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?

You seem to be insinuating that you work in the medical field. It's a concern that this appears your bedside manner when a concerned parent, with no medical knowledge, is worried about the success of a surgery that will affect their beloved childs' sight.

Condescending and apathetic are just a couple of adjectives that spring to mind for you - and two nightshifts don't justify that.

This is really helpful, thank you for explaining the situation in the way you have.

I think your response is natural, most parents want the best for their children.

I also think that this strong reaction is coming from a place of not being in control. You can't control the outcome of the surgery, so are finding it difficult to process. It is understandably terrifying. So, if you feel really, really strongly then I think you should look at self funding and picking a consultant who you feel more comfortable with.

However, in no way will your child be put at additional risk using a registrar. Every step will be so controlled and perfected under the consultants watch. The registrar will have had so much training. And you'll have two pairs of eyes in the room - controlling every step so precisely that you could argue that there is less room for error than an "old-hat" consultant with a big name and reputation.

Thank you, appreciate the support.

As others have said, it'll be a senior registrar. And the consultant will be supervising so it's fine.

I don't think you have a choice - when you go public the idea is they have to train people and use whoever they can (as long as it is safe) so you either accept the allocation or go private when you can pick who you want to to do the surgery. If they let everyone pick NHS would not be able to survive so its important that they say no to these requests. NHS is a basic level service. If you are very concerned and want choice in who does the surgery it might be worth speaking to your insurance and seeing if you can get it done privately instead.

Was it neglect though that caused his death, have you seen the paperwork, read the notes, attended the inquest, do you know what surgery he was having, the risks, are you privy to hospital medical history? Did he die on the table or post op?

Neglect is very hard to prove. Due to the many other factors that need to be taken into account.

It is also likely that the person anaesthetising your child may also be "a student".

U less you are paying you don’t have a say unless you go to the back of the queue, you sound very entitled, they’ll be supervised and wouldn’t be put in the position unless they had shown they process the skills.
Put your hand in your pocket and pay instead of moaning.

I had an operation during pregnancy which was incredibly stressful and had a similar situation - I asked for clarification from my consultant and he explained who the other doctor was, how experienced they were of this specific surgery and how the operation would work (was an unusual surgery which required a specialist surgeon, not just any obstetrician). It put my mind at rest and you are entitled to ask for that clarification.

Thanks for giving this perspective in a kind and understanding way. I’m taking it on board.

I am not at all bedside though am I?
I am in bed.
You do realise our bedside manner is for when we are at the bedside.

They went to trial and won. The operation was a complete balls up and the trust tried to cover their back. I appreciate it’s not common, but things do happen. There was a paediatrician in the news recently who was conducting unsafe procedures on children in the UK for years before it was stopped.

Maybe I’m just projecting my worries around how the operation will go. I’m taking on board the feedback and can see how two doctors would be better than one in lots of ways.

To be fair, night shifts are brutal.

My medical profession family member who does them really struggles with them.

the op is worried. The pp is knackered and should be sleeping.

can’t we call just cut each other some slack?

@RunningThroughMyHead it might worth gathering up a list of the questions you want answers for and ring the number of the consultant’s secretary and ask her if there’s an email address you can email them to and see if she can come back to you?

Your husband isn’t even sure what he actually even said, is he?

Please stop referring to the surgeon as a “student”. Students absolutely do not do operations. If this is how you’re framing it of course it will sound alarming.

Ophthalmologists do 5 years of med school (during which time they are students), then two years as fully qualified but very junior doctors before embarking on a seven year ophthalmology training programme to fully qualify as an ophthalmologist. The person doing the surgery may well be a matter of weeks or months from being consultant, or a bit earlier in their 7 year training. There will always be a “first time” for each procedure but usually they’ll have proven competency in many of the skills used, accumulated through other procedures. This will not be their first ever surgery.

What I’m trying to say is this isn’t some 19 year old oik off the school bus. This is a fully qualified doctor with proven competency under direct supervision of a teaching consultant. Maybe you could ask for more info re the level of training and when the consultant would step in etc to put your mind at ease.

PS. Some of the most skilled doctors I’ve ever met have been registrars - often they’re doing a lot more of the hands on day to day stuff than the consultant who will tend to take more complex procedures.

