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?

@Sheiswaiting yes it’s ludicrous isn’t it ?like some of the replies suggesting the op has no options it’s free shut up and put up.

Go to sleep then and stop posting unhelpfully to a parent concerned about medical care for her child.

Not quite. They gave me the option between 3 health trusts that had their own surgeons working out of each and I got to choose which one and we did that based on their reviews and calendars.

You were given your choice of senior consultant's clinic and hospitals. Within each team there will be the senior consultant and a number of other highly qualified doctors who, depending on the details of the case, may or may not be the ones carrying out some consultations or the actual surgery.

Quite a few years ago I was given the choice of consultant and hospital for a minor procedure. I actually spoke to the consultant once for under 5 minutes and after that saw a different surgeon from the same general surgery team. Due to the nature of this minor op under local anaesthetic this other surgeon did everything on the day including teaching a more junior (but still qualified) doctor who was observing. I didn't even see the consultant after the first time, but every correspondence came from "senior consultant's name" clinic.

Even at my recent first consultation at Kings College that wasn't with the consultant on the letterhead but a different doctor from there. We're talking here about spinal surgery.

Although it's not quite like that DH found it very easy to change consultants when he wasn't comfortable with the first one he saw. He wasn't even asked why he wanted to change.

No I was given specific names and spoke to their secretaries. I met with one and chose him. There was never any possibility of anyone else doing it.

This is how it works. There would be no consultants if nobody was allowed to operate until they were a consultant.

A registrar is considered 'in training' until they are a consultant. They generally do the donkey work under the supervision of the Consultant. This applies to every specialism. If they are surgeons they will be operating probably 4 days a week. The Consultant will probably also have a private practice and spend a lot of time teaching.

In this case the Consultant is going to be there right next to the Registrar.

OP I don’t blame you at all for having concerns. I would request a further consultation to clarify who will be doing what, and how many of these type of operations they have carried out. This can all be done politely, your concern for your child is entirely natural.
Hope it all goes well for your child.
x

YABU. How do you think surgeons get experienced? They work as juniors under supervision of somebody more senior.

Frankly, I’m surprised they told you and didn’t just go ahead.

Yanbu

I think you need to ask all the relevant questions to the people involved. It’s not possible to give an appropriate answer without ALL of the relevant facts. I hope all goes well for your daughter.

Pay for it yourself then

I would rather someone who is being watched like a hawk before every cut is doing my surgery than someone whose done it so many times they risk becoming complacent does it….

Of course they will tell her because they need her consent before they go ahead with her child's surgery. Imagine if something did go wrong and they didn't tell her?

Everything is explained in great detail before you sign the consent form including who is doing the surgery. Or that's been the case for my son's multiple surgeries anyway.

To ease your mind, when my son was 6 he had a brain tumour. It was the person below the consultant who did the op under the supervision of the consultant. My son made a full recovery and is in his second year at university! I hope that gives you some comfort and I sincerely hope your child is better soon.

Do you think this doctor hasn’t done any surgery before? It sounds like it. I honestly don’t think anyone on here can reassure you. Best thing would be to speak to your GP of your concerns.

I work in this field at a pretty senior level. The way the system works is that even if they are called a trainee, they are called so because they are yet to complete all the formalities and the 7+ years of training before they can get a consultant job. If it is a child’s ophthalmology surgery the ‘trainee’ is likely to be one in their later stage of training or probably even a ‘fellow’ who has completed training to become an ophthalmologist but is doing further subspeciality training to be able to work as a Paediatric ophthalmology consultant. Any ‘trainee’ allowed to do any part of a surgery on a child is likely to have had lots of experience doing that or other surgical procedures in other patients(adults and sometimes even children) there may be a trainee doing that particular procedure the first time, but they will have had done similar before. Doing surgery under direct supervision of a senior as a training is the only way to learn surgical techniques to one day become a consultant doing these surgeries without supervision. The senior consultant you would like to have operate on your child is also there at the level because they have once had the opportunity to operate under direct supervision and get trained. Also every child who undergoes surgery is treated equally important by every medical team! Hope all goes well with the procedure.

You are not unreasonable, you can choose your own doctor.

However, at the hospital I work at majority of neurosurgery is performed by students cause there are so few cases and they need the training. These students are in their late 20's or early 30's with PhD and years of medical training and extensive studies in the area.

You are well within your rights to ask that certain doctors may not treat you. The surgeon has told you, the resident doctor maybe the one that operates, perhaps giving you the opportunity to agree or not. It is quite normal, but l totally understand it can be extremely stressful when it's your child. Please speak up, no one will treat you any different.....you never know, this resident doctor could be months off being a qualified surgeon...who knows, but please, speak up...

Out of interest.... how many people on here have signed consent forms for themselves (form 1) or their child (form 2) for surgery without wondering what this statement (which is printed as standard on consent forms) might cover ... 'I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience.' All the OP's surgeon has done is really just explain one of the possibilities that statement might cover.

@hcee19 - it is my understanding that this ‘trainee’ is already a qualified surgeon - they will have completed their medical training and further training as a surgeon after that, but is now learning the specialist skills to be an ophthalmic surgeon. He or she could be near to becoming a fully fledged consultant.

This will most likely be a registrar and the consultant will assist. It's only in the private sector that a consultant always completes surgery, in the NHS it's often registrars operating under consultant supervision after years of already learning as their assistant. The consultant oversees a team of medics of different grades. If the consultant operates, the scrub nurse will be his/her assistant (all surgeons need an assistant), whereas in your scenario the consultant will be scrubbed up with the registrar, they won't just be in the theatre, they will be hands on and assisting. Its a bit like a pilot and co-pilot switching places on a flight, just one is more senior than the other. I fully understand your apprehension, but unfortunately, if you insist only the consultant operates, it may well be that you have to go Private. I hope the procedure goes well.

No, your understanding is wrong.

First, all surgeons are medical doctors. Secondly, all surgeons specialise in a specific discipline.

Ophthalmology is a specialty that medical doctors go into and then they further specialise into medical or surgical ophthalmology. Then, there will be further specialisation and training into specific eye pathologies.

There are no student surgeons. There are surgeons still in training - who are fully qualified medical doctors who now focus on a particular area of surgery. A previous posted was right - the “student”/“trainee” surgeon could have 7-9 years of specialised surgical ophthalmology experience.

Secondly, how NHS operations work is that you will have a named consultant responsible for your child’s care. They will then need to have an assistant who will assist by doing parts of the operation or holding instruments or providing traction - this means that they will be scrubbed, standing be the bedside and be participating throughout the operation.

This assistant (or second operator) will almost always be a “junior doctor.” Sometimes the operation will need several assistants and some simple operations require none.

I cannot comment as to how much of the operation will be performed by the “junior doctor surgeon” but it depends on so many factors - including the difficulty of the operation, the rarity of the operation, patient, how many other cases are scheduled that day, bed pressures, level of junior, level of consultant and personalities of both.

While I understand your reluctance to not have students/juniors operate on your child - this demonstrates how the public perception of NHS doctors as “juniors” is really damaging to patients. There really won’t be a spotty teenager or 21 year old let loose to operate on your child.

He/She will be a very capable and your child would be in good hands ..
and throughly capable of performing the procedure.
We need experienced surgeons and this is how we get them
He will be fine, and have two or three surgeons overseeing & looking after his sight.

I don’t necessarily think private is better. My friend paid privately to avoid waiting 4 weeks for NHS surgery and the surgeon operated on her non-cancerous breast.

The surgeon who did my emergency C-section was a registrar under the supervision of a consultant.

You can refuse surgery on your child’s behalf.