IamA Mr Ross Fisher, Consultant Paediatric Surgeon (that means I operate on babies and children) AMA!

What is it about your training that makes you susceptible to apples?

I'm intrigued that recently the converse is true- the majority of my colleagues carry one in their pocket or handbag

Maybe this is a US Dr thing and they aren't sharing with you?

I thought you were saying our susceptibility to apples (An apple a day keeps the Dr away) and I was remarking most Drs seem to have an iPhone

Gotcha I figured the US doctors are all in the pocket of "big produce" what with their eat real food thing.

very different over here. We are paid by the Government, flat rate, no productivity or speciality specific numbers. So an adult dermatologist or a psychiatrist or a cardiac surgeon all get exactly the same

So then what would be the motivation to do a more time consuming path like Spinal or Neural surgery?

Do you have a shortage of any specialists?

I couldn't tell you.

Why is it that surgeons are referred to as Mr instead of Dr.

Cheers!

The "mister" is an honorary title. Originally physicians would have a barber (hence the barber's pole) do the cutting as it was too menial and dirty for them. Some insightful physicians realised they could do a better job of cutting as they understood the anatomy and disease better and so began doing the surgery. Their colleagues used the term "Mister" in a derogatory way but the surgeons carried on and we now wear our ordinary name, every man is Mr, as a badge of honour in Medicine.

It's old fashioned but tradition and history has put us where we are so I am happy to respect that.

Do you find being in surgery emotional, and, if so how do you cope with that?

yes I do. every operation is on a SOMEBODY, not just a thing. Sometimes we almost forget that but we have to change our mindset from how you would be if I gave you the knife, we have to be a bit detached and focus on the task rather than letting emotion have a big part on what we are doing.

There can be no greater trust by a parent in them letting you take their child off and do potential harm and that weighs on us, but we don't usually show many people. Similarly, that look in a parent's eyes when you go out to tell them everything has gone well...again, completely humbling but totally uplifting.

How do we cope? Most days, fine. Occasionally a little less well. I've sat in dark rooms sobbing with the pressure, but I've also had days where I've had to keep a lid on it from saying, "you know, what we did today was absolutely AWESOME".

It's something we learn as part of our training and hopefully keep learning.

Do you have a "surgery went well" victory dance? I totally would.

Some days...

I'm baking a large madeira cake this weekend. How long should I leave it in the oven? And what temp?

middle shelf of the oven 180C/350F/Gas 4 30-40 mins

When we see diagrams of our internals they are always big and blown up, but really, just how small is say, the kidney of a baby, comparing it to the size of an easily relatable everyday object?

Also, would you operate on your own child, or would it be too emotionally intense?

a newborn kidney is about 4cm.

in an emergency yes. but in reality I'd ask a colleague. i'd CHOOSE the colleague tho!

A four centimeter long object would be about the length of a mandarin orange slice.

Mmm

yup

Thank-you for what you do. My 2 year old had open heart surgery at 7 months. He's fine now, he has a LOOOOOT of energy and is a great kid. Needless to say those 7 months before he was fixed were bad, really rough. I can't say enough good things about all the doctors and nurses who helped us. VSD repair on a Thurday, we were home by Sunday night and it was like walking out of a hole in the ground and seeing the sun again.

I want to say something to you that I can't bring myself to say to the surgeon who operated on my son. The day before his surgery, we went to his office and he showed us what he was going to do, how long it would take, all about the procedure, things we needed to know about post surgery and pre-surgery. And the whole time I didn't say a word to him. I could hardly look at him. I had to turn away when he showed pictures of a heart and of the main points of the surgery. In short I was about as rude as I could ahve been. He was a very nice man, not to mention the fact that he saved my sons life, but I was terrified of him before the surgery. No fire breathing dragon could have scared me more than he did. I had the urge to stand up and run from that hospital with my baby in my arms and never come back to a place where they wanted to cut him and hurt him so much. I knew he needed the repair, I wanted him to have the surgery, but I still felt that way. After the surgery I was able to talk to him and to thank him every time we saw him, but I was never able to bring myself to apologize for how I treated him the day before. I'm sorry.

I completely accept your apology on his behalf. Thank you.

I am sure he would understand both then and now and would hold no malice.

Really you have nothing to apologise for. We understand because what we propose, to normal people, is completely abnormal and hideous; to take a child, expose it to major risk and cut it open simply to make it better. It is entirely normal to see that as scary.