He’s a full blown mature adult, he told me what he thought they said. It’s hard to remember everything word for word in these appointments.

I’ve also received a copy of the letter that went to the GP and it reflects a similar conversation, details I’ve put in a previous response.

A senior registrar will be in their 30-40s, with 10-20 years experience. It will not be an 18 year old medical student.

They are not a consultant so can’t work without supervision (potentially indirect supervision with the consultant elsewhere but available to attend quickly if needed), but they will still be very experienced.

I became a consultant aged 38, so had 14 years of experience. There was absolutely no difference in my clinical work between ST7 and first year consultant. The difference was that I was directly responsible for managing my service, the clinics and procedure lists etc were exactly the same.

Please at least let your husband take your child the day of his op to be his appropriate adult. You will drive the staff mad.

Op I would also feel anxious. It’s natural.

Was dh specifically asked to consent to a trainee doing the surgery or was it presented as normal procedure? If there was an opportunity to “not consent” then you can go back and say sorry you don’t want this surgery and will go back on wait list until it can be done by a consultant surgeon.

Less seriously - I consented to letting a trainee midwife stitch me up after I tore during labour with dc2. Omg it was the worst pain I ever experienced - felt like a hot knife slicing through my clit and she stitched me so tight I was in pain for many months! I really regretted allowing it. I would think twice before letting someone near my dc’s eyeballs with a surgical tool unless they’d done this procedure many times on adults.

Your op is disparaging, plus other comments. ‘I don’t want my son practiced on.’ Disparages the many years of expert practice this student has put in. And it is not at all unlikely to say the student might have more recent experience. I am a senior manager, my team own lots of reports, I know them inside and out, but I’d have to read the procedure to produce them myself these days. My junior team members, who are experienced professionals, could produce them in their sleep.
you’re being quite rude to a lot of people whi are trying to helpfully explain. A complex surgery doesn’t usually mean every part of it is complex, more likely a couple of components are tricky and critical, and many components are basic everyday surgery. The student will be doing those and only doing harder things if they are clearly on their game, and the senior will be watching every move and scrubbed up ready to jump in.

I know this is in no way comparable to serious eye surgery but I have a massive phobia of needles and have had to have my blood taken quite a few times over the last few months. It’s always uncomfortable and I’m always bruised after. One day I had someone with a ‘trainee’ and asked if it was ok for them to draw my blood. I honestly wasn’t keen but am a people pleaser so of course said yes lol I also apparently have wonky veins so the trainee was nervous of this but was reassured by I’ll say her boss because I can’t think of what they’re called 😬 but anyway she took my blood and I didn’t even feel a scratch and didn’t bruise after. I couldn’t believe it and when I commented she said I think it’s because I’m so cautious of making a mistake.

my long winded (sorry) point is that just because they’ve got experience doesn’t mean they’re the best. Sometimes the newer ones take the most care.

I completely understand your anxiety though, this is your child and you have the enormous pressure of making a decision that can change their life so you have to do what you think is best and trust that. 🙂

Sorry, but when did I suggest it was a 19 year old student?

I used the term student as I wasn’t sure what to call them - I’m not clinical.

Im literally a mum, trying to get the best care for my child. Why are people so unkind and patronising in their responses?

Ive had a few really kind and informative responses which have made me reflect on my perspective. There’s really no need to kick someone down for no reason.

Goodness, he’s a “full blown mature adult” is he?

Who isn’t clear on what the consultant said regarding who will be performing critical eye surgery on his young son.

There is no such thing as a student surgeon. Any surgeon up to the point of consultant is a "trainee", but that does not make them inexperienced or incapable or a student.

Qualified consultants don't come the nowhere, you have to do the operations many time whilst you are a registrar in order to become a consultant, up to the point of independence. No one will be allowed to operate if the consultant doesn't deem them experienced enough or good enough, and they will be supervised closely depending on their level of expertise. The consultant will likely have worked with the registrar many times and will know their experience.

Most operations are completed by a combination of consultants and registrars. Your son is entirely safe and a 'trainee' being involved in his operation is normal, and does not mean he is getting worse care.