Interview with Hiro Tanaka

Interview with Hiro Tanaka

Posted on: 18-10-2018


Hiro Tanaka is a consultant foot and ankle surgeon working at the Royal Gwent Hospital in South Wales. He is passionate about improving the quality of orthopaedic training and developing new models for learning. He is the Chairman of the Education Committee for the BOA and developed the BOFAS Principles Course as well as the BOA Bootcamp. He is an FRCS (Tr & Orth) examiner.


Why did you choose to work in South Wales, and what was your  journey there?

I’ve lived in Wales long enough to consider myself an honorary Welshman.  I was educated in a boarding school in Gloucester so many of my school friends are Welsh.  Naturally, I wanted to join them at Cardiff University so that’s where I went to medical school.  After graduation, I did try moving away when I wanted to become a cardiac surgeon and working for Magdi Yacoub in Harefield Hospital was the premier place to train at that time.  That didn’t last long thankfully and I came back to the Cardiff Royal Infirmary to start my orthopaedic career.  My choice to stay for my consultant post was purely because I had colleagues who were my closest friends.


You are known to have a real passion for patient satisfaction, and the personal impact the relationship that clinicians have with patients. What insight would you like to share with our readers and perhaps fellow clinicians?

I’ll just tell you one true story I wrote about in a book.  I think it says it all.

One day in my elective clinic, an elderly lady came to see me with arthritis in her ankle.  She had specifically requested to see me which I was a little suspicious of at the time but the consultation went well and she didn’t need any surgery.  At the end of the consultation she said “You don’t remember me do you?”.  That wasn’t a good sign, I was quite certain she was about to make a complaint.  I obviously couldn’t remember her.

She sat down and said “I’m going to tell you a story and I want you to listen…..several years ago, I broke my wrist and I attended fracture clinic and I came by hospital transport.  I had to have my wrist set and the plaster changed a couple of times.  By that time, I had missed my transport home and I wouldn’t be picked up until late that afternoon.  At the end of the clinic I was sat in the waiting room on my own, everyone had disappeared for lunch, when a young doctor passed me and stopped.  He asked me if I was OK and what had happened.  He then proceeded to make me a cup of tea and some sandwiches and called the transport office.  He stayed and chatted a while.  I will NEVER forget what you did for me that day……..that doctor was you”.

When I was a medical student, I really believed that my purpose in medicine was helping people.  90% of all medical students say that during their interviews and I’m sure most mean it.  Helping people is simply a product of my work as a surgeon.  If I do my job well, people get better.  What I realized at that moment was that empathy and compassion were just as much of a medicine as anything I had spent years training in.


I am aware that you participated in the Health Foundation Generation Q programme and that this had an impact on you. Could you please share how?

The Generation Q programme was a life changing event for me.  They said at the very first session that, in order to lead and understand others, you have to first understand yourself.  It seems like a simple and obvious fact but I never realised how much I didn’t know about myself until I had completed the programme.

One of the most important things I learnt was that before the programme, I was all about succeeding and never failing.  Paradoxically, this made me lack resilience and I nearly burnt out whilst I was Clinical Director.  Truly successful people embrace failure, without it you can never learn and get better.

I also learnt the science of improvement.  Yes, there is a methodical way of implementing positive change in a department or large organisation.  I think we spend way too much time and resource in the NHS focusing upon data and not enough time in extracting intelligence.  The only people who are capable of converting data into intelligence are the clinicians and staff on the frontline, and we need clinical leaders to make that happen.


Your LinkedIn profile suggests that you have done various roles in your career, “some of which I am proud of, some not so much. The things I have done have not always worked but they have all made a difference.” Can you elaborate please – maybe the things you are particularly proud of and also not so?

Ah, the beauty of social media.  I’m most proud of the educational work I’ve done on behalf of BOFAS and the BOA particularly as Ed Comm Chair.  I’ve been able to promote a different form of training focusing upon professional capabilities equal to the technical elements.  Our training system is fantastic at producing knowledgeable and technically skilled surgeons but what makes them great are the professional qualities such as leadership, resilience, relational skills and knowledge of quality improvement.