What is amazing is how modern medicine allows us to do these things and return so many of these children to their parents. I am amazed at what can be achieved in the care of these precious little ones. We need to remain humble and remember that what we consider ordinary is, to many, extra ordinary.

Find the surgeon and send him a card, he, like I, will be humbled.

What is your views on circumcision?

Virtually no medical indication under the age of five save recurrent urinary tract infection. Our colleagues in North America are slowly changing their practice to come into the same line as European Paediatric Surgeons. I don't see good medical evidence for routine neonatal circumcision.

The prime influence in North America is so that boys look like their dads.

And it goes without saying that I completely disagree with female circumcision

I didn't know that female circumcision exist. What kind of procedure is that?

Unnecessary and mutilating. The WHO has a factsheet here http://www.who.int/mediacentre/factsheets/fs241/en/

Have you ever had to 'fix' a victim of FGM?

no

mutilating

How are the terms FGM/MGM, female/male circumcision actually used in the medical world? Is male genital mutilation a "accepted" term or rather seen like it downplays FGM? On Reddit for example just doing what you did and calling it female circumcision will make people really angry.

it's an WHO term, not mine. It is not something I do.

I so admire your work and thanks for the AMA. I live in the US, and since our healthcare is profit-based I would love to hear your thoughts on the healthcare system in the UK for such a specialized field.

In what way? We do what is needed, cost is not a consideration, our outcomes are amongst the best in the world. I'm proud that my taxes support such an institution available to every single member of our society, without hindrance.

I am whole-hardheartedly in favor of your system. What I am looking for is information that will help convince people here that we can do what the UK does.

I can't understand why a society wouldn't offer healthcare to every member. we all deserve health and education, it should never be something that has to be bought

i can't help you any more than to ask why wouldn't people do it? the cost of US healthcare is massive and yet it is directed not by those with concern but insurance companies. one may have a great job and thus have healthcare but what about if your bank goes bust and your child gets cancer. why do they not deserve the best chance in life?

If Scotland get independance will you need a work visa?

I'm hoping a tartan snatch squad will come and repatriate me

My mental image of a "tartan-snatch squad" is glorious.

and mine!!

What has been THE most exciting surgery that you have ever performed?

depends on what one thinks is exciting.

when I operate on new born babies with congenital malformations the amazing thing is that when the problem is fixed, they are cured forever! That's pretty humbling and at the same time exciting.

sometimes the exciting thing is how tiny the babies are that we operate on. surgery on a real live person who weight 700g is pretty amazing too.

sometimes the technical challenge of the surgery makes it exciting in that when doing a large tumour resection where the tumour is stuck to major organs, if we make a mistake...that can make it exciting too.

so all of those are exciting for different reasons.

So the MOST exciting? I think tracheo-oesophageal fistula ligation and repair of oesophageal atresia on a 900g baby. that means she was very premature (14 weeks early) and her food pipe (oesophagus) instead of being joined to her stomach had a weird connection from her windpipe (trachea) to the stomach. We operated on her thru a 3cm cut in her chest and joined the pipes the right way round that were about 3mm in diameter. And she made a complete recovery and when she comes to see me in clinic she's just a normal beautiful little girl.

All thanks to our amazing neonatologists, anaesthetists, theatre team, neonatal nursing team and pharmacists.

I had something the same/similar, not sure of the name but my esophogus did not go to my stomach either, so any liquid would've filled up my lungs and I would've drowned, so I'm told. (I'm a bit shady on the details, I was a bit young to remember!)

Interestingly enough, they went through my back though, not my chest. The wonderful people at the Hospital for Sick Children in Canada patched me up when I was hours old, so thanks for people like you and what you do!!

that's the thing TEF/OA

What made you decide to become a surgeon?

I like doing things with my hands, fixing stuff. As I went thru Med School I became aware of things that could be fixed and I was interested in that process. being part of it was interesting and rewarding. It started there but I still get the same buzz from being able to help and fix things

What prompted you to want to work solely with children?

I like kids!

see below

Why babies man? Sounds difficult

it's a challenge but the reward...

That is interesting that you aren't aware of any bullying within the hospital where you have pastoral responsibility for surgical trainees. That must be a relief, and perhaps a victory for the hospital. How did you feel when you were bullied as a trainee?

firstly we are a small hospital, secondly I am only responsible for colleagues in Paediatric Surgery altho I would have no truck whatsoever with a situation where a physician was felt to be bullying their trainee. They need highlighting and investigating, but sensitively.

