Would you ask to see a different dr because of this?

[RevoltingPeasant]

Genuinely interested in opinions, esp from anyone medical.

So 4 years ago I had kidney surgery. It did not go according to plan. The same surgeon has now advised I have the op on the other kidney. But as the case is not 100% clear-cut, he has referred me to another surgeon at a different hospital for an opinion on whether I should have the surgery or not.

Because of how things went wrong last time, it's in my mind to see if, assuming I do have the surgery, I could be referred to this second consultant for the op itself.

AIBU or precious? This is what happened last time:

• I was not given any aftercare advice, not even a leaflet. The op I had caused some common but distressing side effects like bleeding from the bladder for several weeks after surgery. But no one told me to expect this, and I couldn't get anyone from the surgeon's team on the phone, and my GP didn't know, so I had to diagnose myself via Dr Google.
  

• The standard time to be off after this op is 4-6 weeks. Last time I was signed off for only 8 days. I do not know whether my surgeon wrote to the GP and he ignored it, or whether the surgeon didn't write. Either way I had to return to work early and felt ropey as hell.
  

• The op is a two-part operation, with an outpatient procedure a few weeks after the main op. After this outpatient procedure I was left in the most dreadful pain. I had real trouble getting admitted to hospital again over the next 24 hours as no one seemed to believe I could have suffered complications following this simple outpatient procedure. But I had, and it required two further ops under GA to sort out the complications.
  

• Subsequently, obviously I asked the surgeon what had gone so wrong. He said he didn't know. I asked if he did this op again, as he is proposing, what might be done differently to avoid complications. He said he wouldn't change anything. I asked what support would be in place in case I did experience trouble. He shrugged and said 'A&E?'
  

Sorry, that was long !!! Any thoughts? Am I being demanding? Bit scared to go thru it again after all that but prepared to be told I am over-anxious.

[monkeysox]

You need to speak to pals at the hospital. Doesn't sound very good. Would definitely ask for a different surgeon.

[MushroomMama]

The aftercare I've found for any op is appalling. You're not being unreasonable at all.

I've had non dissolvable stitches left in (had to have them removed at docs after much arguing with the gp). No follow up appointment after surgery either!

It may be worth having a good discussion at your pre op appointment about after care after your previous experiences

[Hobbes8]

You're not being precious at all. That sounds really shoddy. Operations won't necessarily go perfectly and complications can arise, which isn't necessarily the consultant's fault, but they shouldn't be dismissing your very valid concerns. I would speak to the second opinion consultant and ask their view. I would also raise concerns with whoever does your op that the communications with the GP weren't great, as that may have been your GPs fault, so they should be sure to advise you of anything important and not assume your GP will deal with it.

[DancingDinosaur]

Definitely go to PALs and ask for different surgeon.

[RevoltingPeasant]

Thanks all.

See the thing is, this is a really specialist op. Hence why I think my GP hadn't heard of it and assumed it was much more minor than it is. So 'requesting to see a different surgeon' means 'requesting to see one of the three blokes in the region who actually knows how to perform it'. It would have to be at a different hospital.

And yeah, I get that when you have surgery you take a punt on...not waking up, having nerve damage, all sorts! The surgeon can't always help bad outcomes. It's just the attitude to any concerns.

I don't want to get my original surgeon into trouble. He is a nice guy. He has been proactive for me in other ways. But I'm scared of going back into that system.

[RevoltingPeasant]

• to my concerns

[AnchorDownDeepBreath]

I'm a bit unsure how many of these are your surgeons fault.

I've had a few kidney surgeries, the aftercare information is always provided pre-op, including leaflets and a reminder to return to A&E if there's pain/bleeding.

Who signed you off for the original 8 days? The surgeon usually signs you off for 7 days (or instructs GP to), and you visit the doctors after that time to be signed off for longer. It works as a post-op check to raise any concerns, too.

The outpatients bit could be anyone's fault. Was it something that was done wrong in the op, or a complication that arose although the op was done right? If it was a complication, is it likely to happen to you again?

I'm not sure if there's anything in specific that your surgeon should do differently, although in general, you need to make sure your pre-op and post-op appointments are organised and run correctly.

I don't think I'd consent to the same surgery with any of the surgeons doing it without more information about the risks, though, I don't see how you can make an informed opinion if you don't know how likely complications are to arise again.

[RevoltingPeasant]

Anchor, I don't know either. Hence asking :)

There was no aftercare leaflet as to my specific op provided. The pre-op appt had leaflets on 'coming into hospital' and general self-care afterwards. But this is a specialist op and I don't think they even had a leaflet on it.

