6 minute read
CAREER DEVELOPMENT
Rebranding to survive
When his podiatric surgery role was absorbed into a new department, Damian Holdcroft was faced with a big decision: how to develop his career now? Eminent podiatric surgeon David R Tollafield spoke to him to find out.
From 2011 to 2014, the community department of podiatric surgery at Walsall Healthcare NHS Trust was slowly absorbed by the department of trauma and orthopaedics (T&O) until it ceased to exist. For one member of staff – extended scope podiatrist (ESP) Damian Holdcroft – these developments led him to take an unusual step. Faced with the loss of podiatric surgery, he decided to rebrand himself within the T&O surgery team.
There was no guarantee it would even be accepted. ‘At the time, I thought I should do my utmost to preserve podiatric surgery. I was told by the trust they were unlikely to expand in terms of podiatric surgery and employ another podiatric surgeon,’ Damian says.
‘A meeting was set up with the clinical director, foot surgeon and clinical manager of T&O. I outlined how I could be of benefi t to the T&O department and there was a general concensus things workedwell.’
Ready, willing and able
Damian set out his stall and approached the orthopaedic foot and ankle lead, determined to sell himself.
‘I started off by undertaking some dual clinics with the consultant orthopaedic surgeon and lead in foot and ankle surgery, Mr Goswami. We compared how we would approach different problems. This came about in a friendly and encouraging way.’
Initially, Damian attended theatre with Mr Goswami observing. ‘I informed him that I could perform ankle anaesthetic blocks for the benefi t of the patients undergoing surgery,’ he says. ‘Soon I was assisting in theatre and further down the line, suturing and so on. This lead to me taking a supportive role with trauma surgery during the Covid-19 pandemic.
‘I then discussed working regularly in fracture clinic, where the postoperative dressings clinic for all foot and ankle surgery was held. I told Mr Goswami I could be there and pretty well manage all of the post-op patients once I became an independent prescriber [IP]. I knew this would be the game-changer.’
DAVID R TOLLAFIELD
worked for more than 40 years in the West Midlands as a consultant podiatric surgeon. He now writes under the brand ConsultingFootPain for Busypencilcase Reflective Communications
Path finder
At the time, there was no blueprint set out for an ESP used to working in podiatric surgery.
‘I had to make my own path as a podiatrist who had spent years working in surgery, theatres, giving injections, cannulating, going on advanced life support and immediate life support courses, as well as running a nail surgery list within the hospital,’ Damian says.
outlook has paid huge personal dividends. More than ‘just’ an ESP, his role has become almost that of a medical orthopaedic registrar.
‘The professional relationship has gone from strength to strength. For example, when Mr Goswami is away at another hospital, he often contacts me to fi nd out what’s going on. In this way I can report back to him and take any appropriate action,’ he says.
‘With the advent of Covid-19, some roles had to change. Mr Goswami relied on me as his “registrar” as a number of medical staff were shielding. In theatre, it was just him and me.’
‘We had a wide range of drugs we could give, including intramuscular and intravenous, as well as PO [prescription-only] medications. So my experience was broad. I could not let that go to waste.’
Even for somebody with all his experience and expertise, instigating change was not without its obstacles.
‘The nurse in charge of the fracture clinic gave me the impression she thought I might get in the way. After a few weeks, she warmed to me because previously she had to do all the suture removal and dressings after foot and ankle surgery. I could offl oad a lot of her work,’ Damian says.
‘I did the post-op clinic when Mr Goswami was away. My relationship with T&O grew and I found that the orthopaedic team wanted me to just get on and do it.’
Spreading influence
Damian’s infl uence started to grow. ‘In time, the trainees started to come to me with their log books, having had surgical procedures such as osteotomies. After they had undertaken a number of procedures with Mr Goswami, he would suggest I scrub in to support them rather than him. He would say to me “If you run into problems, tell them to stop and then come and get me,”’ Damian says.
‘As I became more involved in the fracture clinic, Mr Goswami would ask me to prescribe medicines. This included drugs such as Clexane to avert a blood clot when patients are immobilised in a below-knee cast. This helped him enormously if he was snowed under.’
Seven years on, Damian says his decision to expand his professional
The journey
So are we ready to develop within the College and its Faculty of Podiatric Surgery the type of work that Damian fulfi ls in his role working with Mr Goswami?
‘While I understand where podiatric surgery came from, cascading skills down would be benefi cial to individuals and the whole profession. The journey made in podiatric surgery is incredible,’ Damian says.
‘Key elements such as IP will give a huge amount of leverage, as well as expanding positively, especially where continuity of care compliments the care pathway.
‘One of my abiding memories comes from a locum consultant orthopaedic surgeon – whom I was assisting in theatre – asking me my grade. I said I was an ESP and he replied that he thought that I was an orthopaedic consultant.’
Damian’s testimony emphasises that, where we once could rely on a linear career, we no longer can expect such stability. It takes courage to change at any time in life, but no less when one has been practising for more than 30 years.
If nothing else, his story is a lesson that could be applied in even wider circles: whatever hurdles you face, there is a route for people with experience and skills.
