To reject trainee surgeon?

[RunningThroughMyHead]

My young child is on the wait list for eye surgery. It’s a complex surgery with risks of blindness or other permanent eye issues if not done correctly. These risks have been explained to us but the benefits outweigh the risks.

My husband took him to the last appointment and the surgeon explained that a student surgeon may undertake all or part of the surgery under his supervision. My husband nodded along as far as I can tell.

Whilst I fully understand that healthcare professionals need to practice, perhaps selfishly, I don’t want my son practiced on. I wouldn’t forgive myself if something happened and I want someone well experienced to do the full surgery.

AIBU to request/insist on this?

It’s not wrong. Push for what you want, even if you have to wait a little longer for a fully qualified surgeon. It’s your son’s eyes. It would be an absolute no from me.

Students do not administer anaesthetics!
A resident Dr may have, one who is in training and is heavily supervised. They are competent.

I think the word 'student' is the wrong choice here and makes them sound unqualified. They are qualified a qualified Doctor and likely have many years of experience under their belt. They're just not yet a consultant.
You can absolutely ask for reassurance around their level, experience in this procedure etc. But to insist on a consultant doing the procedure isn't really an option unless you choose to go privately, which is also your right to do. The consultant will be standing beside them overseeing every move. Majority of the time we have medical care in a public system we're treated by non consultant level doctors, but it doesn't mean they're unexperienced.

It was probably done under local as a GA was contra indicated - it could have taken the same amount of time even if the Consultant had done it - not everything can be seen on xray or scan and only when the operation has started can things be seen!

Maybe people shouldn't ask questions in AIBU if people cannot accept that not everyone will agree with them and that their views/choice of words will be challenged

This 👆

"Junior" doctors can have 10+ years of experience

Why are so many on here making the assumption that all surgeons are great and as good as one another?

There are a few terrible surgeons, plenty of average ones and some outstanding ones, just like anything else.

If someone was cutting close to my child’s optic nerve, I would really want one of the latter group!

Of course, as people said, if the risks and complexity are relatively low and the resident has carried out the procedure several times successfully on a child, my feelings might be different.

But I would certainly be asking challenging questions before just agreeing.

OP, I'm not sure why you're subjecting yourself to this thread. I would unquestionably push for the most experienced and skilled surgeon possible for my child and would not feel in any way guilty about doing so. Never mind what random strangers think (including me :) !

Even if it is the first time the surgeon has done this particular operation, @RunningThroughMyHead, they will already be experienced at all sorts of other ophthalmic surgeries. They will have worked up from simply observing operations to doing the easiest parts of simple procedures, under supervision, to doing all of a simple procedure under supervision. Then onto doing parts of more complex procedures, then doing them under supervision, and so on - basically building up their skills and knowledge.

If they are doing any part of this complex procedures, that means they have already learned a lot of less complex operations.

But, as I said earlier, I think the best advice is for you to contact the consultant’s secretary to ask for an email address, so you can send them the questions that are worrying you, and then you’ll have more information that might set up your mind at rest, or might make you decide to request that the consultant does your son’s surgery.

This set up may well mean there is even more control, checking and follow-up than in a standard surgery.

Initially my gut reaction was no. Thinking about it more the supervision is a lot. As mentioned above ask the questions and see if you are happy then.

Maybe you should get off the internet then, being rude to someone because your tired is not an excuse

It’s not so much the disagreements and differing options, though, It’s more the way some (not all) players have been unnecessarily mean and seem to enjoy sticking the boot in.

My grandad agreed to a student doing his eye surgery. The student surgeon forgot to put the eye protector across the lense of his eye. He was screaming in pain every time we administered the eye drops as we didn’t know the surgeon had missed something.

My dad had cataracts removed by a student and they left half the cataract in his eye. It got infected and he couldn’t see out of his eye properly again.

The person answering the question said it was because she'd done 2 night shifts. She was rude and dismissive. There was absolutely no need for that. Manners cost nothing. Especially when the OP was clearly worried. It's just not necessary.

@RunningThroughMyHead op.. I wasn't trying to be rude. Not sure if you read my other posts.. sorry if clueless was offensive.. I was trying to highlight that your questions are reasonable and most parents are not professionals in these things, which is the post I had replied to at some stage if you care to check my posts. Ive just had major surgery myself, 5 weeks post surgery, open surgery hysterectomy so I get the importance of asking questions.

While I understand your concerns OP, and a lot of your concerns probably stem from the confusing language used for doctors, “trainee” and “junior” doctor for example are not necessarily very junior at all, it could very well be a very experienced doctor who is a year or two away from their consultant post and have spent 7+ years training in their field. Youre certainty within your rights to ask the level of experience and the level of supervision they will be given I don’t think you can insist the consultant does the surgery, Im assuming the hospital is a teaching hospital (as most are) and therefore this is just how it works.

For example in my work in intensive care, u can’t remember the last time I seen one of our consultants do a central line or chest drain for example, the “junior” (still very experienced) doctors do them with supervision. The first hint of concern they will step in or guide them.

I can't believe some of the nasty comments here. I don't know the right thing to do OP but I hope your son's operation goes smoothly and they recover well. It must be really scary for you.

