MO:
Do you come from a medical family?
JCP:
Not at all. But there are many Pouliquens. I remember that, a long time
ago, one of our nannies came back from a consultation at the Porte de
Choisy Clinic and told my wife, "Your husband is very famous, I
even saw his office there." I was not working there any more, neither
did I have an office at the Clinic. However, there was a cupboard in
which they kept Pouliquen splints, with a sign on the door saying so.
I come from a very poor family, from a very humble social background.
Sadly, I lost my father in 1944. He was a school teacher. My mother
had not been trained for any job, and she had three sons: she had to
work hard so that we could study. Actually I am both the son of a "black
hussar" - that's what they called a radical-socialist teacher -
and a "child of the Republic", because it was the State that
paid for my education and that of my brothers, because we were war orphans.
It was a tough time, but we all managed to make good.
MO:
Where did you spend your childhood?
JCP:
My childhood days were spent amidst ruins. We lived in Normandy, near
the Mont-Saint-Michel, in the little town of Avranches, which was completely
destroyed on 6th and 7th June 1944. I was 6 years old at the time, but
I remember it very well. I have relatives who died under the rubble.
There were craters all over the place, where we used to fish for frogs.
Actually, I cannot see how we managed to study at all, since there was
nothing to motivate us. We went to secondary school in Normandy. I was
probably lucky to have had my older brother Yves, who inspired his two
brothers, Jacques and myself, to aim for higher things. Jacques graduated
from the University of Technology, and is a famous mathematician, a
brilliant man who has left his name in Science: he is the Pouliquen
who is remembered in Pouliquen's laws. I was lagging a bit behind; I
tried to catch up with the others, but found it difficult.
MO:
What about university?
JCP:
I went to Paris University. My eldest brother Yves had preceded us,
and wanted us to join him at his alma mater. I really would have liked
to read mathematics like Jacques, but given my level, that was not very
realistic; so I decided to read Medicine, like my eldest brother.
MO:
How did your specialty training go?
JCP: I
think that the first truly formative stage was at the Enfants Malades
children's hospital. I was in my second year, and that's when I met
Pierre Rigault. He was very, very bright, and very, very kind. He made
me work extremely hard, and he helped me a lot. He got me to do bits
of research and to present them. Meeting him was crucial to my further
career; it was the most formative influence of my life.
MO:
Had you already decided to go into surgery?
JCP: When
I started my specialty training, I had not yet opted for surgery. I
remember that I was with Dr Dérot at the Hôtel-Dieu Hospital.
He was into diabetes, renal medicine etc. When I joined him, I was pretty
sure that I wanted to do nephrology. But then I saw what these doctors'
lives were like - just walking round the wards all day, and talking
and writing - I thought that I would probably get bored before long.
So I went home and told my wife, "I'm going into surgery."
MO:
What was so fascinating about Rigault?
JCP: The
thing is that, at the time, Rigault did not have a university position;
he was there part-time, he did a few sessions at the Enfants Malades,
and that was all. He went there every morning, and looked after his
private patients in the afternoon. He was always regarded as a very
cold and rigid person, but in actual fact it was his warmth that endeared
him to people. He was not rigid - just rigorous. He would always welcome
us warmly in the morning; always had a kind word for us. He was extremely
knowledgeable and had vast experience - that's what attracted me straight
away. Rigault was very close to the younger generation of surgeons,
and looked after them a lot.
MO:
Was this not the case in other departments of surgery?
JCP: I
certainly had not come across anyone like him before. The other surgeons
that I had met before were rather formal, and were probably more interested
in themselves than in the juniors.
MO:
And after Rigault?
JCP: I
then did plastic surgery with Mr Morel-Fatio at Ivry; he also was an
extraordinary character, and I liked him a lot. I even toyed with the
idea of being a plastic surgeon. From there, I went to a non-training
post at the Porte de Choisy Clinic, to work with Emile Letournel at
a time when he was not yet on the medical school faculty. And then I
went to work with Robert Judet at Garches.
MO:
How was it with Letournel?
JCP: Letournel
ran an extraordinary surgical machine, with huge lists that started
very early. I probably was Emile Letournel's first junior who did all
the outpatient clinics with him and who assisted him with all his ops.