How did I feel? Appalling. ultimately I came close to suicide. Part of my issue is that my personality allows behaviour that some others wouldn't. I'm not blaming myself simply recognising that I was part of the issue.

How did I deal with it? A struggle. Ultimately, I went to another senior colleague and told her. Everyone knew, that's often the case. Everyone knows where it happens but how it is received is where the big difficulty arises. Previous colleagues had received similar treatment but I broke under it. I asked for help. I felt humiliated, altho I shouldn't have but I was that low, I knoew that I had had enough. They were excellent with me and dealt with the situation helping me to go on and fulfill my career.

That has stayed with me and makes me keenly aware of the issue.

As somebody who was brought to the point of suicide by bullying, although from the school yard and not the hospital, I know how painful that must have been. But seriously glad that you bounced back! Reading the rest of your posts it seems that you've not only saved many lives, but also made countless improvements to quality of life for children.

Thank you.

Thank you for this touching reply. Remember that bullies only target people who they feel threatened by, so you must have been a really good trainee for them to hurt you so badly. Whilst I don't wish you any bad memories, I hope you never forget the experience, so that it might help you guide and support juniors who are similarly bullied.

it has taken time and I am a stronger person for it. I will never forget, even now I feel the sadness that I was in that position.

thank you

What is the youngest age at which is it safe for an individual to begin consuming Taco Bell on a regular basis?

when they can lick their own elbow

What considerations go into separating conjoined twins?

a lot! and it is a very complex issue only dealt with at Great Ormond Street Hospital and in Manchester. There are many many types and each case needs individual (!) planning.

No question, just wanted to give you a huge thank you!

very well received, thank YOU.

Did you ever watch the show E.R? Doug Ross, aka George Clooney, got his start on that show playing a pediatric surgeon, and i was wondering how similar that show was to real life, especially since your name also is Ross.

I have a friend who said that Cook County General (ER) was just like that.

I was a trainee when ER was on TV and was VERY proud to carry the name. One mother was VERY disappointed when my junior colleague said, "Dr Ross is coming to see your child."

... and then Ross from Friends shows up. Really disappointing.

EDIT: If I recall he was a PhD in Paleontology.

a proper Doctor, my titles are only honorary

hi im a final year medical student, four months out from graduating, i find my self losing the empathy i had towards patients earlier in my training. I seem them as just another case. any advice?

talk to them. they are real people. ask them about the reality of being a patient not just the reality of having disease. once you reconnect with that, and escape your exam fears, then you will regain it

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yes it's common. Day care surgery, a general anaesthetic. We find the small hole and repair it. He'll be home the same day with an "inny" rather than an "outy".

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don't. it's straightforward day care surgery. he'll be grand!

Look at you saying grand. As an Irish person it's rare to see anyone else use the phrase.

irish friends!

My son had heart surgery at 14 days old to correct a coarctation of the aorta. I just want to say thank you for being one of the amazing people who do things like this.

Edit: I realize heart surgery is not your specialty; I just meant doing general life-saving things.

thank you. there is little more precious than those heartfelt thanks. we treasure them

If I show you my rash can you tell me what it is?

yes, it's a rash. You should see your family doctor about that. I'm no good with rashes other than knowing, that it's a rash

What was the worst thing that happened to you in the operating room? Like, has anything bad happened and what was it?

an extremely premature baby dying despite everyone's best efforts to save her. her body just couldn't cope with the insults of her prematurity and sepsis caused by necrotising enterocolitis.

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I always wanted to be helpful and help people as a kid. Someone suggested that meant I should become a doctor but to be honest I don't think many people really understand what that entails until well into their training.

As a teenager I was doing well enough at school and the thought that I could become a Doctor seemed and good and worthwhile thing to do so that spurred me on to keep studying.

What was the most difficult part of Medical School? The exams I think. Med School isn't hard, like maths keeps getting harder and harder, it is principally volume that makes it hard; lots and lots of things to learn. You learn how to learn and how to handle facts the same way you learn other skills. I think that was the hard bit.

That's "Dr. Ross Fisher" to us.

But seriously, future PGY-1 in Emergency Medicine in the states here, could never do what you Peds Surgeons do. 10 years of post-graduate training here would be the deeeeath of me, and I've seen you all do remarkable things in the OR. Thank you for what you do!

Thank you for that.

