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"Under The Knife" by Gulzar Mufti

Surgical stories from around the world

"Under The Knife", a book by Gulzar Mufti, published in November 2016, is reviewed here by Mr Mark Speakman, Past President of BAUS.

To read more about the book, or to purchase a copy, please click on the book cover image (right). 

"This is a thought-provoking and very readable book, which describes the many clinical and non-clinical episodes in the author's much-travelled life during a varied and successful surgical career.

"For both surgeons and patients, a surgical operation is a complex and sometimes frightening journey; for surgeons it is an oft repeated journey, whilst for patients it is frequently a life-changing one.

"The story starts in his place of birth - Srinagar in the Kashmir Valley, Northern India - and how his early upbringing influenced his career choices. This was shortly after the partition of the two newly-independent countries of India and Pakistan, and recounts some of the tensions of that time. In those days, there was at least as much traditional healing practiced as modern medicine.

"Gulzar recounts his entry into medical school, followed by his early medical training and tells what made him choose to enter surgery as a career. He relates some of the trials and tribulations of inefficient hospital systems and poor management structures he has met across the world, trying to draw analogies with modern practice and consider how these thoughts may change practice in the future.

"Reading this will allow surgeons to reminisce and reflect on their own practice over the years. The narrative also reports clinical events from colleagues around the world, describing their surgical adventures and anecdotes in a wide range of surgical conditions.

"Plenty of attention is paid to learning the technical proficiency of surgery, but there is also clear recognition of the importance of non-technical skills, well before their recognition by the many Royal Colleges and their introduction into the selection process for good surgeons.  It is written to appeal to both healthcare professionals and the lay public.

"Many of the stories highlight the vital importance of clear communications in the operating environment and how, without this, things can go badly wrong. It stresses how, in the tense operating theatre environment, surgeons sometimes do not mean what they say and, at other times, do not say what they mean. It soon becomes clear that a really good theatre sister is essential. Not only do these accounts follow the actual surgical events that took place, but they also describe the great joy and relief that followed some of these procedures.

"Whilst there are many anecdotes from the past, both in India and in England, these are regularly referenced to modern-day practice, with direct quotes from Royal Colleges of Surgeons and GMC documents such as Good Medical Practice, deomnstrating that the messages from the past are just as relevant today. His professional participation in the GMC Fitness to Practice Committee, and his knowledge of the UK National Patient Safety Agency also allows him to add useful caveats. It is brought up-to-date with recognition of, for example, WHO Surgical checklists (based on airline pilot checks) and the UK avoidance of "Never Events" (such as retained surgical instruments and wrong side surgery), all of which the good surgeons used in the past, often without realising it.

"There is much that we can all learn from this novel as it charts both a personal journey and, to some extent, the development of modern surgical and urological practice."

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