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?

Ophthalmology residents train for 7 years
they are all supervised when operating but all need to be trained and competent so in years to come we have surgeons that can operate on the next generation of patients
They aren't a "student".
And it is likely that in this scenario the two surgeons would be working side by side through the procedure ensuring you'd get more not less oversight of the procedure

Referring to them as a student is very disrespectful.
They are qualified Dr's.
I also said that the registrar may have done the operation more recently as Consultant step away to allow the registrar the experience, they'll be on hand per see, but it may have been some time since they single handed did the op.
This is common in surgery.

I'd ask for clarification. They may just be there learning, or doing a small routine part. Id feel at least that the experienced surgeon would especially want it to go well if they are showing someone else. (not that they'd ever not want it to go well, but I might actually feel reassured having two people there).

I had surgery recently and the super senior consultant did it - it was the middle of the night and they got him up to come in and do it. To my alarm, I think I heard him say "I haven't done one of these for a while" as they were knocking me out. (turned out fine)

Yes YABU. They will be under the close eye of the senior surgeon.

Having ended up with many injuries and long term disability from a student “specialist” including spinal injuries from a student anesthetist when I had my c section I refuse to let anyone without either professor or a Mr who is a surgeon operate on me or my kids!! You are NOT being unreasonable at all!!! Just go back to them and tell them you would feel more comfortable having the surgeon himself operate on your child and the student is ok to be there to watch but NOT to operate or touch your child’s eye at all!!!

You can refuse but remember many experienced docs have god complex that can also lead to poor outcomes. And as others have said this will be a well trained doc with years of experience.

Thank you for being kind in your response. It’s very stressful, I’d imagine most parents would feel iffy in similar circumstances.

Whilst I get that the “trainee” doctor will have had years of medical training and experience, am I really that bad to hope to get the best, most qualified and experienced, surgeon for my child? Isn’t that natural?

His surgery isn’t time critical in terms of months difference, if it was years I’d have to reconsider, so I’m comfortable in extending the wait time.

I just don’t want any blips.

My best friends dad went into hospital for a routine operation and didn’t come out alive due to negligence. I know it’s rare but it’s a motivating factor in me wanting to make sure my kid gets the best care possible.

You're getting a bit of a roasting here OP - I feel for you as a mum who spent yesterday standing outside a hospital theatre suite waiting for news on my DS. It's not fun.

I'd honestly not have trusted DH alone at an appointment for something like this - when it's something so serious and important, I think ideally both parents should be there in case there's any confusion or anything is missed.

We've spent a lot of time in hospitals with DS recently and I've been quite surprised (several times) by how different DHs interpretation of what was said by medical professionals has been to mine. I have somewhat more medical knowledge than he does and definitely have better listening skills (as part of my day job).

Could you ring the consultant's secretary or your own GP for some reassurance around exactly what they told DH?

As others have said, it's the equivalent of having two highly qualified surgeons - one who has more experience, one who has had more recent training in the latest medical techniques and technology.

I had eye surgery under local anaesthetic by a fully qualified opthalmologist under the supervision of a more experienced opthalmologist. It was a bit disconcerting to hear the senior doctor explain things to the less experienced doctor but good that every cut and stitch was closely monitored. Surgeons need to do a certain number of operations under supervision before they can work unsupervised. If they don't get that experience then fewer will be able to do that surgery in future. If it's a difficult or more unusual surgery it is likely that they have experience of less complex surgeries but not the exact one your son is having. Think of it as driving with a driving instructor.
Assume your son would have a general anaesthetic.

Haha I’m glad your op went well, not very encouraging words as you’re slipping under!

The letter says the doctor (trainee one) would be doing all or part of the operation under direct supervision.

I just don’t feel comfortable with it, although appreciate I must be unreasonable from the responses I’ve had.

This is my thinking too

This with bells on

@RunningThroughMyHead I totally understand where you are coming from, you want the absolute best person for the job operating on your child, as you should. Someone else upthread was correct though, it could be the case that the registrar did this operation two months ago and the consultant last did it two years ago. This is not going to be someone fresh out of medical school!

Yes, having general anaesthetic.

Ethically, I understand they need practice to qualify and fill a skills gap as surgeons retire. But as a mum, selfishly I guess, I want my son to have the most experienced surgeon available.

