on exactly who is doing the procedure? They book you with a staff doctor (surgeon) with great credentials and experience; however they work with the doctors in training for a speciality and from what I can tell it is the student that actually does the procedure. That is not particularly comforting...any one have more information on how this works at any teaching hospital...I know some of the best places are teaching hospitals but has anyone else ever questioned sort of being a "guinea pig"? Of course you are out with the drugs so guess they can do anything...

I don't know anything specific about any hospitals but I will share my story. My brother at the age of 34 went in for a laparoscopic gall bladder surgery. He had no underlying health problems, he wasn't overweight, he had an active life. He went to UK hopsital (Univesity of Kentucky). They expected him to go home the same day but he died 3 days later, leaving a wife and two children. The doctors would not tell us anything and never admitted it was a student who did the procedure but I've always thought it probably was.

I think perhaps with the more technically challenged procedures a 'real' doctor may perform the procedures but I would be very cautious about going for anything routine. I'm sorry. I don't want to frighten you but your concerns are valid ones.

But then, I know of another woman, 37 with one child and husband who also had a laparoscopic gall bladder surgery and after being in a coma for a week passed away. I don't believe she was in a teaching hospital (I don't know that she wasn't either) so perhaps every procedure should be considered cautiously. I would ask them bluntly who would be doing the procedure and not just who would be in the room.

Carol -

Excellent answer - so very close to the one I was composing - that I will say THANK YOU and add this.
Mine was more about my own experiences. I have 3 procedures scheduled at a teaching hospital - one this month.
I am not worried. I always encourage residents to be present, to learn to be the next ones.
I have an excellent surgeon, a dangerous medical condition, and I have come very close to passing on from this Earth
after another procedure, when I had a Certified Surgeon with a suite filled with 15 specialists. It still went very wrong
due to complications, they could not have known about beforehand. ASK any questions you have, think about it a lot.
But then ultimately you have to decide - like flying - you have to leave it in their hands.

Wishing you the Best.
Mary Beth

The most skilled surgeons in the world all started out as students. If it were not for wonderful people willing to trust and yes "be the guiney pig" they would never have gotten where they are now! If you are going to be out for the procedure I would INSIST on know WHO will be doing the surgery. WHO will the the qualifying doc overlooking this student and will you be standing next to him during the WHOLE surgery in case something goes wrong??? Ask, ask and ask some more until you feel POSITIVE this is the right move for you. Until you feel safe and confident...let NO ONE touch you! You should go one step further. If the student is going to do the surgery. Educate yourself on the procedure then GRILL the STUDENT to see if they know what their doing. It is YOUR body and YOUR life. Advocate for your own health!

Agreed!

Nothing is perfect, though, there has to be a balance.
Dr's do not offer the 1 hour consults over and over - in fact if you do request them too many hours' worth,
they help you understand that they will not be treating you.

In my case, it is life threatening to wait, and also is in a different way, to proceed.
If it is not, then taking the months to get consults is what I would have tried.
It is not always possible. It depends on the surgery's Medical Necessity.

Mary Beth

Kathy -

Trust is key,
But waiting too long for perfection or guarantees has it's risks too.
That's all I meant -

Wishing you Good luck in your Quest for treatment and answers!
Hugs!
Mary Beth

Ok, here is the answer and you may not like it.

When you go to a teaching hospital that has surgical residents on surgical rotation they will and do practice on us. However, ONLY if you sign the release and merely trust your doctors promise that only he will operate upon you. Yes, your doctor does lie to you. Yes, he will be present in the room overseeing the resident surgeon because he is the one who is liable in a potential lawsuit. Many times your personal doctor will do the surgery (whether it be simple or a more complex procedure. But you cannot be guaranteed of this without taking appropriate steps). If a resident is allowed to scrub in on a case then it is typically the resident who will do the surgery.