It's Mister Ross Fisher over here. The "mister" is an honorary title. Originally physicians would have a barber (hence the barber's pole) do the cutting as it was too menial and dirty for them. Some insightful physicians realised they could do a better job of cutting as they understood the anatomy and disease and began doing the surgery. Their colleagues used the term "Mister" in a derogatory way but the surgeons carried on and we now wear our ordinary name, every man is Mr, as a badge of honour in Medicine.

A bit trivial however: does it ever bother you that surgeons/specialists are referred to as Mr whilst GP's are referred to as Dr?

no. check out the answers to above.

It's Mister Ross Fisher over here. The "mister" is an honorary title. Originally physicians would have a barber (hence the barber's pole) do the cutting as it was too menial and dirty for them. Some insightful physicians realised they could do a better job of cutting as they understood the anatomy and disease and began doing the surgery. Their colleagues used the term "Mister" in a derogatory way but the surgeons carried on and we now wear our ordinary name, every man is Mr, as a badge of honour in Medicine

You are required to be in a cage match, a fight to the death. Would you rather fight 100 baby sized horses or 1 horse sized baby?

i'm gonna go with the horse sized baby. ALL babies love a cuddle

how do you manage to be a successful surgeon and yet not make unwelcome political statements and accusations?

biting my tongue helps

Has a child die on you and if so how do you cope

yes. it's hard.

i go somewhere quiet and cry.

then i try to understand, with my colleagues, why this happened, make changes if we can that might prevent that happening again.

then get back to work.

the ability to compartmentalize those emotions is amazing to some people. other people see it as a kind of cold disconnect and just can't understand how someone can "forget it" and move on.. do you ever take work home with you? something you just couldn't shake? first unsuccessful surgery?

of course we do, i'm not superhuman. Friends and family and colleagues help a lot and then we move on. Mostly

I guess if you can operate for twelve, you can AMA for three. My daughter was diagnosed with duodenal atresia in month 7 and stopped kicking two weeks later. We went in to the hospital and in the midst of a non-stress test, the heartbeat disappeared. Crash csection, no heart rate for 12 minutes, 90 percent blood loss. And I just watched her dance with her kindergarten class and read her favorite book to me. You're a special lot. All of ya's.

AWESOME!

(it's my day off!)

Thanks for taking the time to do this! I'm an xray technologist student, and I have 2 questions for you.

1) Working with pediatrics isn't exactly my strong suit, any tips on working around kids, getting them to cooperate?

2) What's one thing as x-ray techs that we can do to make your life easier? Whether it's in the OR or otherwise?

talk to them. we do BAD things to kids and it is a challenge getting them to co-operate. For men it is harder than women at first as kids have or are taught to be cautious of men they don't know. I always speak to Mum and Dad first. Kids figure if you are Mum's friend then it's probably ok to talk top you.

kids like games too. Make it more of a game or something they can associate with. an ipod in your belly? lying perfectly still hiding from the lions? what can you see on the ceiling (paint stuff)

our radiographers are great; they know what we are looking for in theatre when we do screening for central lines and stuff. offer ideas on how to make it better if you know. be part of the team not a visitor

What do you want to change about presentations, and what presentations?

Not sure if you feel the same way as my wife (also a surgeon). She cannot stand the standard format of presentations given by most doctors - powerpoints filled with lots of text. Not to blame them really, that is all they see during their training.

POP!

Check out http://prezentationskills.blogspot.co.uk/

I've written a little about it...

I had heard that as recently as the 70s doctors didn't believe babies could feel pain and operated on them with only muscle relaxers. It seemed.. ridiculous.. To me.. Was it true?

medicine moves forward.

In my line of work, we deal a lot with women who use drugs during pregnancy. Sometimes the children are born very early and with serious medical problems, like underdeveloped lungs, problems with their bowels, etc, that require lots of surgery. It tears me apart sometimes.

Do you encounter cases like this a lot? Does it bother you?

Thankfully not a lot. Does it bother me? Of course. It doesn't change the care I give to the child nor the respect I give to their carer. We all make mistakes, the problem is the mistake, not the person.

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yes. An amazingly precious gift that families can make that can SAVE many lives.

Immense respect for those that can make that gift.

No questions, just wanted to say thanks to you and all the other surgeons, nurses and staff members that care for kids.

My daughter was born with a pretty severe cleft lip and has had three surgeries so far. We owe a lot to our surgeon and the staff that kept her as comfortable as possible and even managed to get the first post-op smiles out of her just after she woke up. Thanks!

thank you. what a precious thing!

In very long surgeries do you just hold it or do you leave, go to the restroom and then have to scrub back in?

