My blog posts

Values, guidance, NICE and the ESVS.

This is a transcript of a 7 minute talk I was invited to give at the Cardiovascular and Interventional Society of Europe’s [CIRSE] annual conference in Barcelona, as part of a session on “Controversies in Standard Endovascular Aneurysm Repair [EVAR] within IFU” [indications for use]. This talk: “NICE guidelines best inform clinical practice”, was one … Continue reading Values, guidance, NICE and the ESVS.

Human Psychology, Nobel Laureates and Radiology Demand Management

Demand management; responsible requesting; appropriate referring; clinical vetting. Call it what you like: managing the demand for medical imaging is a hot topic. When it’s cheaper, easier and apparently more objective to get a scan than to get a senior and holistic medical opinion the demand for imaging will only increase. Whether demand management is … Continue reading Human Psychology, Nobel Laureates and Radiology Demand Management

Registry Data and the Emperor’s New Clothes

Registries. They’re a big thing in interventional radiology. Go to a conference and you’ll see multiple presentations describing a new device or technique as ‘safe and effective’ on the basis of ‘analysis of prospectively collected data’. National organisations (eg. the Healthcare Quality Improvement Partnership [HQIP] and the National Institute for Health and Care Excellence), professional … Continue reading Registry Data and the Emperor’s New Clothes

Risky Business

When did you last make a mistake? Maybe you had an accident in the car, left a tap running and flooded the house, made a bad investment. How did that feel? Life if full of risks. We try to engineer them or their effects out as much as possible: we wear seatbelts, lie our infants … Continue reading Risky Business

Consent and shared decisions

I go to consent a man for an angioplasty. He had a full length stenting of his SFA twelve months ago. This was difficult, required several attempts over a few days and multiple punctures into the artery at the groin, behind the knee and at the ankle. The procedure was done to treat an ulcer … Continue reading Consent and shared decisions


I’ve always thought of myself as stoical and unflappable. I’ve never really engaged with resilience programmes, but I finished rewatching the first series of Cardiac Arrest. The final episode is harrowing and at the end, alone in the darkened living room, the rest of the family asleep, I found myself weeping, uncontrollably, silent tears streaming … Continue reading Resilience

In praise of doing nothing

“Don’t just do something, stand there” A man in his early 80’s is diagnosed with a large hepatocellular carcinoma. This was detected incidentally on an abdominal ultrasound performed for an episode of renal colic. The liver lesion is completely asymptomatic. The ultrasound prompted an MRI of the liver, then a staging CT, a visit to … Continue reading In praise of doing nothing

What do we mean by need?

The NHS Constitution states that access to its services should be based on clinical need and not on an individual’s ability to pay and that the NHS should provide a comprehensive service, available to all. For many people in the UK, these are articles of faith: fundamental organising principles that underpin one of the great … Continue reading What do we mean by need?

Some personal reflections on AAA guideline development with NICE

The development of the NICE guidance on the management Abdominal Aortic Aneurysm [AAA] has been a long, drawn out and difficult process. Publication of the final guidance (in Spring 2020) was overshadowed by the immediate (and ongoing) crisis created by the COVID pandemic which meant the revised recommendations did not get the scrutiny they deserved. … Continue reading Some personal reflections on AAA guideline development with NICE

Tips for IR training and beyond unconscious competence

In order to master a skill, a trainee needs to progress from novice, to journeyman to expert (a process beautifully described in Roger Kneebone’s excellent book: ‘Expert. Understanding the path to mastery’). Typically four stages of competence are described: unconscious and conscious incompetence, followed by conscious and then unconscious competence. If you are a trainee, … Continue reading Tips for IR training and beyond unconscious competence

PACS: the miracle and misery

I’m writing this sitting at a MacBook Pro, using Pages. The screen is simple and uncluttered, the buttons on the right are clear, and they do exactly what I expect of them. The ways I cut, paste, copy, drag, highlight or format my text are obvious and similar across most of the software I own. … Continue reading PACS: the miracle and misery


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