Sorry to scare anyone. But here is how you protect yourself and loved ones. Take your surgical release form with you the morning of surgery. (Do not include with pre op forms sent to the surgeons office. If the surgical office should contact you ahead of time then just tell them you need to discuss it (the surgical release form) the day of surgery.) When you meet in the pre op area with the surgeon and/or resident - this is what you do. Sign in front of them (but cross off and initial the line that states your doctor (fill in the name) OR whomever he deems appropriate...will be performing the surgery) Leave your docs name and only cross off the additional wording. Smile sweetly while you do this and have your signature AND changes witnessed by a loved one (have them initial too and take a signed copy up to the waiting room). If you feel a need to comment then just say, "I'm happy to have the resident observe but in NO way will I agree to let them do ANY of my surgery." "I appreciate they need to learn but I am too nervous with someone learning/practicing on me." (Write this all down on a 3 x 5 card and take with you so you don't forget anything) ****important to say ANY because the doc still might let them open and or do the closing suturing.......

As long as you are polite no one will get upset with your request. They may be surprised but they will not refuse AND you can be assured of who will be performing your surgery. I have done this several times and it does work. I volunteer at a teaching hospital and socialize with staff, residents and practicing doctors. Trust me, I've seen and heard many things. If you signed the unaltered surgical release than anyone can do your surgery.

No more worries for you and good luck with surgery. Regards, JZZ

I can see your points JZZ - and agree to disagree,
but one key point - if everyone insists on the Surgeon not the Resident,
( and I have found in most cases the Resident is more open minded, younger, sharper)
then you also accept that the lines will be long.

Circumventing them by surprising a team who has put aside time to operate on you
at the last minute, is in my opinion not the best way to respect anyone's time.
Next time, you may find they cancel on you.

I too have socialized with Residents and Doctors. I hear the stories too from their side and I really
listen to see how to make it go well for all of us.

I would not want to be surprised at the last second that all the rules had changed - you don't know who else is waiting in the wings -
( next time it could be you) and does not get their surgery.
Like JZZ says, the Resident is not the one who is liable. So the rest of the team work together.

At one point I wanted to me a medical illustrator - and had to sit in on Surgeries and Also Med Schools
working on learning from people who had donated their body to Science. No one leaves a resident to just work alone.
They are standing very very close by and usually start by holding the reins.

Again, just my opinion.

Off to call my Surgeon right now
Mary Beth

Oh Mary Beth,

I am NOT circumventing anyone by doing this. It is a legitimate request. One can also send the revised form to the surgeons office if they feel a surgery will be cancelled by this request. (But surgeries will not be cancelled. Most surgeons also request that a non resident perform surgery on themselves or loved ones.) And yes a surgical team is in place for ones surgery (ie, anesthesia, or staff, etc.) But requesting that one resident Not perform ones surgery will not disrupt a team or a scheduled surgical time. And, yes it is correct that no one leaves a resident "to just work alone"....I stated that the surgeon would "be overseeing" the resident. Good luck with your surgery and I did not mean to upset you. Merely addressing the original OP. Regards, JZZ And, yes a resident needs to learn somewhere. But, my own personal comfort level is that it is on someone else.

I have observed exactly what is in JZZ's post. A high-risk OB patient in clinic was lied to when she noticed her wristband had a different doctors name than the one she had been led to believe would be performing her c-section. She was told it was a mistake that the hospital made. She was not told that a surgical resident would be operating on her even when she questioned the mistake. I was a nursing student at the time and had trouble with this. Yes, the other doctor was present and assisted but I got the feeling that the staff thought that clinic patients have less rights.

Just my opinion on this, but I am more concerned about who is administering my anesthesia and how long I am going to be under.

It all boils down to YOUR comfort level. I personally would not do this last minute on the table. If you INSIST that your own doc do the surgery why would you be in a teaching hospital to begin with? The words being "teaching hospital"???

Absolutely comfort level is important. And, as a patient, I do not determine WHERE my doctors operate/have surgical priveledges. The doctors determine what hospitals they are affiliated with. Regards, JZZ