I have a break every 2 hours. I stretch (getting old) have a pee and a cup of coffee. I've NEVER been in a case where there wasn't an opportunity to stop. An old boss used to say, "it's more dangerous when I'm here than when I'm resting for 10 mins."

Do you have a pastoral role for junior surgeons?

I do, formally and informally.

None of us got to where we are based on our own brilliance. We stand on the shoulders of giants. Training of the next generation is the responsibility of every surgeon and involves technical, factual and pastoral support.

How do you deal with bullying and undermining of trainees by their consultants, which is reported to be very common according to the 2013 GMC training survey? What happens to such cases which come to your attention?

I was bullied as a trainee.

I am not aware of bullying in the trainees I deal with or by colleagues I work with.

Such situations are difficult to deal with, need time and sensitivity and an individual approach. they represent a problem for all parties involved.

So, what really is the best slide in the world? It's not allowed to be a blank one. That's cheating. It has to be a real powerpoint slide with something on it. A word or a picture. No blank slides allowed, no ctrlB allowed. What slide do you put up?

I gave a talk at TEDx Stuttgart. My point was that many of us are seeking inspiration but actually what we are looking for is inside each of us, our true innter self which can do AMAZING things if we let it, if we stop limiting it.

IS there a best slide in the world? of course not, nor could one slide fit every talk.

for me, it is that picture of me (arrogant eh?) in the talk https://www.youtube.com/watch?v=qFza3W87eDg where I encourage everyone that what they are looking for is there, right now, within them. THAT is pretty amazing.

So the best slide in the world is a picture of YOU, relaxed, happy and about to be amazing.

how's that?

Does the whole anti NHS hate led by the Daily Mail and No Win No Fee companies cause your problems?

sadness.

but we just carry on doing what we do knowing that their agendas are elsewhere and not about patient care.

What advice would you give to a senior medical student interested in paediatric surgery?

do it. it's awesome

What do you think makes a good member of care staff, eg theater Nurse? I have a Uni interview next week and would appreciate some tips :)

Also, do you play music during surgery? And if so what is your favourite song?

team member with initiative but patience.

yes I play music during surgery. I have many playlists on my iPhone so the team can chose their own music (from my music).

The Blue Nile- Tinseltown in the Rain https://www.youtube.com/watch?v=F0wkO0aTtec&feature=kp

Being the lead for the oncology unit - what are your feelings on the upcoming ICD-10 coding switchover? Do you feel it will be beneficial due to the specifics or does it go too far with the amount of codes?

Also, what EHR system do you use and your feelings on it within a surgical unit?

over here we are not involved in coding/cost issues. there is a lot we could learn about its value but such things do not play any part in my practice currently

Have you ever had any doubts or misgivings about pursuing this profession?

I've had doubts about my personal abilities but never the profession itself

Thank you, Mr. Fisher!

pleasure

So, I've done a lot of genealogical research on my family, and I'm always surprised at how many children died in the first 7-8 years of life while living on the American frontier in the 1800's. One family in my line had 13 children and only 7 survived to adulthood, and another supposedly had 14 children but only 6 survived. Meanwhile, another had 13 children and they all lived to adulthood.

Speaking as a doctor, and knowing how sick children might fare "in the wild" without modern medical treatment, what do you think would account for this difference in otherwise similar families? The three families I mentioned were all close relatives who lived near each other physically and concurrently. Is there an inherited predisposition to resilience to now-common infections, for example?

badly.

our village school recently opened its books on attendance during the late 1890s and onwards. they had regular epidemics and children regularly were "removed from the register".

the reason we had big families was so that some would survive.

childhood illness kills; it's why vaccinations are so important

Do surgeons really want patients (or their parents) to ask questions? Do you just inwardly roll your eyes sometimes?

I'm a detail girl, I like to know everything. I felt a little silly asking my child's surgeon questions about the procedure that was about to happen, but I wanted to understand from a person and not from google <shudder>.

Do you cringe when parents like me come along?

I do. I want the parents of a child I am operating on to be comfortable with what the problem is, what options there are for dealing with it, what the surgery entails, what the risks are and what I expect the outcome in my hands to be. then, when we are happy I can do what I do best.

everyone is an individual though and what your friend might need to know you might not want to know. I'm more than happy to answer any question and take as long as it takes. as long as my answers are respected. similarly "but google says" is not what I am there to discuss though.

What brought about your interest in changing the nature of "powerpoints"? I would imagine it has something to do with sitting through endless, reasonably boring, lectures.

