Obstetrician Experience on NHS

[Roxyoc]

Hello - I’m currently 22 weeks pregnant and removing from covid complications so was referred to see obstetrician on NHS.

It was my first appointment and I was given the name of the consultant in advance. At my appointment I was surprised to be seen by a very young doctor who said she was part of the consultants team. While she was very nice she could not answer any of my questIons and kept saying she would need to check with the consultant. I was left waiting about 40 mins until she could get hold of the consultant who was two rooms down the Hall . I did not meet or speak with the consultant which was disappointing . Is this normal? I was told to come back for a scan and follow up growth scan in 3 weeks by the junior doctor but it’s left me wondering if it’s normal not to be seen by the consultant? I’m wondering if I should pay to have a private check up as nervous about impact on the baby and left feeling uneasy .

Yes it is normal to see someone in their team. They still ultimately oversee your care and are responsible for you.

Doctors all need to start somewhere and it sounds like this person was unsure. If you're not happy, politely ask if you are able to speak to somebody else - however if you are seeing someone else in three weeks time I would wait until then.

My experience of 'consultant led care' has been excellent, despite only actually speaking to the consultant herself on one occasion (and it was a telephone call and not a face to face appointment!).

That doesn't sound right to me. I've been consultant led in my last two pregnancies and have always seen the actual consultant at my appointments. I would speak to your midwife about getting a follow up appointment with the consultant (she should be able to tell you if one has been booked in along with your next scan).

Yes it’s usual.

It’s shit in my opinion but what can you do.

If you can afford for a private consultation then go for it.

Perfectly normal to be seen by a registrar or less commonly an SHO who will defer to the consultant if required. The thing is with Covid patients, and the current circumstances, is that there are a lot of unknowns and the policy will basically be made up because there isn’t any evidence to go on, which is probably why she couldn’t be sure.

I saw my consultant throughout my 2nd pregnancy (mental health reasons) but friends who were consultant led saw a mix of junior doctors and the consultants.

I’m consultant led and I’ve only ever seen registrars who just keep shrugging and saying “I’m not sure”. It’s my third pregnancy so I didn’t have high hopes. I’ve given up trying to ask them anything now. I just go in, sit there and it’s usually awkward silence until I say “shall I go now?” It’s pointless.

I’m having my 3rd section and I’m fat no other issues, so there’s nothing really to talk about anyway but it would be nice to see the actual consultant.

It’s how the nhs works for many specialities - one consultant covering a clinic with several junior docs seeing patients simultaneously. Especially in busy London teaching hospitals. It’s why I paid for a private obstetrician second time around.

You can see from the ID Cards on the docs - Eg ST1 is very junior, SHO or registrar close to becoming consultant. In other clinics with my DC I’ve found the junior drs very patient and good at referring back to consultant with q’s.

It’s normal. The consultant typically has two or three patients being seen simultaneously by members of their team and then they sit in another room so they can be given a synopsis of the appointment and make a decision about the next action etc. You often see the actual consultant towards the end of your pregnancy.

In my highest risk pregnancy I saw my obstetrician every week for an appointment (from 10 weeks) who was also the head of fetal medicine so please do feel reassured that if there is a concern about your pregnancy, then you will see someone with more experience.

Normal on NHS.

Second pregnancy consultant led, in my first pregnancy there wasn’t even the name of the consultant anywhere on my file, I just saw different junior doctors on the team each appt and they didn’t want to make any decision at all so always said we will see next appt and again a different person- this led to less than ideal care imo and an emergency section when finally one of the doctors said it was ridiculous that my problem was left so long without action. This pregnancy I have seen two different doctors so far and will see who I get later this week- i know the consultants name this time so I will not hesitate to ask for a call with them if I’m unhappy as the pregnancy progresses and if I’m passed from pillar to post again and again! So while I think it’s completely normal to see a member of the consultants team it can be less than ideal- don’t be afraid to advocate for yourself!

Sounds normal to me. I’ve been consultant lead in 2 of my pregnancies. Both times my 16 week, 28 week, 32 and 35 week appointments were with one of the team.

With DS2 I didn’t meet my actual consultant Until I was in hospital after a reduced movements episode / scan showed my placenta was starting to fail at 37 weeks. She came bu to chat and offer me monitoring over weekend and induction the following week or be admitted for a night or two followed by induction as soon as they had space.

With DD I saw her a bit earlier but just because she happens to be running her normal clinic same day as one of my routine consultant appointments with her team and saw me in the waiting room so said she’s see me herself.

Wow - looks like I have been very lucky then!

Just a wee correction to seniority of the team members @KaleJuicer has mentioned (I work in NHS): FY1-2 are the least experienced, then SHO, then registrars (new term is ST1-7/8 but still registrars, number signifying years in speciality training), then fellows, then consultant.

It is a standard practice that a consultant has several team members working with them seeing patients simultaneously. If you are worried, it's always bring it up there and then so things can be sorted for you.

Further correction @Mc3209 - you aren't necessarily a fellow between St7 and consultant. If you can get a consultants post you would enter a consultant's role straightaway or locum as one for a while/indefinitely.

You can either be a junior clinical fellow (SHO level often between f2 and entering training) or senior clinical fellow (registrar level but often especially if trained abroad can be very senior with extensive clinical experience)

SHO is also ST1/2 but also FY2 level confusingly.

(I'm an Fy2, not in obstetrics)

@lymphopenia, I know the system, I am ST6. The satan himself can break a leg in alphabet soup of title positions and various in betweens.

The point being is yes, it is normal not to see your consultant at the appointment, but usually consultant is aware of what's going on with your care.

Aha nicely put, sorry I probably have jus caused further confusion by wading my big nose in

Thanks very much everyone. This is really helpful as this is my first pregnancy so not sure what to expect. The advice is really helpful and much appreciated 🙏

My first appointment was precovid and with a junior doctor. The consultant popped in at the end to introduce herself and the junior doctor ran through the plan we came up with. The second appointment was during lock down so a phone call with a different junior doctor as my need for being consultant led didn't need a face to face appointment.
I can see if they are trying to minimise the number of people each patient or doctor comes into contact with that the curtesy introduction could easily be dropped.