Thank you for all the great insights here...for Jzz....I believe you are thinking pretty much like I do. I have been going to Mayo Clinic in Minnesota for all my care...always request staff docs for appointments and many times they have residents with them. If it involves say a pelvic exam I have no problem saying I made the appointment with Dr. ... and I want him to do the exam...sometimes they want to share the exam...I decline and no problems at all. I have had some more or less minor surgeries ie removal of skin cancer, colonoscopy etc. and while the staff doc name is on everything clearly he did not do it. I disagree with the post regarding making this request will ruin scheduling...I believe that the staff doc has to be in the room during the procedure (maybe not the closing of the wound etc.)...so why would requesting that he do this himself create any scheduling issues unless he is juggling three or four rooms??? Jzz do you know...don't they have to be in the room? I recently had a D and C again booked with a very well known surgeon who is a specialist in this area but I am certain he did not actually do this surgery....I did not ask questions on this one but got to thinking after about the resident who came in with him after the procedure. Now most of my experiences were for routine procedures but from now on I am going to check about this form etc. in advance because I go to Mayo due to the reputation...I could go somewhere way more convenient but I really want docs doing these things that have lots of experience...I honestly don't think most people understand this situation at teaching hospitals. Any more comments will be welcome. PS my outcomes have been fine but my father certainly had a bad outcome at Mayo and honestly don't know if it was just bad luck or what but I still trust them.

JZZ -

As I said, agree to disagree. Thank you - and I'm not upset, just see the other side and wanted to present it.
I could ponder and post all manner of things to back my opinion and facts to show correctness, but
really, I was just having coffee, calling my Surgeon, waiting for a callback from the Anesthesiologist about the many meds
needed - and maybe I missed something in your original post. You did not upset me. The issue is sensitive and
as they used to say "loaded" and that is why we talk about it.

Now a Dr or resident or anyone treating a patient, who is not qualified would not please me at all.

Talking is good. Even those reading can just view and ask their practitioners etc. None of us has all the answers.

I have a Family friend that is an outstanding Dr. A Specialist - He saw one thing on an test result of a family memeber, 2 other specialists did not.
I had a Specialist recently decide it was safe to give me meds for a condition - where is expertise is only
that has a Grandchild with the same condition. The 3 specialists in his field disagree with his Diagnosis, and Treatment.
It's 5 with one sensible and well tested diagnosis and treatment and such,
against 1 here - and the 1 is the only one willing to deal with my issue as the complications are great.
I do not agree that he knows what he is doing, but the rest of the team does.
Every single Dr on my team arguing with each other - first they all screamed at me - trying unsuccessfully to prove I did not have the conditions I
do. Every note added to what the next Dr would have to read. It has been a scary, weird mess.
But I hit a point where I realized it cost me a lot in just being cool with the world and my DH did with his job taking 18 hours
a day for 9 years EVERY day holidays family and we both just turned a huge corner this last week.

I backed out - I just tel them the meds for allergies I am on, what my previous bad stories were.
In fact I feel badly for the Surgeon - he has a huge risk cutting into a Hemophiliac,
when the Experts change their minds or refuse to look at data. I am not upset - although I was a few months
ago, knowing they would not agree on how and what meds, just that it MUST be done now. Well,
they will attempt it right after Thanksgiving, I think. Maybe earlier. I put my faith where in my heart, it belongs.

I gave this one to God a long time ago. I was nervous last week when my husband lost his job,
but the numb is wearing off and I am not upset about what you said.
In fact, DH just said, "WOW, you are strong, but you are really on your game
and your head is especially cool and calm today!!" (He is a sleepy head cuz we thought we had to go in early to
consult with one of the Surgical Staff, but I was all ready and caffeinated

Anyway - just wanted to reply and hope you can see why.


In fact, I ain't going alone - last time I had surgery they left me alone for hours after and as I woke up.
last time I had a drug infusion, same thing - and ended up in the ER.

I DO agree it's a matter of comfort.

Mary Beth

Gevalia, that is too bad and not good.

I am more concerned about anesthesia, too. I had one who said
"You will feel a little...." I blinked and it was over, no nausea, no intubation, no general anesthesia, but I was so
heavily sedated I recal nothing at all - a headache and I went home!
Yes - I had bleeding and surgical complications, but I was out and back awake with NO problems at all.
I wish I had THAT guy again - no such luck! - He was awesome! I felt nothing bad at all going under.
They should all be so good.

