The Secret Life of a Geriatrician
This new BGS blog series shows how passion for a career and hobby can share fascinating qualities.
Philip Braude is an ST6 in Geriatric Medicine, specialising in perioperative medicine
There is a flash of knowing and relief as I click the shutter capturing a distinctive moment of the natural world. I take a moment to flick on the camera’s display screen to reassure me that everything has gone to plan, or not, and I make corrections for the next picture. Creating a cohesive image from the complex order and behaviour of wildlife takes planning, patience and perseverance.
My passion for nature photography grew from a need to relax away from long general medical on-calls. Many twilight evenings I would use my camera as an excuse to roam London’s outer green spaces. However, my understanding of this art form has developed alongside my medical career.
Geriatric Perioperative Medicine
Today I am carving a niche in geriatric perioperative medicine. As the proportion of older people in the population increases, the demand for surgical procedures is growing. Reports such as the NCEPOD 2010, “An Age Old Problem” and Royal College of Surgeons “Access All Ages” have highlighted this as a growing issue needing immediate attention from experts with geriatric knowledge. I have just completed a year in the POPS team (Proactive Care of the Older Person Undergoing Surgery) at Guy’s and St Thomas’ where older elective surgical patients with multimorbidity are seen preoperatively. Drawing on principles from geriatrics, a comprehensive risk assessment and optimisation plan is made and communicated to the patient, carer, surgical and anaesthetic teams. The POPS team follow the patient through their inpatient stay, while also case-finding problems with older people admitted for emergency surgery. Care is coordinated with the multidisciplinary team to reduce complications such as post-operative pain, pneumonia and delirium while safely reducing the length of inpatient stay [Harari 2007].
Portfolio of Three Photographs
Green and Red Telephone Box
This year I have had competition success with a photograph taken close to my home. It won the Botanical Britain category of the British Wildlife Photography Awards. The image champions local wildlife and describes the relationship between nature and our busy lives.
This image shows the delicate relationship of mating birds and gives the sense of a balletic courtship. I use a focal length of 750mm to keep far from the birds to let them relax and display their natural behaviour.
I spotted this young fox asleep on a neighbour’s lawn and discovered that she is fed daily. I waited behind a car for the fox to emerge for dinner, let her get used to my presence before taking a few photographs.
Tips for Better Wildlife Photography
- Know your equipment:
No matter what camera or lens you own, understand every detail of it. Identify how it focuses, where the controls are positioned; in the moment there is no time to fiddle with settings. Understanding these details are as fundamental as knowing which way up to hold an ophthalmoscope or the morphology of atrial fibrillation.
- Know your subject:
Having a thorough knowledge of an animal and understanding its environment helps plan those ‘lucky’ moments. This is as fundamental as a preoperative assessment; knowing a patient’s medical background and how it may interact with their surgery helps anticipate intraoperative issues and importantly postoperative recovery. Furthermore, it helps to explicitly prepare patient, carer, anaesthetist and surgeon for those ‘unlucky’ moments labelled complications.
- Appreciate other’s expertise:
As an amateur I am constantly learning and value the wildlife expert. I go on courses with guides who have a lifetime of wisdom regarding certain species’ behaviour. The same holds in medicine where I would not expect a surgeon to know how to deal with post-operative stroke, as I do not know how to replace a hip. Only through collaboration do we get better results.
- Be patient:
To take a good shot can take months of waiting, developing skills and striving for improvement in a particular image. Having patience in my day job helps me take the time to fully understand a person’s history, concerns and expectations prior to surgery. I am able to use this to discuss person specific risks and potential issues perioperatively.
Hippocratic Ethics of Wildlife Photography
- “keep them from harm and injustice”:
No photograph is ever worth causing distress or harm. I cannot advocate enough for respecting a creature and its habitat, as I respect those people for which I care.
- “In purity…I will guard my art”:
Digital cameras and computer manipulation make it tempting and simple to alter an image so it no longer provides the viewer with a faithful representation. This can make good digital art, but without clear labelling can deceive the viewer. As with good risk assessment, I can be honest with people to facilitate shared decisions.
- “share of precepts and…learning to my sons”:
The first aim of any wildlife image should be to promote appreciation, conservation and awareness of nature. Better pictures are those that concentrate on the beauty and behaviour of an animal above the ego of the photographer. My website contains links to organisations that protect and manage the wildlife I value. As in medicine we pass information through training and teaching.
Seeing the Whole Picture
The skills I have developed through photography have helped my medicine, and vice versa. Both disciplines benefit from attention to detail, thorough understanding of your subject, appreciating the knowledge of others and respecting those with whom I work. In photography I have a good understanding before I press the shutter, hopefully helping my photographs to be sympathetic to the subject. In perioperative medicine, through seeing the whole picture, I ensure the team and patient has a detailed understanding of the impact of surgery before knife goes to skin.
Follow Philip on Twitter:
Geriatric perioperative medicine: @DrPhilipBraude