Emile was quite an emotional sort of person, he immediately took a liking
to me, and I think he kept that attitude right to the end. When I had
finished my specialty training, he took me on again at the Porte de
Choisy. That was probably my second formative stage. Emile Letournel
was everything people said about him: he was a perfectionist, he could
do things to excess, he had his weaknesses. But all that made him a
huge character, next to which one felt very small. I was dumbstruck
when I heard him hollering at people. I think I got scared as soon as
he raised his voice. But most of the time, he was a charming and extraordinary
guy.
MO:
Did Letournel prepare you for going to Garches?
JCP: He
prepared me so well that when I arrived at Garches, Robert Judet told
me, " You know, I cannot tell you off for anything, because Emile
Letournel told me you were the best". He had prepared the ground
for me so well that I was immediately and very warmly received by Robert
Judet. I had a special place in his Department, thanks to Emile.
MO:
Looking back, how do you now perceive Robert Judet?
JCP: There
was such a gulf between the junior that I was then, and the world-famous
surgeon Robert Judet, that I did not dare express an opinion. I admired
everything about him - his style, his courtesy, his kindness, his humour,
his extraordinary skills as a surgeon. For us juniors, he was a living
god. Today, nearly thirty years on, I see him slightly differently.
However, there was more to him than what one tended to see of him at
work. His personal life was extremely rich. He read a great deal, he
knew music very well, and would sometimes sing bits from operas during
surgery. He knew about the latest books; he went to the cinema, to the
theatre - in short, he was a brilliant man that was never stumped for
an answer.
MO:
Did he look after his aura?
JCP: He
was very simple in his speech, but, truth to tell, he loved being in
the limelight. He had a bit of an actor about him, which meant that
whenever he entered a room, he would immediately be the centre of attraction.
MO:
Why was that?
JCP: He
had huge charisma. There are people who command respect, who command
attention. And even when they say something silly, that's fine, it goes
unnoticed or it is forgiven. He had this tremendous aplomb, this self-confidence.
All the great chiefs of his time were like that - I remember Merle d'Aubigné:
he would come into a room, and there would be a hush.
MO:
How did he react when an operation was not going well?
JCP: He
had this habit: he would cock his head to one side and go humph. He
could be heard doing that; and then he would not say anything else until
he had got everything under control again. He never blamed anyone for
a failure. If a junior had done an operation badly, he would tell them,
teasingly, that they would need to learn a bit more; but it was always
done kindly. There was Robert Judet and Robert Merle d'Aubigné
in orthopaedics - Rob 'n Bob, as Judet would say. He could be quite
funny.
MO:
Tell us more.
JCP: I
loved being in his outpatient clinics. In those days, patients had to
undress before seeing the doctor. One day, this gorgeous 25-year-old
girl comes in, wearing nothing but a teensy-weensy bra and minimal panties.
Robert Judet asks her, "What have you come to see me about?"
So she says "I'd like you to have a look at my bunions," and
then she adds, "I could have gone to a more junior surgeon, but
I thought I'd go straight to the top." And Robert Judet, who was
not averse to seeing a scantily dressed beauty, says sotto voce, "Yes,
lady, there sure are some tops I wouldn't mind going to." That's
what he was like.
MO:
What did your timetable look like?
JCP: The
thing is that I was working both at the public hospital and at the private
Jouvenet Clinic. One had to be there at 7 a.m., and do a ward round
to see 60 patients. Three times a week, the Chief would come in early,
and all the juniors that were there would have to go and see him. Jean
Lagrange was there in those days, and Raymond Roy-Camille (the only
one at the time qualified to teach), Emile Letournel, Gérard
Lord, etc. The juniors did lots of things, but when it came to operating,
they were always with a senior colleague. There were no clinical conferences
as such, and the patient files were discussed in the junior surgeons'
office, which was also the changing room. Thinking back, there were
quite a few "freethinkers" in the department - people who
already had a fair amount of experience and who were doing their own
thing, without worrying about what the others thought, and, in particular,
without consulting the chief. Generally, he put a lot of trust in them,
and allowed new ideas to emerge in this way.
MO:
So that led to the Garches seminar every May, as a stock-taking session
in orthopaedic surgery?
JCP: The
Garches seminars were a bit of a show, not unlike the May Day celebrations
in the Middle Ages. They were a great song of praise to the Master.
Seriously, though, these seminars provided an opportunity for reviewing
patient records, for reporting on work in progress; but there wasn't
much be way of figures, and certainly very little by way of statistics.
One only needs to read the Actualités Orthopédiques books
by Raymond Poincaré to realize that there was then an abundance
of ideas, but no scientific rigor.
