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?

I completely understand you wanting the best for your child. If I were you I would ask for clarification - I believe they may not actually mean “trainee” but senior resident ophthalmologist, who would perform these operations routinely. I am a paediatrician, I have never heard of a medical student performing eye surgery :)

Just to correct a misconception all surgeons who have passed their exams and have membership of the royal college will be Mr/Mrs/Miss/Mx and that includes registrars and senior fellows, staff associates and any number of non consultant grades such as a the one who may be performing the surgery under supervision in this case.

OP I understand your concerns but they are unfounded. Only somebody competent to perform your surgery will do so. They may be referred to as a "trainee" but it doesn't have the same meaning in medicine/surgery as in general parlance. It will be someone with years of experience performing eye surgery who is themselves a specialist in eye surgery. They will be closely supervised with the consultant ready to take over the surgery at any point that things aren't routine and straightforward.

If you want to be able to choose your surgeon individually based on their years of experience then you will need to pay privately. All surgeons gain experience by working with real patients. The system cannot ignore the needs of children just like your son, but whom will need their surgery in 10, 20 or 30 years time. And it is because of other children, just like your son, whom your son's consultant operated on when he was a senior registrar, that he is now available to safely supervise this surgery.

But forgetting for a moment the sustainability of the surgical service for future patients - I genuinely think that any risks of the surgeon having less experience are offset by the presence of a second supervising surgeon. *

• And if the surgery does not require consultant supervision because it is routinely performed by the registrar then it is indeed very likely that the registrar has performed more of this type of surgery more recently than the consultant.

Very experienced doctors/surgeons can sadly also make errors and unexpected events can always occur no matter who is operating, you will never find a surgeon who can eliminate the risks.

My RL example is the opposite. It was a surgical registrar who dismissed me, dismissed concerned nurses and ultimately made a mistake that almost cost my son his life.

Which is why parents need to be fully informed and make a choice they feel comfortable with.

Are you paying privately? If not, this how it works.

I know it’s confusing terminology but basically almost all doctors who aren’t consultants are ‘trainees’, even if they’ve been working for a decade. It won’t be the work experience kid doing your son’s surgery.

My daughter has very recently had a tumour removed from her eye and we went private and we were able to pick an our surgeon. Is that an option?

Surgeons have always been called Mr, @Allthatshines1992 - and now Mrs/MsMx, of course. This dates from way back in history (maybe Tudor times, but don’t quote me on that) where medical doctors were the ‘real’ doctors, and surgical procedures were carried out by barber-surgeons who had no medical training. For this reason, the surgeons weren’t called Doctor - and were looked down on by the doctors - so were Calle Mr/Mrs/Miss/Mx Whatever because the doctors didn’t think the surgeons deserved the title.

Obviously all doctors now have to do the basic, five year medical degree, before they specialise in medicine/surgery/psychiatry etc, so surgeons are qualified doctors, but stop using the title when they become surgical consultants.

I was a qualified nurse when I did my training but I was learning to be a midwife, just like these doctors are qualified doctors but learning in their speciality. There absolutely are trainee anaesthetists, who are doctors training in that field meaning they are learning to do that job. I have had many women say I’m not having a trainee do my epidural.

I’d be asking for the consultant to do it - and yes you can refuse / state you would like someone else to perform the procedure rather than someone who is under supervision.

And how was OP supposed to know that? Ridiculous when people use an excuse like that for being rude.

You will have two highly skilled surgeons. One will be the registrar - a fully qualified doctor who is specialising.

One who is the "student" (aka registrar) they will be pretty much fully qualified but will just need signing off. They will be very "up" on new procedures and new ways of doing things.

They will then be supervised by a surgeon with lots of experience.

I would always prefer to go with that than just one surgeon. Just as at the GP surgery if you see a registrar you get the benefit of two fully qualified doctors.

I dont think it is anything to worry about at all - in fact the opposite. I dont think the NHS does themselves any favours when they try to explain what a registrar actually is.