I’ve made my fair share of mistakes, particularly when I was Clinical Director of my unit.  I don’t think there is time to list them all here!

I was the LNC Chairman and BMA Welsh Consultants Committee when the junior doctor contract negotiations were going on and although we were across the border, I feel that we should have done more to support them.


You are an FRCS examiner. What advice would you offer those preparing to sit the exam?

The first thing you must understand is exactly what the exam is assessing you for.  Everything that is asked or tested in the exam is what you would actually do as a first day consultant.  It’s not about what the books say, or what your current unit does, it’s about what YOU will do based upon your knowledge and experience.  In the clinical section the small details such as how you engage the patient, put them at ease and carry out your exam slickly makes a big difference.  Ask yourself the question, is this what a consultant would say and how a consultant would conduct their consultation?

We understand that everyone is human and it’s normal for you to mess up a section or say something stupid.  The exam is designed to allow you to compensate for such events (as long as they are not frequent) so try not to worry excessively about performing poorly and focus your attention on performing well.

Of course, you could attend the ORUK exam prep course.  That will help.


How do you see foot and ankle surgery evolving in the next 10 years or so?

I think we may be at the tipping point for a major shift in orthopaedic care from one that is reconstructive to regenerative medicine.  Once there is evidence for the clinical efficacy of orthobiologic treatments and they pass regulatory standards, this will transform not just what I do in foot and ankle surgery but will transform the whole speciality.  Stem cell treatment is a good example and I believe we need to support funding in such areas.

Foot and ankle surgery has come a long way over the past 10 years.  I no longer see the severe deformities I used to, in part due to biologics for rheumatoid arthritis, decline of the polio population in South Wales, better management of clubfoot and earlier diagnosis of neuromuscular disorders.

I think the challenge for us for the next 10 years is the acute increase in diabetes with consequent neuropathy resulting in diabetic ulcers, Charcot arthropathy and limb loss.  I’m also seeing a significant increase in lower limb fractures in the very elderly requiring specialist surgery.

We’ve reached a point of diminishing returns for the improvement of surgical techniques and implants.


Noel Fitzpatrick (Supervet) talks of taking developments for animals into human medicine (and vice versa). Do you think there is merit in this and can you see animal prosthetic technology advances benefiting human patients?

Many years ago, I was conducting research at the Bristol Vet School when I was invited to join a case discussion amongst their orthopaedic surgeons.  They were discussing the management of a cat with an infected non-union of the tibia.  I might just as well been sitting in a trauma meeting with my colleagues. I really couldn’t tell the difference in the principles or techniques we were discussing albeit with some slight differences.  Humans generally don’t tend to lick their ex-fixes.

So yes, I think there’s a lot to be gained from cross fertilization of innovation and ideas.  The challenge is ensuring a safe regulatory framework for prosthetic survivorship in humans as we live longer than animals.  I was going to say “and there is more at stake” but I wouldn’t want to upset vets or animal lovers.


Drawing upon your career experience, what is the most valuable advice you would pass on to others?

First and most importantly, your consultant career is defined by the relationships that you develop with the people that you work with, your trainees and your patients.  It shouldn’t be about the titles or positions that you think you ought to have.  Secondly, only do something if you believe and have a passion for it.  Don’t do it because you feel you have to.  Thirdly, learn how best to make a difference and improve patient care.  This is about leadership and going back to my first point.


If you had to choose an alternative career what would it be and why?

I have to think about that for a minute.  There are so many options, is that a bad sign?  Realistically it would have had to be joining the military.  I seriously thought about that as I was leaving school because I was in awe of the camaraderie and leadership skills of officers when I was a cadet.  I wouldn’t survive Sandhurst now so if I had to do something else then I’d like to join the intelligence service.


If you were on a 6 month sabbatical, what would you do and why?

I’d like to do the IHI Fellowship Programme in Boston.  I gained so much from my programme at Ashridge Business School that I’d like to see what I can learn across the pond.  IHI takes a very scientific view of healthcare improvement and I’d like to use that knowledge to enhance my ability to change NHS systems.



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