MO:
And you were surrounded by this abundance of ideas?
JCP: Yes.
When RJ discovered something new, either during a ward round or on one
of his many trips, it would "click" in his mind. He would
not talk about it. He would think about it. If he needed something made,
he would ask a manufacturer to come round, and explain to them what
he wanted; and he would find a name for it. For example, the famous
trochantero-iliac coaptation: I still remember the morning when he had
placed what was left of the upper end of a patient's femur into the
acetabulum, and was wondering what to call this newly-invented procedure.
He came back next day, and said, "We'll call it a 'trochantero-iliac
coaptation'". One day, I was doing the ward round with him, and
there was this young girl in one of the beds, and she had this dreadful
equinus. Emile Letournel had put a Steinmann pin through her calcaneum
and one through the metatarsals, to correct the deformity, gradually.
Two weeks later, Robert Judet had designed his joint distractor. I always
thought that the invention was directly related to what he had seen
on that ward round. He hated to keep patients in bed, and that's what
gave him the idea for a joint distractor that would allow gradual traction
whilst maintaining joint mobility. Every three months, there was something
new - and this something might be good or bad, it might stay or disappear
again. He must have developed six or seven models of total joint replacements
in the space of ten years or so. In other words, he was always searching
for something new. The advice he got from his fellow surgeons was not
always judicious, and he sometimes got things wrong. However, he was
the sort of person who always tries to do things better, which probably
means that he was never completely satisfied with what he had done.
MO:
What about the private clinic?
JCP: We
used to go and help him at the Clinic, with the operating list and the
outpatient clinics. I very often went with Jean Judet, because I was
more on the paediatric side. We learnt a lot there, because there were
many patients and the surgery done there was excellent. Afterwards,
there would be a big dinner, always with a delicious Beaujolais, so
we sometimes found it a bit difficult to go - I mean, it could be difficult
to find our way out of the entrance gate. It was a lovely atmosphere
of simplicity, warmth, and hard work. We felt good.
MO:
How did he cope later on, when things weren't going so well?
JCP: I
was very close to him when he was deprived of his position, on trumped-up
charges of tax evasion. He thought it was a political revenge, that
someone very high up had it in for him. He thought it was all terribly
unfair, and he was not wrong, because the conviction was overturned
a few years later. He was bitter about all politicians at the time.
He never told me who he thought it was, he never said anything bad about
anybody. It was his secret. He coped, but he never forgot. So, in 1976,
he left the hospital, and he continued his private activity at the Jouvenet
Clinic, which was doing well. Professionally, I do not think he was
too badly affected. He had kept many contacts with his former students
and with the orthopaedic fraternity worldwide. Lots of people still
came to see him. He loved having people round to lunch. Maybe it was
also an opportunity to keep the famous Beaujolais going.
MO:
When you were training at Garches, were you already considering paediatrics?
JCP: Yes,
I was. After that time at the Enfants Malades, under Rigault's influence,
I had kept up an interest in paediatric surgery. There were lots of
children at Garches, so I was often asked to look after them. Later,
I spent a year as Senior Registrar at the Enfants Malades, and Rigault
would take me very frequently to the seaside children's orthopaedic
hospital at Roscoff. When I was back with Robert Judet for a second
year as Senior Registrar, he asked me to set up a section of paediatric
orthopaedics in his Department. That is how I came to start this work
at the end of my specialty training. I was still going to Roscoff -
in fact, I kept going there for over fifteen years. Once I was fully
qualified as a specialist, I worked part-time for two years at the Porte
de Choisy, where I practised adult surgery with Letournel. I helped
him a lot with the trickier cases, because I wanted to keep up my adult
orthopaedics skills, in case I failed to find a position in a public
hospital.
MO:
Do you think there is a great deal of difference between paediatric
and adult surgery?
JCP: Not
technique-wise, but the general approach is quite different. When one
does paediatric orthopaedics, then, as Henri Carlioz puts it, one is
first and foremost a paediatrician, and then maybe a surgeon. The concept
is different, the postoperative management is different, the relationship
with the patient is different, and the hospital stay is different. The
only thing that is not different is the actual surgical procedure. If
one takes an orthopaedic surgeon who has only done adult cases, and
teaches him the three or four specific aspects of children's surgery,
they will be perfectly OK operating on kids. Technically, though, adult
surgery is generally more difficult than paediatric surgery. That's
why I think that it is absolutely necessary for a paediatric orthopaedic
surgeon to have had a sound training in adult orthopaedic surgery.
