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?

OP, can you afford private? I had a eye issue a few years ago and went straight to the best professor that moorfields private had to offer. It used to cost £275 about 5 years ago. Honestly no way I would leave this to the NHS.

2 stage consent?

I am not being dim.
The consultant may not have done the operation in a while, they step back and are there to supervise, to teach, to empower.

You have the right to ask the Consultant more questions and to discuss your fear here.
And, if you are not happy you have the right to say so and to discuss the impact of that decision.

Horrible, elitist (plebs, don’t question medical doctors) attitude. Quite sinister really, how very legitimate questions and concerns are being shut down.

@RunningThroughMyHead I hope you have been reassured some of the explanations you've had, but just to reiterate, your child will not be being operated on by a student. If it's complex surgery then it's going to be someone who is capable of the procedure and is almost certainly in the very last stages of their training prior to taking up a Consultant post, having passed all their postgraduate exams. There is very little difference between someone in the final stages of training and the early years of being a Consultant and when a senior trainee is being supervised by an established consultant you're kind of getting the best of both worlds.
Whilst age does of course bring experience and having done something many times before is really helpful, but younger doctors also bring different things to the table. I learned a lot from my trainees over the years, as well as hopefully teaching them a lot!
Titles don't mean as much as people often think they do. I have worked with Professors that I wouldn't want to treat me or my family - they may be brilliant academics but that doesn't necessarily mean they're particularly good clinicians. And one of the best doctors I have ever met wasn't even a Consultant. He trained overseas and never ticked all the boxes to become a Consultant in this country so is in a permanent middle grade post but he is an incredible doctor who I'd be delighted to see if I was sick.
I am sure the supervising consultant would not be allowing the trainee to operate on your child unless he or she was competent to do so. It's their skills that matter more than their title. I know it's easier said than done - worrying about our children is part of being a Mum - but try not to be too anxious about this. I hope everything goes smoothly and your little one is soon feeling better.

You could look at it the other way, would you rather someone likely 28-38 at the prime of their physical ability, likely to have the steadiest hand doing the operation or would you rather have someone 40-60 who may be past their physical peak?

Ok that was obviously using an extreme example, but a Registrar may have performed the op hundreds of times, while the consultant may not have done for a while.

You can find out how many particular operations a surgeon has done per year. It's usually available online as part of their CV/ biography, even on the NHS.

And it's something anyone having any surgery needs to ask.
"Do you do this once a year or 3 times a day?"

40-60 is not past their physical peak.

Some of the best surgeons out there are mid 50s or older.
They are experienced.

OP I just wanted to validate your feelings of stress and worry as a mum, they are totally natural and normal. I am so sorry you’re going through what is clearly a hugely difficult, stressful, overwhelming, emotional, uncertain and scary time for your child and your whole family.

I want to send you virtual hugs, prayers and encouragement that it is ok to feel exactly how you feel. Today in this moment and every day you are with your LO on their surgical journey and beyond. You love your child and want the best for them. You deserve reassurance and I hope your surgical team can give you this. Your LO deserves health, happiness and a wonderfully successful eye operation and I pray with all my heart they get it ❤️‍🩹 🙏

Lean on all the loving support you have in IRL and take each day one day at a time.

Breathe and speak out words of life and blessing over your child’s eyes and their operation - words have power 💪. Care for your own mental health lovely and give yourself permission to cry and detach at times. If you feel panic rising try to ground yourself with something sensory, something within reach you can pick up and feel in your hands and focus on what it feels like and try to breathe slowly (in through nose and out through mouth slowly). Something you can smell, if you can get to something soothing even better eg lavender, lemons, rosemary, ginger. I find soothing instrumental music very helpful to de-stress. We all fall apart as parents sometimes and that’s ok. You are an amazing mum. You will get through this x

Notification that a non-consultant surgeon may/will perform some or all of the procedure is so the NHS doesn't get tied up in law suits where they are sued because a different person performed the surgery than the one named as the senior consultant at that department, whatever the outcome.

You get this when you go for consultations regularly - you will probably see the named consultant on your first visit but later appointments are often (I would say usually from my experience) with a "junior" person from the same clinic - a highly experienced doctor just not the named consultant. There's always something in the appointment letter that says to attend Mr Soandso's clinic, but that you may be seen by someone else.