Resident doctor anaesthetists (which is what they are called now, not ‘trainees’) are not ‘students’. And if they’re doing obstetrics they’ll actually be quite experienced anaesthetists because you don’t start doing obstetrics until you have quite a bit of experience.

In many hospitals in the UK, out of hours on LW, there’s a reasonable chance that the resident doctor will have done a lot more epidurals recently than the consultant covering from home (and some of the SAS grades will have done a lot more than the consult a have ever done). Absolutely your right to demand a consultant….you might not be getting someone with a lot of recent experience and you may be waiting some time for them to come in.

My child recently had strabismus surgery on both eyes and guess what, it wasn't a Consultant who performed the surgery. Did I care? No. Did I even think to ask the qualifications of the surgeon when he came to see us on the ward prior to going to theatre? No. I was happy that my child was finally having the surgery and trusted that they were more than capable of doing it. Every surgery poses risks regardless of who carries out. Having a Consultant operating doesnt mean it's risk free.

I’m in the EU, and one of my biggest regrets is allowing a ‘trainee’ to perform a laparoscopy on me years ago. I didn’t really think about it beforehand, but they made a complete hash of my tummy button and my stitches didn’t heal properly.
I wish I had known that I had the right to refuse this trainee surgeon.
It might well be different in the UK, I don’t know, but if you’re not happy to have a trainee surgeon please speak up and see if they can rearrange who will do the surgery.

Your not wrong op.. I'd feel exactly the same and want absolute assurance that only the best is operating on your child .
Considering the risk you are are not unreasonable at all.
I'd contact them if you can and get all the assurance you need for yourself for your son in this situation x

If you don't feel comfortable with a Registrar Ophthalmologist just say so, and if you’re feeling awkward telling the Consultant that in person, go via their secretary or PALS can support.

I'm an experienced paediatric nurse and I wouldn't feel comfortable either, because you want the best for your child. And there is nothing wrong with that.

To put it frankly, yes they have to learn, but not on your child.

I wish him all the best.

@KidsDr im not sure why you have quoted me in this as I am responding to a post by the OP.

and presumably a trainee means they haven't done the op before,

I'm surprised that after 14 pages of being told what's meant by the term "trainee" you still think that! Or you haven't bothered to read all the posts which explain that the term means maybe not the absolute highest grade there can be, consultant but still highly experienced with many times of doing that and/or similar operations under their belt.

I wouldn't worry at all. In fact, less is likely to go wrong in my opinion because there's 2 of them there. The experienced surgeon will be instructing his every move. And the trainee surgeon would be pretty brainy himself and wouldn't want to screw it up so would be being extra careful. You could ring them for a chat though if you're worried. How you feel is how you feel

It will be a registrar under the supervision of the consultant! I’m not sure what your problem is! Just remember these are our consultants of tomorrow and if your son needs further surgery in the future and there’s no one to do remember your thoughts now!

I was thinking the same thing.

Op, if you reject the ‘trainee’ do you get put back on the waitlist until an experienced surgeon is available?
can you little boy wait a bit longer.

You have a right to chose from what is available. I imagine with eye surgery there will be a local hospital that does it and you will have it done by their surgeons whoever is on that day. Otherwise it's private healthcare...

You do have the right to choose. Your choices accept that an NHS surgical team is far far more experienced to assess someone's abilities to perform surgery, refuse consent for the operation and explain to your son how while he suffers you and what ever your profession is knew better than medical professionals or pay for the operation yourself.

They arent bringing in a 17 year old fresher at uni to do it 🙄

They will be an experienced surgeon who will be supervised by an even more experienced surgeon. Our daughter had this with one of her heart surgeries.

Regardless of who is carrying out the surgery, there are risks. These risks are still risks regardless if its the trainee or not.

This whole debate is completely ridiculous as we still don't know the surgery the child is having.

It might just be a simple squint/ptosis surgery or an experimental one for a misdirection of a nerve or a replacement of a previous IOL where it needs an anterior placement/ PI.