What qualities of powerpoints do you think make them best?

exactly. that and giving them myself.

it's not a powerpoint it's a presentation and that is made up of a single idea, a story, supportive media and delivery. What makes them best is when YOU engage with your audience. If I had wanted you to read me something it would be "Winnie the Pooh" not your powerpoint.

Check out my blog at http://prezentationskills.blogspot.co.uk/

To what extent is Oncology surgery reactive and proactive?

Can you explain your use of those words a little more please?

Might have used the wrong words! I'm wondering how much of your work is managing a condition and how much of it is actively trying to prevent it spreading?

it's ok, I was wondering if there was a specific use of the words you were referring to.

We manage paediatric malignancy as part of a multi-disciplinary team. There are Oncologists (they use chemotherapy), Medical Oncologists (they use chemo and radiation) and the surgeons (we use sharp things!). Every child has an individualised plan based on the best evidence available as to what needs to be done. Our aim is the best care for that child, sometimes that is cure, sometimes it is palliation.

What I actually do is a combination of taking biopsies for diagnosis, putting in special venous catheters that allow administration of chemotherapy, removing tumours and dealing with problems in palliation.

The balance of that depends on what patients are currently under our care. recently we have done two large tumour resections for which we as a MDT are hopeful have cured the patients.

The overall cure rate for paediatric cancers is hugely better than in adults, which is encouraging.

what's the recurrance rate for people who survive childhood cancer - much higher than the rest of the population?

long term there are problems, our oncology colleagues run a "Late Effects" clinic. firstly, children live longer than adults. I know that's obvious but it means that the effects of tumours and treatment have longer to have (bad) effects in children than in adults. Chemotherapy is bad stuff. That's why it works but also can lead in the late term to further problems. We know that survivors of childhood cancers have higher incidence of other cancers in the future than their unaffected peers, poorer fertility and issues of organ function. This spurs on our research to reduce this as much as possible without losing the curative effects. It's a balance, but better to be alive in 20 years with a new malignancy than not here at all eh?

absolutely thanks for the answer, and as a parent, thanks for your work

thank you.

If chemotherapy has so many side effects why is so much research still going into it? Why not research new methods?

because it has many positive effects too!

Paediatric Surgeons that I have met consider themselves as ' general surgeons', some with a specialist interest in a particular field. Would this carry on being the case in the future, or will it (like adult surgery) become more specialised (i.e. training, practice etc?)

We are the last generalists.

Will it carry on? I suspect so as part of the reason it has persisted is an issue not of increasing specialisation but of numbers. The adult surgeons have changed for differing reasons.

In most specialist hospitals such as Sheffield Children's, the individual surgeons have areas within which they offer specialist services but the requirement to carry out the "non specialist" work in addition will remain unless we double or triple the work force. The more general work is also of value in maintaining skills for the specialist care. The point at which either service requirement demands more surgeons is where the numbers discussion has to be entered into and for the foreseeable future I don't seem hyper-specialisation becoming an option.

What's your approach when you have to tell parents that there is nothing more you can do for their child (i.e., how do you tell them their kid won't make it)?

honesty.

i sit down with appropriate colleagues in a quiet area, I look them in the eyes and just tell them that we have done our best but that just isn't enough and that the disease is stronger than even the best.

(and then I desperately hold it together until I can be somewhere I feel safe)

Have you ever had a case of regeneration with a child. I understand that this is not as rare as most think?

extreme premature babies sometime lose sections of their intestines due to problems. it can grow a little.

Favourite Sheffield restaurant?

currently Graze Inn on Ecclesall Road

do you have your own, personel X-ray C-arm and monitor for when your in theatre?

I wish

Hi Ross. What's the attitude within your paediatric surgery department/your hospital on GPs? Worth their weight in gold, or nuisances who send you duff referrals? Have these attitudes changed over the years?

I'm a GP myself.. but in a very different part of the UK, I promise! Just since you're doing an AMA and we're out of the professional sphere here...

Worth their weight in gold.

Need us to share knowledge on paeds surgery issues rather than expecting them to know everything about everything.

better communication all round. Got a problem? Phone.

I interned at Alder Hey in Cardiothoracic. What is your view on paediatric Cardiothoracic surgery in England and the sweeping changes they did two years ago to cut down to 4 centers outside of London and 2 in London? I remember watching the staff as they were tensely waiting for updates on how it was going to be. Thanks for doing this!

very difficult, very emotive and very politically charged.