Ophthalmologists are surgeons…they perform surgery on eyes. It won’t be a medical student doing it, it will be a fully qualified doctor who is likely almost a consultant ophthalmologist and will be performing the surgery solo very soon anyway and just needing/wanting extra supervised practice.

The very vast majority of operations done in all specialties have at least two surgeons scrubbed and it’s really not common for them both to be consultants - you cannot do a lot of operations without an assistant and declining to have a registrar/fellow assisting might just mean they can’t do the operation.

a resident/fellow/staff grade doing a paed eye list isn’t going to be someone on day 1 of their post-grad training. They will have demonstrated that they have the skillset to do at least defined parts of lots of operations. What the surgeon has done here is good practice and supposed to be reassuring - they will let their colleague do some parts because they are comfortable they’re experienced and skilled enough but they’re not just going to wander off and leave them to it in case things turn out more complex (and because most operations need 2 people anyway). It’s worth remembering that a non-consultant surgeon could still be someone who’s post-CCT and doing/done fellowships in sub-specialist bits of the specialty that may be exactly right for the operation in question. Or it could be someone more junior who’ll be holding retractors and cutting sutures and doing the very basic bits that most operations have. It isn’t in anyone’s interest just to let any old amateur that’s game have a bash at ‘complex eye surgery’….at the very least the paperwork it generates if there are problems mean that no one in their right mind would let it happen!

if you don’t trust the surgeon’s judgement enough to believe they’d only be working with a team who have the skillset to do the job safely they’re probably not the right surgeon for you.

Consultant doctor here (not an ophthalmologist).

As others have said, the language used can make things sound different. I was a junior doctor for 13 years. I was a junior doctor the day before I started my first consultant job, despite having all that experience and postgraduate exams passed years before.

When the junior doctors' strike in 2016 happened, my consultant colleague posted about how when she needed an emergency C section, the registrar (so the same level of doctor that is being talked about in the OP) made the correct decision that the C section was needed, and got her baby out and safe before the consultant could arrive and get changed/scrubbed for theatre - and he only came because the patient was another consultant!

Resident doctors (who used to be called junior doctors) are running hospitals overnight, dealing with cardiac arrests, operating on emergency cases, giving anaesthetics, doing invasive procedures such as lumbar punctures on tiny babies. They have been given gradual exposure to procedures/complex cases as they have become more senior. I'm not a surgeon, but when I was in my first year after qualification doing a surgical job, we sometimes assisted at operations - this meant that we might have started off holding a piece of equipment to keep the surgeon's view clear, but you might also be asked to put in stitches at the end. For a surgical trainee (meaning a fully qualified dr, in a training programme to become a consultant where their progress and experience is reviewed regularly by a body of other consultants) they would then progress to doing a more complex part of the procedure e.g. for keyhole surgery, the surgeon might let them operate/move the "port" (sorry surgeons, it's been decades since I knew the right terms!) and check their knowledge at that point - can you identify the gall bladder? what's that structure there? where are the blood vessels/nerves supplying it? ,moving onwards to doing a part of the operation, and finally a full operation under supervision. It's very carefully monitored, and I hope that if you speak to the consultant you might be reassured - it's ok to ask - what parts of the surgery will the consultant be doing, and what parts will someone else be doing, and I hope that will make you feel more confident.

It's completely possible that the anaesthetist may not be a consultant either , and you are trusting them with more than an eye.

My kids are grown up, but I would have no issues whatsoever in consenting for a "trainee" to do the operation on me or any of my family.

I hope all goes well for your child.

This is not that. This is a situation where the OP was told that the trainee might well be doing ALL of the operation. FFS it's his eyesight!

I would take a resident (what you describe as a "student surgeon") over a consultant any day of the week.

1. They're at the top of their game. Cramming for their v specialised postgraduate exams, practicing every chance they get.
2. They're not operating alone, and have a consultant with them overseeing
3. They're likely to be younger with the improved dexterity and eyesight that it comes with. Especially vs e.g. a consultant nearing retirement.

DoI - consultant medic, not a surgeon. Lots of experience with surgeons though.

If anything this thread shows that perhaps these things need to be explained more clearly, especially where there are children involved. That responsibility lies with the clinician who takes informed consent from
the caregiver. The fact that op is concerned and did not fully understand the language used (or at least what was relayed to her by her husband) shows that further explanation is required.

Experience and skill are often not the same thing! We all know people who have been driving for years and are still a bit pants, and others who seem to pick everything up in a few weeks. Keeping to the driving analogy, you get drivers who are very experienced and think because they've been doing it so long they can get away with bending or breaking the rules (drive too fast, cut the corners on bends etc).

@RunningThroughMyHead there's a fair chance that the letter is a bog standard stock letter for that clinic with just the patient details & dates etc changed. Your consultant will have a big list, probably even a few other patients on that day, and will decide which of the various operations can be done and to what degree by non-consultant surgeons, but the letter will read the same to all those patients. Yes he probably did say to your DH there would be a more junior (than consultant) surgeon assisting him who may well do some parts of the operation, and I'm sure there will be more routine operations being carried out on the same list that can be done perfectly competently by a resident.