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 would talk to the hospital and get more info.
They will know much more than anyone here can tell you.

Op sorry to hear about your son and wish him the best in his surgery. Aside from this i honesty don't think this thread is the best place to discuss your concerns. You already sound very set in your mindset so im not sure why you are trying to convince the thread of your opinion. Its your son not ours, you must speak to the team involved in his care and decide what you want to do accordingly. Wishing you all the best.

I’m surprised they actually told you it’s that standard a practice

I think it's very easy to say the OP is being unreasonable when it's not YOUR child on the operating table.

She's not trying to denigrate the medical profession, she's scared. The stakes are extremely high for the OP and her son, but for everyone else it's just an online hypothetical discussion.

I think there have been some really helpful, insightful responses though that have explained the situation well, and OP has said herself that she has read them and is taking them onboard.

Also for those suggesting going private
This may not be an option given that this is a child requiring a GA.
not all private hospitals will offer this service

Everyone wants and deserves the very best surgeon for themselves, your son is no more special than anyone in that regard. But in order to become competent you have to learn. And learning under guidance of a more senior colleague is the process for that. If you trust the senior colleague than you have to trust they know that their ‘student’ is ready and capable of.

for what it’s worth I had complex eye surgery in 2015 but due to health complications I had to have it under local anaesthetic rather than full sedation. There was a fully qualified surgeon and a trainee under his guidance. I can’t unheard some of the horrors and the increasing alarm in their voice. But it was all fine in the end!

I have malignant glaucoma. Have had laser treatment and six eye operations. You can either delay surgery and get your preferred surgeon or go private. I can't see any other option.

Because Doctors below Consultant level aren't students at all. They may not be Consultants but they are still experienced Doctors.

I also understand why you are so stressed, it is completely natural.

The surgical team is a team. You've got the person physically doing the work and all the specialist advisors gathered around leading and watching.

It is how things are done successfully. They are not letting someone off the leash to just go at it, as they see fit. As others have said it will be a very controlled environment.

You do realise PP isn’t at work and how they act anonymously on the internet has absolutely no bearing or indication on how they might operate at work?

Yes, but she didn't understand that, she wasn't being deliberately disparaging; she just didn't know. I feel like people have been unnecessarily mean to the OP. She's just worried and confused.

They will be experienced over several years. This is not a 'student' straight out of college but an experienced surgeon. He/she is being supervised for part of the operation. No way would this happen if the surgeon being supervised was not entirely competent.

I can only imagine the added worry of being awake, especially if things don’t go to plan. I had a similar thing during my emergency c section and I’m a strong believer in ignorance is bliss! Hearing scary stuff on the operating table isn’t nice. Glad you had a good outcome!

Logically I realise everyone deserves the best care, but as a mum, I obviously care about my family’s care more, as I’d imagine is natural.

I’ve heard what people have said and will be enquiring about the level of qualification and experience but appreciate it could actually be beneficial to have the “student” (registrar doc?) present too. So I think on balance I’ll go along with what the department suggest and just hope for the best outcome.

So she can take what the NHS is offering then, or not have the operation.

My own child has had to have emergency surgery under GA in the past so I am not unsympathetic to that, but do still feel OP is BU in her expectations.

I would take this like a shot. You get not only someone experienced but a very senior individual supervising and stepping in - bringing far more experience than you would normally have.

I'm not placing any value judgement on what I'm saying
just saying a lot of private hospitals simply don't have the staff or facilities to anaesthetise and care for children 🤷‍♀️

This - OP, you are getting a loy.of flack. Of course, you have a right to probe and ask further questions.

It depends, they may offer an alternative, or they may not. Perhaps they’ll be able to reassure her.

I think you should make another appt if you can to discuss this.

I 100% understand your concerns when it's a risky op and blindness is a potential outcome.

At the same time, all surgeons need to practise on patients and under supervision. I'd also assume that the consultant would step in if the jnr dr was not doing what was right.

There may be parts of the procedure that are less risky and the 'trainee' may do those and leave the harder parts to the consultant. These are questions to ask.

However, you have a right to discuss this and air your concerns.
Don't be aggressive at the meeting, but show your worry as the parent and say you need a fuller explanation of how a trainee can manage complex surgery.

Your 'experienced' surgeon could be a very experienced arrogant lazy arse who thinks he knows it all after umpteen years at the coal face and now phones in his performance.

The trainee on the other hand is likely to be on his best behaviour and paying full attention, especially if he has an overseeing senior surgeon breathing down his neck.

