Setting a Great Example

What is the role of the college?

If we go back to the Royal College’s charter, we have a very defined role which is essentially focused on setting standards, propagating good practice, educating the public, encouraging and facilitating research, and running exams to maintain standards. The challenge is applying that role in the setting of the current UK National Health Service (NHS)...

How would you describe the political component of your role as president?

I would use “politics” in the widest sense, in that we need to propagate and engage with all communities and individuals that have an impact on ophthalmology services in this country. My basic aim is to help ensure that all patients have equal access to the best care possible for their eye condition – it is an aspiration I think any eye doctor would say. To do this we need to engage with the wider NHS, and with anybody who may have an influence on our ability to achieve that.

Any comments regarding Brexit?

We’ve been discussing this and have started a watching brief in college. Brexit may well impact workforce and our ability to undertake international research, particularly with our colleagues in the EU with whom we have very strong research ties. But until we have more information and the true nature of Brexit is made apparent, all we can do is speculate. We will do our best through the college and the academy to try and mitigate any adverse actions from Brexit. Currently, I am reviewing our relationships with other nations’ colleges and trying to foster collaborations despite Brexit.

How would you define the modern ophthalmologist?

One of the biggest changes I have observed over the past 30 years is the shift in the NHS to a consultant-led service. We at the college are reviewing and reflecting on what a modern ophthalmologist is – and assessing what they need in their working lives so that we can support them. We recognize that there are challenges for trainee ophthalmologists – challenges that we probably didn’t have to face when we were training. There is no doubt that the whole NHS is under pressure – and it is being felt by every single person working in an eye department today.

It is very difficult to predict where the future is going to take us. In my lifetime, we have gone from saying “We’re very sorry, we can’t do anything for wet age-related macular degeneration (AMD)” to an era where anti-VEGF drugs have brought about a huge change in how that condition is treated. We could end up with an AMD drug that is a one-off treatment, but we could equally find ourselves treating dry AMD in a similar way to how we treat wet AMD now – and either could have huge implications on the practice of ophthalmology.

Why medicine and why ophthalmology?

There are all sorts of answers. My dad was a general practitioner and that almost certainly subliminally encouraged me! When I was at school I really enjoyed physics and mathematics, but it dawned on me that I was never going to lead the field in these areas. It might be trite to say, “I’ve always wanted to help people,” but it’s true. You can’t practice medicine for 30 years without at least wanting to try, and despite some of the pressures we are under, it is still a great joy to be able to help patients. This personal satisfaction certainly keeps me going in ophthalmology.

Why I chose ophthalmology in the first place is a question I ask trainees to reflect on. In my day, we had the opportunity to try a variety of subspecialties before choosing – I wanted to try ophthalmology, found I liked it and carried on. There is less opportunity nowadays, so I encourage trainees to consider the routine procedures of each subspecialty, and ask themselves the fundamental question: “Can you stand the thought of doing that for 30 years?” For ophthalmology, the routine procedure is cataract surgery, and although I have performed many thousands of procedures I still find great personal satisfaction in doing it and doing it well. So I can justify why I have chosen ophthalmology.

And your journey towards neuro-ophthalmology?

A combination of people influenced me towards considering neuro-ophthalmology as a career. After training in Oxford and Birmingham, I had the opportunity to spend a year in Brisbane where I started working in neuro-ophthalmology with John Harrison. I was also fortunate enough to be appointed at St. Thomas’ and then the National Hospital (London) to train as a general ophthalmologist with an interest in neuro-ophthalmology. I still do general clinics, manage glaucoma and perform cataract surgery, but half of my life is neuro-ophthalmology. One nice thing to look back on is being involved in setting up a center at the Queen Elizabeth Hospital in Birmingham, which is now of a size to rival any other neuro-ophthalmology service in the world.

How have you approached your career?

I like to think of myself as a fair-minded individual, and I do genuinely believe I have a patient-centered approach to health care. I would say that is probably what I’m most concerned about. The rest, fundamentally, is add-on; when it comes down to it it’s about doing the best for the patient, and that’s what I put first.

What advice would you offer those entering the profession?

I jokingly say to my trainees that they’ll qualify as a consultant at 34… then spend the next 34 years doing the job. I do encourage trainees to review and maximize their training so that they’ll get the best out of those many years. One of the pieces of advice I would always give trainees is: don’t hurry to the top; instead, make sure you’re as fully trained as possible across a wide spectrum, not just for the clinical work. I encourage people to spend time abroad, if possible – I had my best year of training in Brisbane for all sorts of reasons.

Any advice for the young Mike Burdon?

Apart from taking up golf and winning the open or taking up tennis and winning Wimbledon, I am not sure I would make any changes! I genuinely think that I – whether it be through design, luck or combination of the two – have ended up in a career that I consider to be very worthwhile. If I were to make any changes at all, it probably would be completing a PhD as a trainee.

What makes a good mentor?

The people that I really look up to are those who set an example. Early on in my career I would point to Hung Cheng, a consultant ophthalmologist in Oxford, who set a quiet example of professionalism that I took with me. Similarly, in neuro-ophthalmology, Michael Sanders and Liz Graham, in particular, set standards of professionalism and knowledge, and how to be a doctor that people can learn from. I don’t think anybody sat me down and said “Mike, you’ve got to do this,” but instead influenced me by setting examples that I aspire to follow. I also want to mention John Harrison from Australia – he’s a man of very few words but his intellect is significant and he taught me a lot, whether he knows it or not.

What has been particularly memorable in your career so far?

I’ve had some interesting moments. For example, I was invited to Tony Blair’s most recent evening function when he was thanking hospital staff for looking after soldiers from the wars in the Middle East. Another time I was teaching in Christchurch, New Zealand, when the major earthquake happened – so I know what 7.1 on the Richter scale feels like! The other thing I would like to emphasize is the international work. One of the things that the college can be proud of is its increasing support of international ophthalmology, particularly in East Africa, and I’m very proud to have been a part of it. I don’t want to sound smug or trite; there is a genuine sense of satisfaction from helping in Africa. You can see the clear need – and if you can make a difference, it’s rewarding.