Consultant wants to operate on my son - am feeling uneasy about this

[tigermoth]

I'm happy about my 11 year old having an op to remove his tonsils and adenoids.

Was originally happy that the consultant himself had chosen to perform the op.

Now less happy - 6 weeks on, no date has been set because the consultant is having a long summer holiday. Have spoken to the admissions assistant who in very adamant that the consultant must do the op. She admits if it was another doctor, the op could be booked easily.

Am beginning to wonder exactly why the consultant has chosen my son. He knows the op is needed quickly because my son is in pain at least half the time. Is there a hidden reason why the consultant wants to do this op himself? Anyone know what makes consultants choose certain patients?

[dejags]

Tigermoth - I can't comment on why a consultant would want to operate on a particular patient. I would also be a bit concerned that the operation wasn't taking place as quickly as it should in order to accomodate the docs holidays.

Could you insist on a consultation with another ENT Surgeon at your hospital?

FWIW - DS1 had his tonsils and adenoids out in March this year and he recovered very quickly indeed.

[tigermoth]

dejags, I am considering asking if another surgeon could do the operation, but the vibes I get from the admissions assistant make me believe this will be impossible. She is very definite that only 'Mr X' will do it. I want to know if there is a reason behind this. I have not been that forceful however, so if this drags on, I will say more.

I am glad your son recoverd quickly. Am hoping for a quick recovery very much.

[dejags]

Tigermoth - in my experience, the only reason Mr X is the only person that can do it is to keep admissions clean and simple. If your son is in pain it seems absolutely unreasonable to schedule a necessary operation around the surgeons' holidays.

I would put my foot down on this one! I think it might be worth pointing out that a tonsillectomy/adenoidectomy is not the most complicated of procedures (although the experience will be stressfull for you I am sure).

[tigermoth]

Dejags, you're right about the op being a routine one.

If noone on mumsnet can give me any reason why the consultant might need to be the one to perform the op, I will put my foot down as suggested. Thanks for clearing my mind about this.

I will wait till Tuesday to see if anyone here can give me a plausible explanation. If not, I'll get in hassle mode and phone up admissions.

[roisin]

TM I must admit this sounds rather odd to me. My db is a consultant surgeon. Some jobs he prefers to do himself rather than leave to the registrar; some jobs really need the expertise of a consultant. A tonsillectomy doesn't really come into either of these two categories. I'm confused!

Hmm... Just had a thought. Surgeons now have stats published on them, and they are very broad brushstrokes, and most medical people think they're a load of tosh. But the Press and Public tend to refer to them. For instance I think they have % mortality and surgery success rates per consultant ... sounds fair enough. BUT if your Mr Bloggs is a specialist ENT surgeon, he probably does loads of complicated surgery. Including for instance, loads of throat cancer, and throat cancer has dreadful mortality rates - nothing to do with the surgeon. So in order to artificially boost his 'scores' when the ratings are about to come up, he makes sure he gets some lists crammed with very straight forward, 20 min tonsillectomies. Is this plausible?

This is pretty much pure conjecture on my part, and I'm just thinking off the top of my head. But it's just one possibility as to why a consultant would choose your son as his patient?!

[tigermoth]

That's a very interesting thought, roisin.

The idea of this consultant choosing to do this routine op on my son is odd. Going back to your though, I wonder if ds is considered particuarly low risk as he is a very hale and hearty 11 year old? Might still come under child category, but only just, IYSWIM

[lailag]

No specific experience with ENT but if he is under the care of one consultant it is a bit unusual to be be transferred under the care of another consultant. Certainly if it is a "routine" operation. In case of emergency and consultant away no other option.
Even if the operation could be performed by the registrar the consultant should be available as back-up.
I wouldn't take the admissions assistant's word for it, could you try the consultant's secretary?

[Tissy]

Doubt if he is boosting his figures by doing an easy op rather than a difficult one.

I suspect the admissions clerk (if that is what she is) doesn't know why the operation has been marked as to be done by the consultant only, so don't blame her.

Probably the Consultant cannot trust his junior to do the operation him/ herself (sometimes they get very junior juniors allocated to them, so can't leave anything to them. Also, it is required now that surgeons do NOT leave registrars to operate unsupervised, they are supposed to in training, and until fully trained must be supervised. Or maybe he doesn't have a registrar at all at present, it happens. Or maybe the registrar and consultant are taking leave at the same time.

BTW, unless waiting lists are amazing in your area, or your ds is an urgent case, I wouldn't expect a date to have been set yet- typical waits are around 6 months in our area.

As for the consultant's holiday, if he is taking a long summer holiday, it means that he has less leave throughout the rest of the year; they only get a maximum of 6 weeks a year, and he's entitled to take it when it is convenient for him and his family, as long as there is someone else around to deal with emergencies.

It is unusual for another consultant to operate on a Consultant's patients without a special arrangement between them- they have their own lists, so I wouldn't expect another senior surgeon to do yor ds's op just because one is on holiday.

I suggest you speak to the consultant's secretary and explain your concerns, there may be a simple explanation.

[roisin]

Sometimes as well there's relationships between GPs and Consultants, that can influence who actually operates. Are you on good terms with your GP? Could you phone up on Monday morning and ask his opinion on the matter? It is possible that Mr Bloggs is a specially good mate of his, and he particularly asked him to do it personally, because he knows he'd do a good job? Or that Mr Bloggs owes him a favour. Or that Mr Bloggs knows that your GP has recently referred 'interesting' cases to another consultant/another hospital, and he wants to win him over ... by doing some fancy embroidery in your son's throat?! I think I'm definitely in the realms of fantasy now!

[Surfermum]

Hi Tigermoth. I used to be a Consultant's secretary. It could just be that the admissions clerk doesn't have the authority to move your son from one doctor's list to another.

I would suggest you contact the Consultant's secretary on Monday, explain your concerns, and see what she says. If there is no reason why someone else can't do the op she should be able to organise this with the Admissions Office.

[tamum]

There is another, maybe too melodramatic, reason for the admissions assistant's remarks. It could be that the consultant you are booked in with is simply much more competent than the alternatives, and they are trying to signal that to you subtly. I know it sounds ridiculous in the context of tonsils, but is something that happened in a similar way at Bristol when those paediatric heart surgeons had so many deaths.

[tigermoth]

Tissy, according to the admissions secretary, if someone else was doing the op, I would have had a date set by now. I realise the wait may be up to 6 months, but at least I would know the date. I don't know the situation regarding this consultant's registrar. I get the impression there are other people able to do the op and this delay is due to this particular consultant choosing to op on my son. I think I need to talk to her more, just to see if anyone else is qualified to do the op without changing my son to a different consultant's list.

Tamum, that's a good word of caution. The same melodramatic thought crossed my mind actually. I
know I am probably way off the mark, but there's something worrying about being told a consultant has deliberately chosen to do this routine op, when it's obvious they are short of time. I will take this into account when I speak to the admissions sec. I am totally fine about a less senior person doing the op, as long as they are competent.

So it may be a good idea to phone our GP as well, as you suggest, roisin, just to see if he has an opinion. I have what I'd call a neutral relationship with our GP, so I don't expect much enlightenment, but I will try.

[lailag]

Sorry, have to agree with Tissy. Patients on the waiting list of one consultant would normally only get transferred to another consultant's waitinglist if arranged and agreed between the 2 consultants. Eg in very urgent cases (can't wait til after holidays), or very complicated patients (for a second opinion). Whoever does the operation there has to be a named consultant who should be available.
I think the most useful person to contact would be his secretary. Sorry, don't have to much faith in the admissions assistent....