The surgeon I have been referred to for 2nd opinion is part of a 'centre of excellence' for kidney surgery and his dept specifically produces patient-friendly leaflets for this op that are available online. That is how I diagnosed myself.

The surgeon did not sign me off at all. I self-certified based on hospital discharge notes for 2-3 days iirc, then saw GP about 3-4 days after op and he signed me off for about 8 more days. So I was off for about 2 weeks in total.

About the likelihood of complications - don't know. This is it: surgeon says he has no idea what went wrong so we may as well just go ahead. If anything does go wrong, back to A&E. I am worried about that as last time that approach left me fighting to be seen as OOH provision did not believe me that anything was wrong.

[RevoltingPeasant]

Shameless bump for evening crowd!

[Lollipopgirl8]

Ok as a surgical registrar (Ophthalmologist) I always tell patients clearly about potential side effects which are based on evidence in literature and risk ratios are given so people understand risk of side effect happening. That's why patients are asked to sign consent form. Informed consent is key to our practice.

Communication is key and it does sound like there's has been a breakdown which has left you feeling the way you are now.

PALS is an invaluable service for patients who can help you come to terms with some of these issues.

You are entitled to a second opinion or altogether different surgeon but this will not change the overall chances of you having the same complication. Even a very junior surgeon would be supervised by a senior consultant.

[Lollipopgirl8]

Lack of aftercare information leaflet may be because your type of surgery is very specialist and so might be part of a general leaflet. If you feel what you were given was it substantial it's worth telling them so perhaps one can be made up for future patients we are always doing this in Ophtho as new ways of doing things are always being established.

I don't think the fact it's a centre of excellence makes any difference surgical training is pretty generic in the UK and risk ratio for side effects is based on operations that have been done by a breadth of surgeons and how often that complication happens. Often all that means is that they are doing a lot of research which attracts academic type doctors doesn't make them better surgeons in fact maybe less so if you think overall numbers. Acedemics often sacrifice training time to do research... Sorry I digress.

We often ask patients to self certificate and then continue via their GP I think it may be a hospital policy

[Cel982]

Did your GP refuse to sign you off for any longer, or did you just go back to work after the initial 8 days without seeing him/her again? I'm a GP, and it would be quite normal to sign people off for a week at a time, as recovery times will vary so much between patients. If somebody felt they needed longer I would usually be happy to recertify them after a week, and again for as long as was needed.
It's hard to comment on the other aspects of it without knowing the details of the surgery and the complications you had - sorry you've had such a rough time. Go for the second opinion, ask the surgeon all your questions about the op and raise your concerns given what happened the last time. I don't think it would be at all unreasonable to ask the second consultant if the surgery could be carried out at his centre given that it's a centre of excellence, and your course has not been straightforward so far. Best of luck.

[RevoltingPeasant]

Thanks Lolli and cel.

Lolli I guess I am less interested in the complication not occurring again and more interested in him taking a bit of responsibility. I don't think for a second it was his fault but I guess I feel if you cut someone open and they're ledt in a bad way afterwards, it behaves you to be proactive in trying to make sure they're not left like that again, iyswim? Specifically I wondered if the outpatient procedure (a flexible cystoscopy) could be performed as inpatient so they could monitor me after. Surgeon was quite non committal and unbothered about it all.

Cel my GP refused to sign me off again. I self certified for a couple of days. I went to see my Gp who said upfront he didn't know anything about the op. Fine, he's not an expert! He signed me off and then I rang back when the fit note expired for an appt. he rang me back and said he considered me fit to go back to,work so wouldn't renew the note. Well, I didn't know any better so I just went.... Subsequently found out I should have had more time off and shouldn't have been driving.

As a Gp would you expect a consultant to write to you about a specialist op your patient had had or would you be expetced to research advice to give the patient yourself, may I ask? :)

[Scremersford]

I would request another surgeon then, if there is a senior consultant. He might well be excellent, but he doesn't come across as very caring, and perhaps a bit rushed. Or perhaps his excellence lies elsewhere.

I'm a bit surprised that your GP is incapable of a bit of basic research on your procedure. You are one of his patients. How hard is it to find out about something that is part of your job?

[Cel982]

I haven't worked in the UK so I appreciate things might be different here, but typically the GP would be sent a discharge summary with any specific info they should know about the patient's op, recovery period, need for meds etc. In my experience letters from consultants can take weeks to arrive.