Dr Fix-It

Female orthopaedic surgeons are a small minority, but Dr Susan Liew has climbed to the top of the profession through hard work, passion and an undying fascination with how things work and how to put broken things back together

ORTHOPAEDIC surgeons get called many things — meathead, boofhead, butcher, larrikin — and they are used to being the butt of their non-orthopaedic colleagues’ jokes.

“What do you call two orthopaedic surgeons looking at a chest x-ray? A double blind study. Why do orthopaedic surgeons insist on wearing ‘surgeons hoods’ in theatre? To avoid their heads transilluminating. What’s the difference between a carpenter and an orthopaedic surgeon? A carpenter knows more than one antibiotic.”

Only 34% of all Australian specialists are women, and in orthopaedics, the gender bias is even more pronounced. As at 30 June 2014, of the 1551 members of the Australian Orthopaedic Association, which claims to represent 98% of all orthopods in this country, only 3.5% were women.1,2

Dr Susan Liew is one of the few. She is the first to admit that orthopaedic surgeons are often on the receiving end of bad press. “There are a few larrikins in the profession who like to perpetuate that image”, she tells the MJA.

Dr Liew is the Director of Orthopaedic Surgery at The Alfred in Melbourne, and before she took up that post in 2007, she held the same position at Austin Health. She also teaches at Monash University and is a visiting medical officer at the Royal Children’s Hospital.

She specialises in spinal trauma and scoliosis, but also continues to practise in general orthopaedic trauma and elective surgery.

Putting it together again

It’s a storied career, but it wasn’t born out of a burning drive to be a doctor.

“I started out in engineering”, Dr Liew says. “Quite a number of orthopods start that way, you’ll find.

“I dropped out of engineering — it was the wrong course for me. I wanted to do something practical so I went off and worked for the rest of the year and then I went into medicine.”

But that proved to be problematic as well.

“I hated it”, she says, “but I realised that I couldn’t drop out again, so I went on and finished.”

The need to fix things and provide practical solutions was something that had always been with her, she says.

“I was always building things and taking motorbikes apart. That kind of thing.”

Dr Liew realised early on in her medical training that she didn’t want to be a physician, and the practicality of surgery, and particularly orthopaedic surgery, appealed.

Spinal surgery was especially attractive.

“It’s quite cerebral”, Dr Liew says. “You have to plan. It’s like a jigsaw puzzle.

“At the time I was getting involved in spinal surgery, in the 1990s, it was a growing field. It was one specialty where the technology and advances in what we can do has exponentially grown.

“Back in the day you would see patients who were in traction for 3 months. You hardly ever have that these days, because we have the technology.”

Gender imbalance

Dr Liew is philosophical about the gender imbalance in orthopaedics.

“I think it’s a reflection of people’s interests”, she says.

“There are fewer women than men in surgery in general and that’s down to a number of factors, I believe. It depends what you want to give up.

“Surgery is a vocation. You have to have a passion for it and you have to spend the hours doing it, and that puts a lot of people off.”

Another perception of orthopaedics is that it’s more physical than other kinds of surgery, and that, too, may put women at a disadvantage. But Dr Liew disagrees.

“I’m 5’4” and 52 kg”, she says, “and there’s nothing that I’m not able to do. I’ve reduced some pretty big young men’s dislocated hips without any problems.

“You have to operate smart.”

Being director of a large surgical unit means Dr Liew does more paperwork and sees fewer patients these days.

“A huge part of my job is people management”, she says.

“The bigger the staff, the more diverse the personalities. The junior doctors are a transient population, and there are matters of performance reviews, guidance and mentoring for trainees. Everyone is so much more accountable.”

Watching trainees is one of her great pleasures, Dr Liew says.

“Some are more suited to orthopaedics than others, of course, but watching a trainee blossom into a fantastic surgeon is just a pleasure.”

Hot topics

Like every specialty, orthopaedics has its ”hot-button” issues.

Knee replacement surgery is currently high on the list of debate topics among orthopods.

“The public has very high expectations of us”, says Dr Liew. “Knee replacements are on the rise but the problem is they are nowhere near as successful as hip joint replacements.

“The knee joint is less constrained than the hip. The question is, are we making the right decisions. Twenty per cent of patients are still unhappy after knee replacement surgery. That’s phenomenally high.

“That’s a debate we’re continuing to have and that we’re [continuing to research].”

The recent controversy over knee arthroscopies has now been largely resolved, she says.

“It’s quite clear that for mechanical problems — like something jamming the knee joint — arthroscopies are fantastic, but in terms of arthritic wear and tear, for example, MRI scans are the way to go.”

Negative pressure vacuum dressings are top of the orthopaedic hit parade for the treatment of open, complicated wounds.

“Back in the 90s when I was a trainee and we needed to use an external fixation on a complicated open wound, we had to wait until the soft tissue was better. Now we’re not waiting. We’re getting bolder and fixing fractures as soon as they come in.”

Ageing population

As with most specialties, the ageing population is having its impact on orthopaedics.

“We are getting more osteoporotic and we’re living longer”, Dr Liew says.

“Things like neck fractures in the top of the neck in older people who are more fragile and frail — those are things we worry about when people fall.

“People are living longer with congenital conditions like spinal deformities and so there is more need for us to intervene. It’s a matter of finding the balance between quality of life and not killing them along the way.”

With four children and a husband who is an electrochemist, Dr Liew is living proof that being female and a successful orthopod is possible.

“Sometimes it can be a bit of mess”, she laughs, “but my husband is great … For me [this life] suits me very well.”