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 think these are questions for your surgeon- not mumsnet.

while pps are correct that this ‘student’ will be highly qualified, it doesn’t sound like the medical professionals you’ve been speaking to are great at communication. Im sure your son is in very safe and qualified hands, but they need to explain why.

you need to ask them what they mean by a ‘trainee’. that will give you a far better idea.

but also ask them to talk you through the differences between this ‘trainee’ operating and a more experienced person.

say you are worried that it’s a high risk operation with significant side effects so you’d like to know how that might affect outcomes for your son.

it sounds like they haven’t really allowed you to give informed consent if your husband just nodded along to what he was told.

ask them to spell it out to you.

( I’m sure it will be fine, but you are not unreasonable to ask them to talk through the risks)

Good luck with your little ones surgery, I hope it goes well and they have a speedy recovery. xx

I understand your concern OP, but, as others have said, someone who has been given the green light by their supervisor to carry out this kind of surgery will have a wealth of experience, otherwise, they wouldn't be given the opportunity in the first place.
They're not "practicing" on your child, they're doing the real thing and they're being supervised by someone with even more experience.

Given your concerns and anxiety about it, I'd speak to the surgeon and even ask to meet the student/trainee to find out about their background etc. Ask how much of the operation they would be involved in (you said it could be part of or the whole of the operation).

Oh loads. Like, the vast majority of cases involving operative or peri-operative m&m are the consultant's "fault" (not that we use that language as such), maybe 95% or even more? And of the ones where a registrar/fellow was primary operator and there was an issue, the vast majority will be emergency cases or non elective, not routine elective cases. Sorry not to have specific numbers but like I say I honestly can't remember a recent case from my caseload where a trainee doctor doing a routine elective case under consultant supervision made a negligent mistake. I'm sure it does happen but few and far between for sure. The consultant doing the supervision/teaching sometimes does a bad job of it mind you, and the residents mess up plenty outside the immediate theatre environment, and no-one of any grade is immune to the sorts of nasty behaviour that ultimately gets you struck off like lying, thiefing, bullying, harassing, assaulting people etc but all that's cold comfort to OP (sorry OP!).

Just goes to show though that opting for consultant-led care or going private for a named consultant as was suggested earlier on the thread is really not a total guarantee of safety (personally and my biased /anecdotal opinion only is that I'd never go to a purely private hospital for any operation, private wing of an NHS hospital and with a mainly NHS consultant maybe but you won't catch me in a pure private hospital anytime soon).

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

I wonder if OP's worried that the supervision might not be as close as hoped, @NoctuaAthene, or even that the more senior surgeon might go AWOL because of pressures elsewhere?

I'm not suggesting for an instant it would happen this time, but it could be another reason to discuss it with them herself. As mentioned such worries will be nothing new to the medics, and if they're halfway decent I'm sure they'll be happy to offer reassurance

Isn’t there usually stats on surgeons where you can see how many of each operation they perform each year?

This is really silly what you've said. Of course doctors expect questions from someone other then the patient, especially as its a child. Of course it will be the parent who of course is probably not qualified. 🤦‍♀️🤦‍♀️🤦‍♀️🤦‍♀️

This. You really shouldn’t turn your nose up at a highly qualified medical professional. My baby had his life saved by a registrar who treated me as an emergency in the middle of the night, performing complex surgery that she had only ever read about in textbooks because the complications I/my baby had were so rare.

Completely fair point, yes you're trusting the consultant to do a good job of the supervising, to recognize emerging complications sooner than the trainee might do and know when to step in etc (which is a skill in itself and one they have to learn, not just any consultant gets to be a supervisor, they may be a very skillful surgeon themselves but terrible at teaching), but fortunately/ unfortunately either way you have to trust your consultant to do a good job whether they're scalpel in hand themselves or supervising someone else. Just like you have to trust the pilot of your plane whether they're doing the flying themselves or supervising their first officer, your life is just as much in their hands. I wouldn't say (personally) you're much safer either way. That is to say, you're very safe in both scenarios but mistakes, distractions etc can always happen, I wouldn't say overall one is much safer than the other, certainly the consultants I know and work with personally of course take patient safety and outcomes very seriously at all times, but probably particularly so when supervising trainees because there's double consequences if a bad outcome happens, not only the patient and their family but the impact on the trainee too. Selfishly they also don't want their teaching/supervising privileges taken off them.

But ofc I'm not so naive as to say there's not poor practice out there, laziness, downright negligence. Sadly that is not the reality, it's a risk we have to live with whenever we employ humans to do a skilled and difficult job. All I'm saying is if my consultant (that I trusted) felt it was a suitable case for a trainee to do some or all of, I personally would be very happy with that for myself or my child. Mainly because that means they've already judged it to be a lower risk case TBH which is correlation not causation but point stands!

Massively unreasonable.
What if everyone "insisted on this"? We'd never have any new surgeons.
Your child will be absolutely fine, under the care of a multitude of highly-qualified professionals.

And it’s fair enough not to want surgery done by someone who has to be guided with discussion and more “heavy-handed” than a more experienced surgeon.

YANBU at all. I went in for one of my planned c-sections and there was a trainee anaesthetist all set up to do my spinal block. It was extremely disconcerting sitting there waiting for a huge needle to go in my spine while simultaneously hearing the consultant saying to them “yes see on here that’s the bit you want to be going into, no not there, over to the right a bit, no left a bit more, you’ll have to make sure you get the right angle” etc. I said actually, no, I don’t consent to this, sorry I know you need to train new doctors but I’m already extremely anxious about this and literally shaking with fear, I don’t also need to worry about this. The trainee looked crushed but the consultant just shrugged and said of course, no problem, I’ll do it.