Has an operation ever gone south quick?

yes. Not often and never without the possibility being know; that is part of our preparation.

Extreme premature babies with a condition called necrotising enterocolitis can be halfway through death's door when as a team we decide surgery may be an option to try and pull them back through. Here I am in complete awe of my neonatal and anaesthetic colleagues who deal with the disasters of homeostasis whilst I try and deal with the surgical problems.

As for massive bleeding- thankfully I have never caused that without being aware that it was a possibility and whilst we have "gone south" for a period of time we have also turned the ship around and successfully sailed "north" again. That's what training and team work help with.

How common is open heart surgery in kids?

More common than people think! But also more successful too.

Have you surgically altered any babies in fun ways? Like given them gills or extra hands?

I used to make assholes if that's what you mean?

1:5000 babies are born with ano-rectal malformations, some form of abnormality with formation of their bottom. I did corrective surgeries for that.

What are your thoughts on cancer being an industry and a cure never being found because it would result in the loss of a industry (lots of jobs)?

rubbish.

Do you have any experience with children requiring surgery for meckel's diverticulum? After having mine operated on at age 6 I was told it was shocking it hadn't been diagnosed dealt with before.

Hardly. We diagnose things on symptoms. If nothing had happened until then then nothing needed to be done. Many people die with theirs intact never having caused any problems

What would you consider to be the greatest breakthrough in pediatric medicine/surgery in the last 20 years?

Alberto Pena developing the Posterior Sagittal Ano recto Plasty

As a medical student looking into paediatric surgery, how was the training run? I know you have to start with surgical training, how was that to get into? Did you always want to deal with kids when you went in for surgery or was it something you found later?

general surgical training and then specialist paediatrics. In UK you will do 2 years foundation, two years of core training and then specialist training 6-8 years

I was lucky enough to do some paediatric surgery as part of my general training. (watch this https://www.youtube.com/watch?v=qFza3W87eDg)

Have you ever heard of Langerhans Cell Histiocytosis? BC I was just diagnosed with it at the children's hospital at Montefiore. Can you tell me anything about your experience with it if you have dealt with it before?

yes I have heard of it and operated upon cases too but an Oncologist is your best place for asking such questions, surgery isn't the mainstay of therapy

So do you do it for kids in accidents with a appendage damaged in that sort. Face-lifts or fixing noses still just that different cause?

In trauma, it depends which bit is damaged who fixes it. Principally things in the chest and abdomen for us, limbs for orthopaedics. Facelifts and noses aren't in my area of expertise.

The chest? is that one of the more focused areas, I mean not many people are going to see it anyways

what specific area are you asking about?

trauma i guess, what other reasons are there usually for children then?

there are also congenital abnormalitiies of the chest - pectus, a colleague of mine deals with this.

thankfully there are few major chest injuries in children due to trauma. we ask our adult colleagues for input if needed but are prepared for emergency surgery if required.

how much more studying would you have to do to become an orthopaedic surgeon?

We chose career pathways a long way back from where I am now. I was doing orthopaediacs in 1992 so i think I'm beyond help.

I admire what you are doing - it's actually my future dream for later in life. I've taken a step towards the medical field work as an MDRD (or CSD.. CSR.. SST.. sterilization) tech, and even though I probably have no idea what I'm getting into, I would love to be a paediatric surgeon in particular for oncology, up here in Canadia. Do you have any guidance for how I should get started, and what to expect?

it's an awful long way ahead but use that to drive you onwards to pass the immediate goals first of all.

what to expect. Hard work, lots of study, a few tears, a few victories and ultimately, if it's what you want, you will achieve it.

I already saw your answer about why you wanted to do surgery, but how did you come to pediatrics specifically? I'm a first year med student-very interested in going into some form of minimally invasive surgery, but I have no idea what field yet.

Check out my TEDx talk https://www.youtube.com/watch?v=qFza3W87eDg I shared a bit there.

Why paediatric surgery- the whole package: technical, emotional and physical.

How do you charge your clients? What if a very sick patient needed your help but they lack the funds to get you as your doctor? Do you feel guilt that you can't be their doctor?

in the NHS we don't charge. health is free at the point of delivery. and always should be

Have you ever thrown instruments at your surgical technicians or nurses?

once. they told me i couldn't be a proper surgeon unless I did. so one day we cooked up a RossGoesPostal scenario and I got to throw something. everyone just laughed.

It never works for me, never had the situation where I thought it would help and I would just feel bad after.

