5 Questions for Hassan Malik, President of BASO

Siobhan Harris

Disclosures

July 07, 2020

Hassan Malik is a consultant hepatobiliary surgeon at University Hospital Aintree and is the current President of BASO - the Association of Cancer Surgery.

He obtained his medical degree from Glasgow University in 1992, was awarded FRCS in 1996 and an MD in 2000.

Mr Hassan Malik

Mr Malik has extensive surgical experience and has performed more than 500 liver resections. He also has an interest in retroperitoneal sarcoma surgery. He has more than 100 publications within his field of interest. Medscape UK asked him about his career highlights, the implications of COVID-19, and his views on the future of surgical oncology.

Q&A

Did you always want to become a surgeon? If you weren't a surgical oncologist what else might you have been?

No, when I was in medical school, I wanted to be a respiratory physician. In those days you did a junior house officer job and mine was in respiratory medicine in Glasgow. After spending a year as a very junior doctor my thoughts and ideas evolved and, as you also did a surgical job, that attracted me more, so at that stage I went down a surgical career path. From the beginning it was always medicine as it’s a fantastic career in terms of what you can do for patients. It's gratifying emotionally as well as being very challenging but I wouldn't ever look back.

What would you class as the greatest achievement in your career to date?

I think what we have achieved in our unit around training and research has been the greatest achievement. As a surgeon you work within a team, but surgery is a craft. What you do lasts through your career, then you retire, and that craft is perhaps lost. The way to prevent that happening is to train the next generation. Seeing people who've been inspired to enter my area of surgery who've gone on to do fantastic things, that's a great achievement. Similarly, research fellows who do some phenomenal work - beyond my understanding, to be honest - and who have bright careers ahead of them: that's gratifying.

What do you think will be the long-term impact of COVID-19 with so many cancer surgeries being cancelled? How are you dealing with the backlog of surgical oncology cases?

COVID-19 has exposed the fragility of the system. I think ultimately there will be a temporary issue where we play catch-up. Certainly, for patients who were listed for surgery which was cancelled, we are pretty much caught up in our hospital. For the last 2 months we've been playing catch-up and getting through the backlog.

The big issue will be the loss of diagnostics in the patients who've delayed presentation, that backlog will come through the system probably in the next 6 months so I can't see it being a major issue unless we have another significant spike.

I'm hoping we've learnt our lessons and are able to run our services in a more robust way. We have certainly learnt a lot in the last few months.  Our traditional job plans went out of the window. We were able to bring in innovations that we'd been trying to introduce for years, things like virtual and telephone clinics, which have been fantastic. Although there are IT issues, these have made a big difference and these are areas of good practice that we will be keeping.

What changes can you envisage in your field over coming years? Do you think technologies like artificial intelligence (AI) with robotics, big data and imaging will revolutionise oncology in the future?

People talk about big data, AI and robots and all that, but when you triangulate all that, you can encapsulate that in one word – autonomy. Surgery is an art form and we are all artisans to a certain extent, but in the future I could envisage the operations that I do today being done autonomously. Basically, a robotic system that can physically do the operation, with an AI brain that's able to guide the robot in real time, potentially with a human operator who is managing the caseload. Whether that is a reality that people want to accept I don't know. For some the loss of the human interface, the surgeon, is something that isn't acceptable. If you need a gall bladder operation, for example, and the choice was to have it done at your local hospital with a local surgeon, who I'm sure would be excellent, or to have it done using an automated system that has been trained by the best five experts in the world what would you rather have? I think things will transform over the next few years, but will it be acceptable to patients? A surgeon of the future may be someone who manages a bank of robots in a system that can work efficiently 7 days a week.

We are already seeing the impact of imaging in radiology. There are certainly areas on the diagnostic side that are ideally suited for AI systems that recognise patterns. What may drive developments may be the future choices of medical students, or the cost of healthcare. A lot of the costs at the moment are salary costs. I think ultimately if these technologies allow us to do operations that aren't currently possible and to cure more patients of cancer then it's time [for greater use of automated systems].

The NHS has shown how adaptable and durable it has been through the current pandemic. What challenges do you think the NHS will face looking forward?

I think I'm always positive about things. There'll always be challenges in terms of funding and adopting new technologies. With medicine I think it's important to keep things simple. As a doctor, which is fundamentally what I am, I do the best I can for the patient in front of me. If every other individual in the NHS does the same then the future is bright.

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