Surgeons at the Sharp Edge: Doctors Dealing With Knife Crime

Edna Astbury-Ward

September 23, 2019

Birmingham - The Royal College of Surgeons has held a special event focusing on knife crime. Medscape UK talks to Mr Ewen Griffiths, a specialist in treating stabbing injuries.

   

Mr Ewen Griffiths

A stint in 1998 in Soweto, South Africa, set the career path ahead for Mr Griffiths, a consultant upper gastro-intestinal and general surgeon at Queen Elizabeth Hospital (QEH), Birmingham. Little did he think those early years of his surgical career would stand him in good stead for the trauma and knife related injury surgery he now does as part of his work in Birmingham's QEH. There have been 269 knife crimes recorded in the city so far this year representing a 17% increase.

Overall, the police in England and Wales recorded a total of 47,136 offences involving a knife or sharp instrument in the year ending March 2019. This is the highest number of offences involving knives or sharp instruments since recording began. It is a situation that Mr Griffiths referred to as "a public health emergency". Mr Griffiths presented his work as a surgeon treating penetrating abdominal injuries to delegates at a multi-professional conference on knife crime in the West Midlands. He talked to us about his life as a surgeon at the sharp end of knife crime.

Q&A

What are your views on the Government's previous announcement asking doctors to report knife crimes ?

Previous GMC guidelines suggest that all health care professionals, not just doctors, have a professional obligation to report both knife- and gun-related incidents to the police. The guidelines are controversial and clearly we need to balance the right of the individual patient to confidentiality with those of wider public for safety reasons. There have been concerns that patients would avoid seeking medical attention or abscond from hospital after treatment to avoid a police interview. Certain patients affected by knife crime do abscond or self-discharge from hospital and poorly attend for follow-up appointments.   Luckily it is usually the emergency department staff who initially liaise with the police if required.

Emergency surgery as opposed to scheduled surgery presents exceptional challenges, what concerns you most?

Trauma is fast-paced, with time pressures to stop bleeding or to fix life-threatening damage to the intestines or other solid organs. Patients are taken to theatre very quickly, so there isn't much time to plan the operation. Trauma is very unpredictable and often occurs outside normal working hours when staffing is less. Sometimes other injuries can be found during the operation – this all adds to the challenges of treating these patients.  

My biggest fear is of a patient bleeding to death on the operating table and of me not being able to stop the haemorrhage.  This can occur with the severest of knife wounds to the major blood vessels and in patients who develop a coagulopathy and essentially lose all their clotting factors due to the severity of the bleeding. Fortunately, this scenario is very rare. 

Obviously, your main concern is to save the life of the patient or minimise injury at the site of the stab wound. What emotions do you feel at the time?

I completely park these emotions to one side, otherwise I won't be able to do my job as a surgeon, as this requires me to be completely focused.  I don't want to know much about the patient who I'm operating on in a life-threatening emergency. If I know they have a young baby at home or have recently been married, this may affect my judgement. I also certainly don't want to know if they have stabbed and killed other people, especially children, as this emotionally would be far too much to deal with. Essentially the NHS will treat anyone injured as they come in through the door, and the questions will be asked later by the police or the courts. You get pretty good at compartmentalising in this way.

Do you ever feel angry that your surgical expertise is being used in this way?

I like to remain as professional as possible at all times and anger isn't a particularly helpful response in these scenarios, whilst treating patients who have been injured with knives.  However, in general, knife injuries are upsetting, especially with the stories all across Birmingham about everyday people getting injured with knives in a variety of scenarios, such as robberies and car jackings, through no fault of their own. Probably the angriest I've ever felt about a stab injury patient was a man who was treated in my hospital who had killed his own child and then injured himself with a knife in an attempt to commit suicide.  He was treated with surgery by my colleagues for a severe knife injury which could have easily have killed him, but he survived due to the skills of the NHS.  Although I wasn't involved in his care, I did worry about whether I would have been able to adequately care for a man who murdered a child of similar age to my own children. Again, the NHS as a whole will treat these patients no questions asked, and the other systems will look in to the circumstances later.       

What frustrates you about your trauma work?

I find it really frustrating when patients who have been stabbed are recovering on the ward but are perhaps rude to nursing staff or resistant to the care that we are trying to offer. In an ideal world we would have the staff with training to explore this further, for example with psychological input, but the reality of the system is that we patch them up and send them on their way.

What has been the most complex knife injury surgery that you have performed?

Luckily most knife wounds to the abdomen are fairly easily treated and some don't even need an operation. The more complex ones either involve injuries to the chest, with the knife going through the diaphragm and injuring the thoracic organs, or vice versa. Injuries that involve the head of the pancreas or the retroperitoneal structures such as inferior vena cava, aorta or renal vessels are also a major challenge. Injuries such as these are best treated at major trauma units such as the Queen Elizabeth Hospital, as we have all specialists on one-site, such as vascular surgeons, cardiothoracic surgeons and pancreatic surgeons all under one roof. It is always reassuring to know I am part of a wider team of other specialists, from the ambulance staff to emergency doctors, anaesthetists and theatre scrub team and ICU. 

How do you process what's happened to you in the day?

I don't, I block out my feelings or it would drive you nuts!

So do you think that there is sufficient emotional support for surgeons doing such traumatic work?

No, I don't. If I were a psychiatrist or psychologist there would be, and I'd know how to get it, but as a surgeon….well you're not sure. The trouble is, we don't celebrate our successes enough, we always focus on our errors, 'we should have done this or that', when in fact we should really be celebrating our successes.

What are you most proud of, or has been your greatest success in your surgical career?

I once had to go to the Crown Court to give oral evidence on my surgical treatment of a patient who was being tried for murder and who had suffered significant stab injuries which required emergency surgery. A few years later the patient's father stopped me on my way out of the hospital to thank me for treating his son and [said] that although he was in prison, he was very grateful that he survived and had a chance to turn his life around. I'm very proud to work at the Queen Elizabeth Hospital and be a part of a hospital that has excellent surgical facilities for treating patients and gives world class care, with a strong focus on team work. 

What are your views on the new West Midlands Police knife crime initiative to use murderer Sadam Essakhil to front their campaign?

It is clearly controversial to use a convicted murderer to front the West Midlands Police knife crime campaign. However, his message to children and teenagers is clear, in that they should not carry knives for self-protection. Hopefully teenagers and young adults will listen to his message more than they would from doctors, police officers, teachers or community leaders.

What in your view is the single most important factor in tackling knife crime?

Prevention is the absolute key to this issue. Treating patients who have been stabbed is important, but far too late. We need to tackle the other associated issues and deep root causes of the underlying problem, including addressing inequalities, social deprivation, unemployment and drug and alcohol abuse.

West Midlands Police and Crime Commissioner (PCC) David Jamieson has recently secured £7.6m for the ' knife crime emergency ' in the area. It doesn't seem as though any of it is being spent in the health sector, which ultimately has to patch up and care for its victims. If you were allocated some of this money, how would you spend it?

This is a great start for the West Midlands and I fully support this initiative. I think more money needs to be spent on the prevention of knife crime, with similar police and educational strategies in schools and colleges for example. I also think knife crime in the UK needs to be seen as a major public health issue.  

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