I'm not zenlike calm all the time i know but when the stuff hits the fan, calm is what i personally need not throwing tantrums.

Hi. Im a slightly ginger man in his early 20's. I'm going travelling with a work collegue of mine, shes thin and blonde. We're travelling round Australia, the USA. My main worry is when I get to BANGKOK and I want to meet with the lady boys will it put her off me? I'm confused......and still Ginger

focus on the friendship or the lady boys, not both.

As an aspiring pediatrician,do you have any suggestions on books about pediatrics?Also,what kind of classes should I take in high school?

Your local area career guidance will be best on those specifics, I'm totally out of touch.

Books on paediatrics as a text? I can't help, I'm a surgeon.

Books on paediatricians- there are loads of amazing role models.

Hello :) first, thank you for all you do! You're wonderful!
Second, what is your favorite book or books?

Thank you.

The Sacred Art of Stealing- Christopher Brookmyre Tess of the d'Urbevilles- Thomas Hardy

Do you have any issues or problems with how the billing of any medical work yours/your peers do is not regulated? (Since there is no real supply and demand market, where fair price will be discovered.)

there isn't a price

Hello Doctor!

I am a US medical student about to write for my board examinations. I'm interested in going into surgery, and have my first surgical rotation in a few months. Do you have any advice for me on how to be successful in the OR and on the surgical floor?

i'm not sure how US theatres are different from ours. In my theatre when we have students I try to introduce them to people and make sure they are comfortable but know the rules. I will try to teach so figure out what is being operated on and what might be appropriate. be polite and interested. be yourself?

How do you learn to detach yourself emotionally from the child/baby you're operating on?

practice and experience. it can be hard.

Thanks for your reply, I'm in awe of anyone in the medical profession, and a paediatric surgeon of all roles is one I have a massive amount of respect for.. So thank you for doing what you're doing :)

thank you

At what point in your career (# of years/operations) would you say it took to really be able to do that-separate yourself that is? And, have there been life events that has caused you to take a step back (birth of a child/death of a loved one)?

it's a constant process. i trained in adult surgery doing little operations and building up. it's a mental process that occasionally shakes but it's sound

Has any member of the public with a looser grasp of vocabulary ever mistaken you for a paedophile?

not me, but it does happen.

http://www.pressgazette.co.uk/wire/8897

Thoughts on the Anti Vaccine movement?

information is not knowledge. sharing knowledge and respecting each other is important but when evidence is overwhelming there comes a time to stop seeing conspiracy and accept reality.

Hi Dr. Fisher....What do you think of the state of coding in our system? I work in healthcare and have seen many different views of coders, and the multiple setbacks in the ICD-10 switch. What do you think is the biggest problem in the transition?

Also, this may be a blunt question, but, why are you not board certified? You have a clear license and are viewed as a highly qualified physician with great credentials; just curious to hear your view on the ABMS and their requirements. Thanks for your time!

The US and UK are more different than their spelling of the discipline.

Why'd you choose this field of surgery?

see above. Love kids, love surgery. Whole package

My young cat keeps clawing the curtains, should i have her declawed?

no. spray the curtains with dilute lemon juice.

Have you ever had a case you wish you hadn't taken?

cases come to us, we don't chose them. i've had some challenging cases, some difficult ones, some difficult families too but all of that is what makes every day different and a challenge.

Hi, thanks for doing this AMA. I was born with a congenital heart disease (TGA solved by senning), and one of my CHD compatriots is championing the idea that diet education is completely inadequate in the western world, particularly when it comes to the causes of life ending coronary issues.

I was wondering what your thoughts are on that, and specifically the way we approach healthcare. My friend (Adam) has the point of view that healthcare is too reactionary, and there is so little work into preventative medicine, and ensuring we don't end up in hospital in the first place. Do you think this is an important thing that we should be looking to change, and is it even possible?

I'd also like to thank you for the work you do, without people like you, I wouldn't be alive. (If you want to check out my friend and the work he is doing, please google Intelligent Eating - I'm sure he'd love to have some feedback from a medical professional)

amazing stuff.

the things I operate on are congenital, that means they are caused by things going wrong with how we are made. so far we have yet to find anytjhing that causes them so i'm not in that area where diet makes a difference.

amazing result for you though.

Shouldn't your title be 'Dr Ross Fisher'?

see above. it is. And isn't

can u give my child a face lift?

No child needs a face lift

If life begins at 40 does it end at 50?? ;-)

who says life ends at fifty??