Surgeons advising different things - should I complain?

[Lovecats27]

Just looking for a bit of advice really please. My 76 year old father has undergone a leg bypass back in April which has now unfortunately failed due to poor calcified veins. He was seen by the vascular surgeon who said his only solution is to have a leg amputation now. That particular surgeon said that artificial veins can't be used as they all come in one size and is too big for my dad to use.
A couple of weeks later his toe became infected and sore so GP done an urgent referral back to the vascular team at the same hospital. We were seen by a different surgeon this time and I did mention to him we are very concerned of dad having his leg amputated as it is such an extreme measure and I mentioned what the previous surgeon saying there is only one size artificial veins. This surgeon said that there are actually different size artificial veins but they are very expensive.
Understandably we are very upset now as we feel the surgeon is only looking for the cheapest way of doing things which is to amputate rather than try to save dad's leg.
Should we make an official complaint and how can we do this?
We are having another meeting booked on the 15th of September to discuss the amputation. Should we wait til then and discuss it or go ahead now and make a complaint?
We just want to make sure all options have been explored before going to such extreme as amputate.

Thank you for reading x

Did the second surgeon offer to do the operation ?

No dustylee123. He was only there to check the infected toe and see if the operation needs to be brought forward. He is not dad's main surgeon. His main surgeon is the one who said there is only one size artificial veins. This surgeon did however said that this is not a reason to amputate as there are different size veins but much more expensive than the standard one. He did seem to agree that patient care should come first and not the costs.

I don't think you have grounds for a complaint and what would you want the outcome to be anyway?

Different surgeons have different opinions - thats why people get a second opinion.

The surgeon hasn't said he WILL amputate your dads leg. He's just said it's an option. Ultimately the decision is down to your father.

Why doesn't your father ask the second surgeon to carry out the operation, being as he can source the right size artificial veins?

Its probably likely that the reason the artificial veins aren't being recommended is because the likelihood of them working effectively is low.
Is your father diabetic? Prone to infections in the legs? If so then this would be a huge no for vein transplant as it likely wont be effective and run the risk of huge risk of infection post op.
There's clearly other risks associated with it that they haven't been too clear about.
I would get the full breakdown from the surgeon to be honest

The main surgeon said that amputation is the only option not just one of the options. Our concern is the lie. Why say is only one size vein when in actual fact they do come in different sizes?
We want to ensure we make an informed decision before having such an extreme operation as amputation as there is no going back and if there are other options even if more expensive that they should be looked at.

He's not lying. He's telling you what he's prepared and capable of doing.

Thats not grounds for complaint.

Is it likely that, as an NHS patient, there is only one size available.It doesn't make it any better but this could be the reason why.

The main surgeon is most familiar with your father. When he said the device only comes in one size, he may have simply meant “the ones suitable for your dad only come in one size” or “only one size has the appropriate risk/benefit” or “only one size is recommended by NICE” etc etc

Bring this up with the doctor. Your dads mobility and health are key - don’t worry about asking.

I wonder if it’s like lens replacement after cataract surgery. You can have a varifocal lens if you go privately, but not on the NHS as I understand it.

It may be that the NHS guidelines only allow one size of artificial vein, especially if others are more expensive, so the surgeon wasn’t lying if he was only considering what could be offered on the NHS.

Edited to add - cross posted with @ChannelyourinnerElsa, ie NICE guidelines may only allow one size.

Thank you all for your advice. We will ask at next appointment for more information. If indeed NHS can only provide standard size than we need to know so at least we have the option to explore it further privately.
That was the thing that upset us, that he didn't even tell us there are different sizes, if the second surgeon would not have told us we would have been none the wiser. We are just looking for clarity.

If the surgeon who knows your Dad says bypass is not possible that is his position. The business about the vein sizes may have been giving you a shorthand version of his rationale - after all you are not the patient. Unless your Dad has been assessed as incapable of making this decision and you have been legally appointed to make decisions it's between the Surgeon and your Dad.

It’s not nice but he could he said it for 2 reasons he could think of:

1. The other size veins are only available to private patients. So although other sizes exist they aren’t available on the nhs, so rather than explain that it was easier to say ‘only one size’ as realistically there is only 1 size available to your dad under nhs care. The second surgeon could be aware of other veins but not be aware that they aren’t an option for nhs patients.
2. Your dads age. Sometimes the nhs won’t pay for certain expensive medical treatments if the patient is of a certain age. I have heard of certain amber tteatments and such being available if your say 30 years old with a possible further 50 years of life expectancy but not if you’re closer to the end of to it life expectancy. Not saying it’s right but a possibility?

You want clarification on the points - not writing a complaint. Find out the facts before launching into he lied etc etc
to the person who said as to only one size available in the NHS think before saying such utter crap. do you think they will squeeze the same graft into a 6ft+ man versus 5 ft lady - of course there are different sizes - it may be for the size of person and location but OP needs to go back and ask for some clarification and ask questions.

This is not a complaint yet.

They're not obliged to give you all the options, only the ones that they believe a body of professional opinion think are reasonable.

76 isn’t considered old these days. I know many elderly people who have had excellent and expensive treatment on the NHS.

OP, I would ask about the other veins and for the reasons he is saying they aren’t available for your dad. You can always get a second opinion if your father isn’t happy with his surgeon. It might be the amputation will provide the best outcome for your dad even if it sounds very extreme at the moment.

Sorry what are you hoping to achieve by complaining? Let your dad have another discussion with the surgeon and ask the questions he needs to.

It may well be the case that different sizes are not suitable/won’t work/not available or that particular surgeon does not use them.

Rather than jumping to complain, ask for clarification and further explanation. Much more adult way to support your dad to make decisions than immediately assuming the surgeon is out to do wrong.

Agree with others. No complaint and I think you are wrong to assume the first surgeon has "lied".

It is not their job, nor do they have the time (nor would it be professional or kind) to discuss hypotheticals with you if these are not something they or another surgeon can actually deliver for your father. Perhaps they have given you faulty information but it seems way too early / a reach to conclude this at this point.

However, and especially given this is such a big decision for your father, you are completely entitled to ask for a referral for a 2nd opinion. You and your father need reassurance. Your father cannot have an amputation believing there might be another better option.

They might well come in different sizes but that diesnt mean that they are available to that surgeon on the NHS.

Until you ask that question you have no grounds for complaint.

I think clarify a few things with his surgeon first, and if not hally get a second opinion.

There are multiple reasons why the first surgeon may have said what he did.

I don’t know anything about artificial veins but if I were you I’d get reading up. This article suggests there are indeed different size veins . Maybe the first guy thinks some of the size needed aren’t suitable but he should explaining this. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9255792/

I think raise your questions and discuss it at the next consultation.

I would not automatically leap to the assumption that he lied. I mean, a google search disproves what he told you, so why would he lie?

I think it's more likely that he didn't go into a full explanation but it is right that you ask for clarification.