As the OP says, ignorance is bliss. I think we've perhaps gone too far in "informed consent" because without the knowledge and understanding about how surgical training works, being told that a "trainee" is doing an operation just increases the level of anxiety that patients and their families experience.

Where do we draw the line? Do you want to know about whether the surgeon is about to go on holiday, because there's evidence that this increases the risk? Or whether they had a row with their husband before work and got stuck in traffic and are really stressed about their child's exam results?

There comes a point where you have to trust them or not have the operation.

OP , I’ve just had eye surgery myself the consultant who was doing it runs a fellowship training program and it was them who did my op … I was under local anaesthetic ,so I was able to know what was going on .. yes he watched and oversaw everything and yes they were both already ophthalmologist doctors.. but surgery was longer however, I had a better outcome as he was teaching and went the extra mile so to speak .. hope this helps

If it’s an NHS operation you will get who you get

So why does the NHS website say you have the right to choose? As I said upthread DH has requested a different surgeon as he wasn't happy with the first one he saw.

I would have no problem with it. I think you are anxious for your child and looking for an outlet elsewhere.

Ask if you have a choice. If you do, don't take it, if you can avoid this. Your husband might not have let it sink in yet, and maybe he was just put on the stop, but otherwise he was bloody foolish to just nod along.

Some students might be very talented, but they will no way have the confidence and skill of an experienced surgeon.

What they're basically asking you is - 'Could we practice on your child in this complex operation that might lead to blindness if done incorrectly'?

There will be a lot of self righteous people on here that will say 'Well you can't choose your surgeon', or that everybody has to learn sometime, but I wouldn't care. It's not their child at the end of the day.

I think the reason why they've asked you, is because they know full well a student surgeon doesn't have the experience and the operation is therefore riskier, and they want to cover their own backs legally by making sure they have your consent before they proceed.

My child (6) recently had very complex eye surgery under GA, and the surgeon was supporting a ‘trainee’ who did the op (on both eyes!) with constant direct supervision. I completely understand your anxiety around a newbie performing this surgery, and you are well within your rights to decline this, if you feel it necessary.

my child had complications AFTER surgery, nothing to do with the op itself but the GA, so it happens.

The ‘trainee’ will never be performing something they do not know, and would of course stop and let the more experienced surgeon take over. These are very skilled, highly intelligent people who know what they are doing, and would never intentionally put someone’s health at risk for the sake of ‘carrying out an operation’.

The risks will be the same regardless of who is performing it. From a mother’s point of view, I get it, completely. But these people learn and learn as they go along. That highly qualified surgeon that you would like to carry the op out was once a ‘trainee’ and had everyone refused to have them carry out the ops he/she would never become highly qualified.

By all means decline, that is your prerogative, and nobody can judge you on that, but look at the bigger picture here.

I wish you and your child all the luck in the world for op, it is scary, but it is so worth it x

Honestly, whenever something like this comes up, there's always a few righteous women who come along and seem to enjoy saying 'YOU'LL GET WHAT YOU GET'.

They come across like sour dinner ladies who enjoy sloping a horrible meal on a plate. YOU'LL GET WHAT YOUR GIVEN CHILD!!

Same with women who DARE say they would prefer a female gynaecologist - always a few who come along and make the poster seem unreasonable or ungrateful.

In both of these cases, I imagine it was one 'consultant' with little oversight doing the operation. I bet that paediatrician was less likely to conducted unsafe procedures when there was another surgical paediatrician in the room, even one slightly less qualified' than he was

You have no real idea if the experienced surgeon is actually a very good one. He very likely s but it is vanishingly unlikely that both the doctors will be poor ones or have malicious intent

When you have two doctors in the room, you have two people looking out for problems and sort of 'overseeing' each other. Whilst the more experienced surgeon will have the final say, the other surgeon will also be experienced and can act as an additional pair of hands to deal with any unforseen problems. The more experienced doctor will be more alert as well as he/she will want to be judged well by the other doctor.

Why do you think commerical planes have a pilot and a co pilot even on short flights where no break is necessary? Two people checking things is better than one at all times

How do surgeons become experienced without operating?
The procedure will be performed under supervision, he is not going to be left alone to get on with it.
The risk is no greater than with any other surgeon.
Fully understand your concerns around the surgery but the person doing the procedure doesn't need to be one of them.

OP. Whilst I take your point, how do you think surgeon's get experience in surgery if not by operating on patients. The Consultant will be supervising them, they are not being left to do it on their own.

I wouldn't be happy with a student doing this either, if that's what they've said - and you can say no to students. Based on what other PP's have said though, I would call the secretary for his consultant and clarify who this student surgeon is, what his experience is so that you can have all the facts and information first. It might be that he's fully qualified.
I don't think it's unreasonable to have a preference who does your surgery and to voice this - many people do this in the NHS, and if it's possible I've seen it be accommodated. This is for things like elective surgeries etc but definitely on the NHS. if you have a concern about the person who's doing it I'd definitely be asking questions - I'd at the very least expect reassurance that they are qualified enough to do it, and if it's just a miscommunication then so be it - you can at least know for sure.

You can choose to have a particular surgeon in NHS, I've done it. Amended tbe paperwork I was signing after discussion. Somebody had already buggered it up first time so wasn't risking it a second time.