My husband anaesthetises children and is a “trainee” , is the most senior doctor in ICU at night and is a “trainee” , the surgeon who did my emergency c section at 1am was a “trainee”. Trainee doctor or “resident doctor” as they’re newly called. The old term was “junior doctor” but that was recently changed as the perception from the public was often that they’re medical students or inexperienced.

The surgeon will be a registrar so will have completed 5-6 years of medical school, 2 years of foundation, 2 years of core training and then 6 years of registrar training. They also have immensely difficult postgraduate exams throughout all of this. Often they will be in training for longer than the above time frame due to taking time out to do a PHD or work on portfolio so they can have a better chance or working where in the UK they want to, time out to have children etc.

The registrar will have the consultant on hand in theatre as it is a planned daytime surgery, and even if it was the middle of the night they can contact an oncall consultant to come in if things get hairy.

It will be fine.

Aww Sweetheart, scary time a.
I think you should think about what concerns you , write it down and see if you can speak to the surgeon, who I'm sure would be willing to alleviate any fears about the "trainee".
You are going to be anxious enough about this surgery.
Hope everything goes excellently
🫂 💐

They wouldn’t let the doctor operate if they weren’t confident he or she could deliver the same outcome as the other surgeon.
The experienced surgeon will be making this judgment. And it sounds like you already have faith in his or her judgement.

Just read that your child will be under GA, chances are this will not be a consultant either. I can understand why if you’re not medical this can seem scary or unsafe, but as much as I a stranger online can assure you, it will be fine

I would have more confidence in a more junior surgeon being supervised by a consultant. The consultant is going to be keeping an extra close eye and certainly wouldn't let the junior proceed if they weren't confidence. The trainee isn't going to have a momentary distraction, or get slapdash because they've done it a million times, or be called out for something half way through.

The most experienced surgeon is not necessarily the best one.

I just don’t want any blips
You can't have such insurance from anyone. Experienced consultants are not God's, they too make mistakes and sometimes can be even more prone to them as experience can lead to less attention to detail. This is seen with pilots. Planess crashes happen even when the pilot has many thousands of flight hours behind them. Do you ask how experience the pilots are everything you get on a plane.

The surgeon in charge will be clinically responsible for the surgery themselves, so you can be assured they will make sure as much as they can that nothing goes wrong.

My eldest had a difficult operation on her wye when she was 7 years old. Another child in her class had the exact sane surgery 6 months before. The surgeon was extremely experienced. The other child was a total success, my child was only partial.

I think you need to explore getting this done privately and then you can be assured of getting 'the consultant.'

I work in the NHS and unfortunately you have absolutely no say in who operates. Even if you think you do, they can change surgeons at any moment. They move residents and fellows around according to lists and what cases they need for their training.

Saying that, they won’t be a junior student, they’ll be a doctor who has virtually finished their training. They’ll be closely supervised.

I often find these supervised surgeries better in some ways, you have 2 highly trained professionals concentrating fully, discussing as they go.
They’ll often have longer operation times too, less rushing.

If you want control over who does the surgery, you’ll need to pay privately.

The "Mr" (or indeed "Miss" title) comes when junior doctors pass their first lot of surgical exams in the first section of their surgical specialist training, so within the first 4-5 years of qualifying.

It will take another 4-5 years (and very likely more with research time if you do a PhD and then fellowships for a particular sub specialty) before you become a consultant. (Medical consultants retain the Dr title throughout and some Obs/Gynae surgeons use Dr, as do many dentists.)

Thanks for understanding, did your son’s surgery go well? I work so can’t attend all appointments (three kids, to of whom have two ongoing conditions so lots of appointments). I also wasn’t aware this would be the appointment where the surgery details were discussed as we have regular eye check ups.

Ive had an NHS letter from the clinic confirming that “the surgery will be done under the care of Mr Xxx, with possibly a trained doctor doing all or part of the operation under my direct supervision”.

I understand they’re well trained and experienced as a doctor, but surgery is different and with an eye, there’s not much leeway to slip up.

As a mum with a child who’s recently had surgery, can I ask how you’d feel? My gut is feeling uncomfortable but perhaps I’m being totally unreasonable given the responses I’ve had.

I think you should ask all the questions you like, and hopefully they will reassure you, but ultimately I think I would trust the consultant on who is qualified to perform the operation!