Not suggesting a more experienced surgeon WOULD be like this. But tonnes of experience doesn't automatically mean better.

EDIT: And I've used male pronouns all the way through that post. Someone fetch the paddle! 😳

Hi OP, you're getting a bit of pasting here in some quarters but imo it's completely natural to be worried about your child having an operation and want the best for them. You've had good info already on the difference between a medical student and a doctor training to be an opthalmologist/ opthalmology surgeon (same difference / terms interchangeable). I'll just chip my two penworths in, I work in the medical negligence field (loosely) and since my day job involves dealing with all the horrible and distressing things that doctors get wrong, including surgery and opthalmology, plenty of things do give me the heeby jeebies should my family or I ever face them (I can tell you what they are but no need to scare you), but funnily enough while I can see why it would be worrying to a member of the general public, a planned, elective, day time operation involving a junior/training surgeon, even a very very junior CT1 or ST1 (lowest level where they'd be allowed to do any operating, 2 years post medical school), directly supervised by a consultant, isn't something I'd worry about. It's such a controlled, planned out and regulated environment when they're training the juniors, and there is plenty at stake for both doctors (particularly the trainee) and the second something is a bit unusual or not as they expect the consultant will step in. It's really rare in this context to see careless mistakes or the kind of errors that happen when a surgeon is on their own or in emergency or out of hours situations when people are rushed or stressed or operating on the edge of their competency or without the proper chance to prepare. Bear in mind too if it is a more junior/inexperienced surgeon they highly likely will just be doing the easy/low risk parts like the initial incision or closing, and they'll then observe or assist the consultant with the more delicate stages, which is a very different thing to being presented with the patient on the table and being told 'go' with no help start to finish. I'm hard pushed to think of a surgical incident that's happened with a properly supervised trainee in the last few years (and believe me like I say I do see plenty of all flavours of mistakes and incompetence generally) - never say never of course, strange things can happen but really OP I'm sure he'll be absolutely fine. Best of luck with it.

How on earth is anyone supposed to reach the point of being an experienced consultant/ specialist, if everybody refused to allow trainees to practice their skills?

DH is waiting for a hip replacement and has been able to choose the consultant. He wasn't happy with the first one as he didn't believe in minimally invasive surgery and requested to change to a consultant he'd seen privately on a previous occasion and is now on his NHS list.

I think @Starwarsepisode3’s advice is good, @RunningThroughMyHead.

I used to be an operating theatre nurse - I did 8 weeks in the theatres at the Eye Hospital in Manchester, as part of my post basic theatre course, but don’t have a lot of specific experience of eye surgery, so what I am saying is more general.

As people have said, the surgeon who is learning this procedure, under the consultant’s supervision, will be a fully qualified doctor with experience in surgery - maybe years worth - following qualification, before they specialise - in this case, in ophthalmic surgery. They will be experienced and skilled in surgery, and will have done less complicated procedures, first supervised and eventually unsupervised. Basically they will have started with the easiest procedures, and worked their way up to more complex ones.

But you have every right to feel anxious about this - having a child undergo surgery is pretty scary, as I know from experience - and the letter clearly added to that anxiety.

As I say, I think the advice I’ve quoted above is good - you may feel better if you have more details, and answers to the things that are worrying you. There is evidence that shows that patients who have all the information they need, prior to surgery, show fewer markers of anxiety post op, recover more quickly, and lead less pain relief - and it makes sense to think that the more information you, as the mum, have, the less anxiety/stress you will have.

A good consultant will be happy to make sure you have the answers you need, and should try to set your mind at rest.

Finally, although it is a while since I worked, it is my understanding that the patient (or if the patient is under age, or cannot make the decision, their next of kin) can refuse to have a student perform a procedure on them, and I would assume this applies to trainees too. Since the consultant will have to be there, to supervise the trainee, requesting that the trainee does not perform all or part of the procedure won’t change the staffing in the theatre so I can’t see any practical reason why they should refuse that request, of the consultant can’t set your mind at ease.

Everyone wants and deserves the very best surgeon for themselves, your son is no more special than anyone in that regard. But in order to become competent you have to learn. And learning under guidance of a more senior colleague is the process for that. If you trust the senior colleague than you have to trust they know that their ‘student’ is ready and capable of.

I think the issue here is that the 'outcome' is possible blindness. It's not as if there may be a bigger scar, or something fairly trivial like less than neat stitches, where the body will heal afterwards.

It's a child who could lose their sight. Every parents' nightmare.

you all need to try to show more empathy with the OP instead of picking her up on words she's using when the point is very obvious!