to include one of our trusted Securos Surgical consultants. Duncan Midgley, BVMS, CERTSAO, MRCVS, clinical director, Rutland House Referrals, St Helens, UK, teaches courses on both sides of the Atlantic. Read on for his thoughts on the value of asking questions and why teamwork is essential to patient outcomes.  

What does a typical day look like for you? 

I spend my time working in orthopedics and neurosurgery. Any given day involves seeing new patients. We allow 45 minutes for a consultation, which allows us time to perform a thorough examination of the patient, have a comprehensive chat with the owner as to what we deem appropriate, and discuss any potential surgeries with relevance to outcomes, prognosis, and complications.  

I think it’s quite important to establish what we as veterinary professionals may expect from the procedure and what the pet owners want. These expectations may be two different things. For example, cruciate ligament disease has several different ways of being treated, some of which are more likely to return a patient to athletic function than others. The questions are: Does that patient need that level of athletic function? Is this an 11-, 12-year-old dog that's quite happy ambling around, or do we have a 2-year-old German Shepherd that really needs to be back to as much function as possible? Once that's settled, patients will be booked for surgery. 

I work three days a week in the clinic. The rest of the afternoon is then taken up with surgeries that were booked from the week before, such as knee ligament surgeries, which is something I teach for Securos trauma cases, the occasional total hip replacement, etc. 

The end of the afternoon to the evening is a discharge clinic. We go through the postoperative instructions to make sure that the owners are aware of what we expect from them. Being a surgeon is like being a gardener. People think that surgeons make things heal. We don't. We set up the optimum environment for things to heal, and then it's up to the owner to continue with the treatment plan at home and obey the exercise restrictions, give the appropriate medications, etc. 

It's obvious if I don't do my job properly, that's bad. But if the owner decides that from day three the dog can run around unrestrained, it's perhaps not surprising the implant might fail. If one or the other side of the partnership falls down, then the dog is not going to have as good an outcome. 

The rest of the week, I spend my time as a part-time examiner for the University of Liverpool's master's course or providing support to Securos both here in the UK and in the United States for veterinary surgeons and veterinarians that have taken our [Securos’] courses and look at technical issues and planning issues. If not working, I can be found on the golf course trying to reduce my handicap. 

What is one thing you wish people knew about working in the companion animal space? 

How impactful some of the mean comments that people make about the profession are. These really impact the team's lives, not just the surgeons, but the nurses and the receptionists, too. If someone's pet had a poor outcome, which is often not the veterinarian’s fault, owners can post things on social media, and they really are massively damaging to the profession. I think clients should be aware we understand that they're emotionally involved and invested. But you know what? So are the veterinarians and teams that deal with them as well. 

The most surprising thing I’ve learned from my clients is ____________. 

The flip side is most of them are actually really kind and grateful for what we've done. I learn things from everyone, all day. People say, “Well, I'm going to ask a stupid question.” And there is no such thing as a stupid question. There's only a question that hasn't been asked.  

When we're teaching, we make the point that if you're thinking of that question and are too afraid to ask it, I guarantee you the person sitting beside you is thinking the same thing. Sometimes you get questions that challenge you and make you think, “Why can't we do it that way?” Some of the great advances in surgery have been made simply because someone said, “Well, why don't we do it like this?”  

I learn from clients who are asking me about their dog’s treatments. I learn about communicating with clients by listening to them because everyone communicates in a different fashion. Not everyone wants to talk about Young's modulus of elasticity as it relates to titanium rather than 316 LVM steel. Sometimes you have to say, “This one snaps, and this one doesn't.” 

What made you want to partner with Securos? What is Securos’ “unique fingerprint,” the thing that makes it stand out in the market? 

My history with Securos goes back probably about 15 years now to when they introduced a locking plate system in the UK. And I got involved with that because the mechanics of locking plates are something that interests me. I was asked to teach one of their courses specifically on locking plates.  

I realised Securos produces a very high standard of product with an ethos that supports that. That's unique. Securos really has an ethos of trying to provide not just the best product but the best after-product service in terms of technical support and educational support for the veterinary surgeon. Combine that with implants that are German-made of a very high standard with an infrastructure that offers next-day delivery in the UK, which I think is a superb service. Securos is one of the few veterinary implant companies that test to ASTM (The American Society for Testing and Materials). It’s very highly manufactured material that will do what it says on the tin, which to a surgeon is quite comforting.  

I'm a bit of a numbers guy, so I'm very interested in mechanical and material properties, etc. That led me to a friendship with Clare [Potts, Commercial Manager, MWI Animal Health & Securos Surgical], and then that developed to providing technical support and developing some courses for Securos, both here and in the United States as well. 

What brings you the greatest professional joy? 

There are two things really. The first is patient outcomes. Seeing the patient that you've operated on four weeks down the line and thinking, “My team has done that.” My team has provided that patient with sufficient care. We've improved their quality of life and the owner’s quality of life. There is nothing better than getting a dog back to mobility. That's not a me thing. That's an us thing. That's me and my team. Without my nurses and my technicians, I'm nothing. Without the receptionist, the patient doesn't get booked. That teamwork is a source of great joy. 

And the other thing that really gives me pleasure is teaching and seeing surgeons that we've taught and mentored grow and develop a number of the techniques. We invite everyone that's taken the course to submit follow-up radiographs of cases and request for advice. We see these surgeons developing and gaining confidence and benefiting their patients with some more advanced techniques. The ideal for any teacher is eventually your students grow to become better than you. So hopefully, we'll achieve that. 

Tell us about the biggest risk you’ve taken to advance your job/career and what the outcome was. 

It was scary to borrow almost $300,000 secured on a house worth $60,000 that had about $9,000 of equity in it to buy my share of the practice back in 1996. That was literally putting your house [on the line]. That was a risk, although we were backing ourselves. But for over 20 years, we were the captains of our own ship. We [my fellow owners and myself] could direct our own careers, build a new hospital, put an MRI scanner, put in a CAT scanner. It meant that we could do some things that we couldn't otherwise because we had access to more facilities. 

Did we do OK at the end of the day? Absolutely we did. I've had, for the most part, an extremely happy and fulfilled career, because I've been able to take the courses I want to take, approach the people who would teach me, and wander around trying to learn as much as I can. 

I define success as ___________________. 

Happiness. If I can be happy in my job, I'm successful. If I'm happy in my home life, I'm successful. I'm happy if the students I'm teaching are benefiting and developing. It's as simple as that.