@NoctuaAthene I would find it interesting if you could remember any approximate percentages of those medical negligence cases where the person performing the surgery was a consultant. I have read of many cases in recent years of doctors being struck off, and those all seem to be consultants.

A young trainee surgeon performed my daughters very successful transplant surgery.

This was during Covid lockdowns and we were so incredibly grateful the surgery was being performed at all.

Your GP wont have a fucking clue what was said in the appointment.

I would at least ask for further clarification if it makes you feel more comfortable. I mean how many of us have asked for a gp appointment and been given a physician associate or nurse practitioner? It’s not the same but it does demonstrate a lack of transparency in the nhs which we should be well within our rights to question.

Can you imagine, GP - I know you weren't in the appointment and have no idea what was said, by whom, but can you just tell me again what was said.

My son has had several major surgeries, the first one was incredibly high risk and I said no to any medical students touching him.

I was always happy for medical students to watch, observe and do things such as take his observations but that's it. I always made that clear and it was never an issue at the hospital my son was at.

I think you should say it and see what happens, at least then if something does go wrong you know you tried….peace of mind

I’d suggest calling the consultant’s secretary to explain that you require further information or clarification

Going directly to your GP wouldn’t be the first option, they may or may not have received the clinic letter yet. Even if they have the letter it’ll likely say they’ve been listed for surgery/discusssd with parent/s

Your GP will not be able to advise on the ins and outs of the surgery/relative experience of who will be operating- you’ll have to go directly to the consultant surgeon via his/her secretary

My DP had a complex knee surgery (revision replacement) and it was the surgeon’s first time he’d ever done that particular surgery. He was excellent though and my DP trusted him, the surgery went well. He had a great result. I imagine so much preparation goes into it before they would even think of letting a surgeon loose on a patient.

It's always been made perfectly clear to me if I'm being offered an appointment with a PA or nurse; usually the option is given "PA this week, or an actual GP next month".

In fact at my current GPs I would always prefer to be seen by one particular PA if the problem relates to my back issues, as he has done extra studies in that area and grasped my issues more quickly the first time I saw him than any GP. And the last person I'd want to see for a blood test or injection is a GP, PAs/nurses or (ideally) a phlebotomist are always better whereas I end up like a black & blue pin cushion with a GP!

But it isn't higher risk with a trainee, that's what people are trying to say (more or less kindly). It's understandable that as a parent/patient you'd feel as though it is risky, but this isn't actually the case. An inexperienced trainee without adequate supervision or working beyond their competence would be higher risk, as would a variety of other circumstances, but there's been nothing to suggest this would be the case here. There are lots and lots of rules and protections in place around what procedures and surgeries trainees are allowed to do at various levels and with what amount of independence/supervision. If there was evidence to show patients had significantly worse outcomes when trainees are operating then there would be serious consequences, ultimately the hospital would be stopped from having trainees at all, as clearly they are not educating them properly aside from the ethical and patient safety implications.

OP's fears are understandable but not actually justified here, it's not nice to just dismiss her out of hand but nor is it dim to say she's also fine to consent to the trainee doing the operation under supervision, in the conditions and context she's been given. I totally understand everyone wants the best for their child but how are we supposed to have qualified surgeons at all if they're never allowed to operate as a trainee?

You don’t have the “right” to choose your medical
professional. If you want this then go private.

The person doing the surgery will not be a student. This is not possible and has somehow been misinterpreted.

Just to add, my 3 year old is having open heart surgery in a few weeks. We did not get to pick our surgeon. We got who we were given.

I completely understand how you feel about this, @MsTamborineMan - my own DS is partially sighted and still has to have work done on his "remaining" eye so I know what a worry it is for us parents

PPs are quite right about the care that'll almost certainly be taken, but I wonder if it would help to talk to the senior surgeon yourself? I've been very lucky in building up a brilliant relationship with ours - though I wish I hadn't had to - and believe me they'll have heard this before and will probably be very happy to put your mind at rest

I had eye surgery in May this year by someone not fully qualified - this surgery was to prevent further sight loss in eye already very bad. She was guided all the time by the head of that department at Western Eye Hospital - where I have been going for many years. The surgeon stood right beside her all the time discussing what was going on etc.(local anaesthetic.) The person doing the surgery was probably a bit more heavy handed than the surgeon would have been - but apart from that was OK. I most likely would not have had a choice or would have a long wait - which was not a good idea with deteriorating vison. I have had other eye surgeries there too - this was only one by trainee.