But I know......I nearly had the wrong breast operated on, because one person wrote "left" instead of "right".
More than Yikes. Caught it on that morning's pre-op checks - right before I was put under. Staying calm is needed for sure.
~Mary Beth

WEll spoke with Mayo today regarding getting at least a copy of my report since I have had little communication. I did address the "teaching hospital" situation and feel sort of stupid asking about it now as opposed to before the surgery. The nurse did verify that most probably the resident did the whole procedure under direct supervision of the staff doc but if I had requested the staff doc do it he would have...it is a process whereby since you are at a teaching hospital it is understood you are okay with residents working on you. When I asked if the doc could leave the room there was some evasion but she did think that they could move to another room and get things going there. The reason I go to Mayo is for the most experienced hands I can get for surgery or even routine procedures and I am just now realizing that is not what I am getting at all. The "experience" is in the room (hopefully) but the hands are learning and honestly that is not good for me. I will in the future be much more careful and hopefully others will be aware of what the deal is in advance if they happen to read this. While all the is perfectly ethical the average patient is led to believe that the guy you talk to is the guy doing the surgery and frankly he /she is not. Lesson learned.

Kathy,

Wishing you the best treatment and outcome for sure. Thank you for your postings on this.

I was not in the position to have to ask this time, my Surgeon is the top guy, since I am a bleeder, no one else
will even consider it, and he has ben loudly yelling about how he himself will be doing the surgery.
I always look at what I sign - despite the mountainous pile at the hospitals these days.
But it's ALWAYS good to be informed. I think he is right, although if I did not have Hemophilia,
I would be fine with Residents on minor procedures.

Just a side note about my experiences;
I do admit here that have lost any ego/pride during and after my UNsedated Colonoscopy in my 20's.
I was having such problems they suspected Chrons but thank goodness it was not. But I was wide awake and om gosh.

But it happened again - and for final, the day they asked if "someone" in training could sit on while they hooked me up to an ECG.
I always say Yes. But this time, after I said yes, There I was, about 15 years ago, 35 yrs old, curtained off, suspected cardiac failure, then was
left bare from the waist up. Well a CREW of very young male residents came by to see first hand how the little stick on electrode things are applied,
and they were there for a while, watching. It became very graphic, which I can't get into here, I guess - board rules. No, they did not touch me.
But from then on, though I only focus on what will teach others and protect me, that removed any sense that my privacy in there
would be assured. I just don't care as long as I get out alive. I don't think about it. All shame and modesty went out the window - gone that day
for stuff inside the hospital. Having an Army Medic for a Husband - who has seen it all, we focus on getting through in one
piece. If I am treated nice it's extra. And I appreciated it. But I don't count on it anymore, I just want to live.

Mary Beth

Here's my story:

I went to a teaching hospital for my first surgery in 50 years. It was an umbilical hernia repair - very routine. I was completely naive. While I was waiting for the surgeon to arrive the resident or "fellow" introduced herself and said "I'll be assisting the doctor."

Here's how I know she did my surgery. I woke up during the procedure (yes, I felt pain) and the surgeon said, "We're almost done" but he was nowhere near my stomach! Picture me lying on the table and him standing behind my head. That's the way it went.

Two days later I had a MRSA infection. It would take over a year to fully recover and another surgery to get it right. This time I went to a different hospital and found a wonderful surgeon who did it all himself. I'm fine now.

I don't mean to scare you. I'm sure that 99% of the time things go great. Nevertheless I would follow all the good advice given here - especially about signing those papers.

Good luck!

Helen

[Helen...interesting and scary story. My major objection here is that most people just do not know what is happening...frankly it is the staff doc that you meet prior and staff doc that comes in after (at least in my cases) so logical conclusion is that he /she did it. I am guessing somewhere along the way there have been problems but I'm sure they are covered with signatures etc. I honestly don't remember on this one signing anything. I would imagine for every 20 surgeries maybe 1 person specifies that the staff doc actually perform the surgery and then the resident just watches....that will be me!! I do think from my reading there are very good things about teaching hospitals...innovative technology and treatments and cutting edge science and some of the best minds in the business...actually more eyes in the room too. I did however read where the residents grad in July so recommendations are not to ever schedule surgery in July...I mean there are alot of articles on this!! Who knew not me...I hope at least my resident was not in her first year. I know I'm making too much out of a D and C but for me it was a big deal and scary.