MO:
Once you had finished training, did you stay in touch with Garches?
JCP: I
did sessions at Garches, worked part-time at the Porte de Choisy, and
went regularly to Roscoff, where I did paediatric orthopaedics only.
I shared my time between these three places. This actually lasted only
two years, because Emile Letournel was appointed at Garches, but very
soon left for the Porte de Choisy. This left a vacancy, and the Chief
offered it to me. I was appointed in 1974.
MO: And then?
JCP: I
was made a member of the medical school teaching body in 1974, when
I was mainly doing paediatrics. Unfortunately, in 1976 the Chief had
to leave, and there I was with Alain Patel as Head of Department. The
situation was a bit difficult, because I was reporting to him, and every
time I would say something, he would say the contrary. So I had to go
and see the Chief Administrator of the Paris Public Hospital Group,
to ask for my independence. In 1978, the paediatric department was made
into a separate entity, so I was free, and had my own staff. However,
the new unit was desperately poor. By way of office, I had been given
a little wooden hut, with a single x-ray viewing box; and it took several
years to get the necessary funding. It took ages to get the unit up
and running. Eventually though, and thanks to my loyal co-workers such
as Jacques Beneux, we managed to make it into a department that won
the respect of the French paediatric orthopaedic community.
MO:
What were your special interests?
JCP: I
have always had two main interests: scoliosis and limb length discrepancies.
At first, I only followed what the Judets did to treat the discrepancies.
They had started femoral and tibial lengthening with their external
fixator at the same time as Wagner was doing his work. They pioneered
the idea that the bone must heal by itself, whereas Wagner lengthened
and then grafted and plated.
MO:
How could they lengthen with the "rail" fixator?
JCP: There
was a threaded bar for distraction. So, they had actually invented healing
during distraction, the principle that would later be publicized by
Ilizarov and then by De Bastiani.
MO:
You mean they had already got the idea that bone might heal during distraction?
JCP: The
Judet brothers did not do anything further to the lengthening site;
they thought that the bone had to consolidate on its own, because the
periosteum had been preserved and stripped up. They had understood early
on that the fibula needed to be transected and the external malleolus
had to be fixed to prevent it riding up. That is something the Italians
did not accept until twenty years later. The Judets had designed a universal
technique that could be applied to all bone segments. Mind you, they
were helped in this by such co-workers as Pierre Rigault and Jacques
Plumereau, who had contributed some improvements. We used that technique
for about 12 to 13 years. Yards and yards of tibias and femurs were
lengthened, still with the old distractor, until we discovered the Orthofix
Fixator.
MO:
And no "Ilizarov period" in between?
JCP: Oh
yes, I did play at that. I tried to do a few Ilizarov fixators, even
though I kept pricking myself because I am such a butterfingers. I found
the Ilizarov very uncomfortable for the patients, and I did not think
it was that helpful, apart from a few rare cases that would have been
difficult to do otherwise. So I stopped using this technique very quickly.
That's when I went to Verona, where I met De Bastiani and his team,
with whom I established close links.
MO:
What did they have in Verona?
JCP: They
had hardware that was better and easier to apply than ours. It was more
or less the same philosophy as ours, but with the difference that in
Verona they had invented dynamisation. The Verona Team, whom I like
a lot, had created little "enhancements" of the hardware,
and had some new ideas. So we started to use this kit, and one day we
started looking into what to do with tibias. This is how we came to
design the T-Garches that is nowadays in worldwide use. There were several
reasons. Firstly, it had occurred to us that the tibia should not be
lengthened in the diaphysis, which does not consolidate very easily,
but in the metaphysis, where consolidation occurs quite readily. Secondly,
when a tibia is being lengthened, the first and very common complication
is a valgus deformity. When the tibia is being lengthened in the diaphysis
and there is a valgus deformity, it will be in the diaphysis. If you
need to correct it, you will need a diaphyseal osteotomy, which is not
good for consolidation. So we came to the conclusion that what we needed
was a metaphyseal osteotomy with a device that would allow us to correct
every time the bone went into valgus. That is how we came to the design
of the T-Garches fixator. It inserts in the metaphysis and the diaphysis,
and includes an axial correction facility. This allows the user to continually
correct the valgus; it also enables the surgeon to start from a varus
or a valgus tibia and to correct the deformity in the process of tibial
lengthening.
MO:
What did the Verona team think of it?
JCP: The
Italians had not seen it, and they were a bit critical at first. Then,
slowly, they warmed to it, and now they use it all the time. It is also
being sold in all - or nearly all - countries of the world. The most
common application is actually not in tibial lengthening, but in knee
alignment in older patients, to allow them to weight-bear immediately.
That's not what it was designed for, but it is used this way in many
countries, in particular in Spain and in the Nordic countries.
MO:
Do you still do a lot of limb lengthening?
JCP: I
am doing less than before. The morbidity of limb lengthening is extremely
high, and one needs to select individuals that are likely to benefit.
With some patients that have only minor shortening, I prefer doing an
epiphysiodesis on the other side at the right time; this is better and
less risky for them. With patients that have gross shortening, I sometimes
think that lengthening programmes would be too risky, either for the
hip or for the knee; in such patients, orthotic solutions may be preferable.
Let's say that as one gets older one gets more cautious, and one no
longer tries to correct everything and anything with high-tech solutions.
One prefers to play it safe. However, while I am doing fewer such procedures,
I have not entirely given up limb lengthening, because people are coming
to our centre from quite far afield, having heard of this well-established
technique of ours.
MO:
Do you still use the T-Garches?
JCP: Sure.
For tibial lengthening, I use the T-Garches about nine times out of
ten; if a three-dimensional correction is needed, we may need to use
the Ilizarov. For the femur, we use the Orthofix almost exclusively;
and in some difficult cases, we would use Mike Saleh's hybrid fixator.
Having said that, I am not opposed to lengthening over an intramedullary
nail. Christophe Glorion, who works with me, has used one in our Department.
It is a good technique, but it is not suitable for all and sundry. It
must be used only when growth is complete or nearly complete; if the
femur is not too deformed, and if the medullary canal is wide enough.
That's a lot of ifs. When some of the mechanical problems are resolved,
I think it will be a worthwhile technique, but not everything has been
resolved yet.
MO:
What about scoliosis?
JCP: The
question is whether significant advances have been made over the past
20 years. The answer is: yes and no. The big novelty nowadays is the
Cotrel-Dubousset system, which enables patients to stand again very
quickly, and which allows angulations to be stabilised with fewer non-unions
than before. It is of benefit especially in neurogenic scoliosis; however,
it has not meant major progress either in terms of final reduction or
in terms of cosmesis in idiopathic scoliosis.
MO:
How was it done before?
JCP: With
Harrington rods and casting. The cast shaped the spine very nicely,
and I can assure you, it's very encouraging to see again the patients
who were done with Harrington rods 25 years ago. Most of the time, these
patients are pain-free. Girls who had Harrington rods have grown up
and had babies, without too much trouble; and they bring the little
ones to me, so I can check and see they haven't got scoliosis. They
may have a flat back, spinal curves that go the other way, etc.; but
when all is said and done, they are doing very well. So perhaps one
should not go for over-sophistication. The big mistake nowadays is to
want to achieve a nice X-Ray. The problem with scoliosis is not to achieve
a nice X-Ray, but to achieve a scoliosis that does not get worse, and
a fusion plane that is horizontal so that it does not hurt.
MO: Why not go for sophistication?
JCP: Because
this is still risky surgery. The biggest catastrophe that one can have
as a surgeon is to operate on a girl of thirteen and a half who has
a scoliosis that she could have lived with absolutely fine, and to leave
her with paraplegia. That is a terrible tragedy. I don't think that
one is a scoliosis surgeon: one is a doctor who sees a child who is
growing and who has a scoliosis. The scoliosis and what is going to
happen with it have to be seen in the context of this child and her
family, and her other activities. Nowadays I leave many girls to complete
their growth; I leave them with a 40° thoracic scoliosis, with double
curves of 50-50; and I tell them that if one day they are unhappy, there
will still be time for surgery. They simply need to be carefully monitored.
MO:
Do you think that we have gone too far with instrumentation?
JCP: I
do not want to be dogmatic, but we need to be extremely critical and
admit that since adult orthopaedic surgeons are so good at treating
scoliosis, we do not have to sort everything out in childhood. Can we
not leave some of these kids in peace for ten or fifteen years? And,
who knows, by the end of that time, there may be some new way of treating
their spines. What fascinates me in the management of scoliosis is the
medical side - I find it almost more interesting than the hardware aspects.
I find these "Spine-Centers", where it's hardware all the
way, rather frightening. The human element will be completely lost sight
of. We must remain paediatricians. We must acknowledge that not all
problems need to be sorted out before the child has stopped growing.
MO:
What would you think of a large orthopaedic centre that would treat
everyone - from babies to the elderly?
JCP: If
it has all the other paediatric specialities, that's fine by me. I am
not at all against collaborating with adult orthopaedic surgeons; but
the idea of a children's hospital must not be lost. The children's hospital
is above all a place that is open to children round the clock; and it
is a place that offers virtually all the specialties that a sick child
may need. Let's take an example. In my Department, we have lots of cases
of paediatric rheumatoid disorders. This means there are children who
have to have their hips, their knees, etc. replaced. These patients
obviously cannot be treated without the support of colleagues who routinely
do such joint replacements. Working together with adult-orthopaedic
surgeons is essential here. But these are very fragile children. They
are very difficult to intubate. They are on drugs, on cortisone, etc.
They usually are of low weight. It is vital to keep them in a paediatric
environment, with appropriate intensive care facilities, and with paediatricians
who know how to look after them. In other words, the problem is primarily
one of the right environment. A paediatric surgery department needs
a comprehensive paediatric environment, and it needs it all the time.
An adult-specialist surgeon can always be called in to perform a procedure
that one does not feel fully qualified to do. But that is on a one-off
basis.
MO:
Why did you leave Garches?
JCP: First
the Paris paediatric surgeons had wanted a reduction in the number of
paediatric surgery departments in Paris; that was during my term as
General Secretary. Then, Garches was going to focus on disability, and
was getting further away from everyday paediatrics. And finally, Rigault
was leaving, and the Governors asked me to take over. On this occasion,
I offered to transfer the entire paediatric facility at Garches to the
Enfants Malades, so as not to leave the unit amputated. Things then
happened somewhat faster than planned. Philippe Touzet sadly died, and
that hastened my departure. It is not easy to arrive at a department
where you are a kind of usurper. I had many contacts with quite a few
of Pierre Rigault's colleagues, who had assured me that everything would
go well, that I would have a warm welcome, but, actually, it was all
a bit more difficult than I had anticipated.
MO:
Why was that?
JCP: At
Garches, my department was almost brand-new, while the department at
the Enfants Malades had not been redecorated for a very long time. When
I was asked to go there, I was told that all the renovations would be
carried out. This work was only partially done, and with a two-and-a-half-year
delay. I had to reorganise the entire department, to mould it to our
way of doing things, which is very much team-based. One could say that
Christophe Glorion and myself have recreated something that is close
to what we had at Garches; and we now have a very close-knit team, with
people for whom I have great admiration - people like Jean-Paul Padovani,
Georges Finidori, and Jean Langlais.
MO:
Do you have any regrets?
JCP: The
change-over meant losing a certain number of posts in the Department.
This was despite the agreement that we had, according to which there
would be no reductions. However, the task is enormous, and I am still
hoping to get a few more posts back. Paediatric orthopaedics does not
feed a surgeon; you almost have to try and recruit saints. There aren't
many people who would be prepared to do as they are told, with no certainty
as to their future prospects. If you take someone on of whom you think
that he or she is Consultant paediatric orthopod material, and they
fail to find a position at a public hospital, what is to become of them?
They may go into the private sector. But you know as well as I do that
in order to have a sufficient number of cases, one has to work at four
different places. It will be a dog's life. The result is that there
are very few young surgeons who will commit to this specialty, and it
is incredibly difficult to recruit and train them.
MO:
Should the system be changed?
JCP:
It is absolutely necessary to review the hospital hierarchy; and many
are thinking about it, in the wake of Henri Carlioz' initiative. We
cannot go on the way we are doing now. At present, someone is made a
Consultant and Professor for life, meaning that it would take gross
misconduct for that person to be fired. Whether they actually do any
teaching once they are tenured is a different question. I think that
the academic part of the post should be in the form of a time-limited
contract with the medical school. Also, much more consideration will
need to be given to the candidates' willingness to teach, and the whole
system be made less automatic. In a revised system, applicants could
be graded in terms of their academic aspirations and abilities, into
different grades - say, one, two, and three. Selection could then be
made accordingly. This would be fairer when it comes to filling hospital
posts, and it would mean that those with who genuinely wish to teach
could rise on the academic career ladder.
Maîtrise
Orthopédique n° 108 - 2001, November
