When a pain specialist at a teaching hospital recommended an epidural to relieve my back pain — an injection into the scarily weensy area between my spinal cord and vertebrae — I requested that he himself do the procedure — not an intern or resident (doctor in training). After agreeing he asked me to remind him later in the operating room. Sure enough when I got there, a resident was already gloved up and ready to roll. Obviously disappointed (maybe I was his very first practice epidural), the resident stepped back while my doctor scrubbed up to perform the tricky needlework.
By the time I later had full scale chest surgery at the same hospital, I had been examined by so many departments and doctors, I felt like I was in the care of a large team rather than just my surgeon. Also, somewhere along the way a young doctor had informed me it wasn’t wise to interfere with the natural flow of hospital routine such as insisting that a doctor take over an unfamiliar procedure that he was not used to performing on a regular basis. In sum, I was beginning to feel it would be smart to let my surgeon lead his team through the course of my surgery without any help from me. Known to occasionally (okay, more than occasionally) exhibit control freak tendencies, I nevertheless couldn’t help but feel a twinge of doubt about completely stepping aside and handing over full control to a bunch of masked people wielding sharp knives.
For those who have negative feelings about medical students transferring their neophyte surgical scalpels from cadavers to anesthetized patients, a recent large-scale study addressed these concerns. At over 225 US hospitals, the outcomes of 600,00 operations were analyzed to show how well patients came through surgery when a surgeon-in-training was involved. The results, published in The Journal of the American College of Surgeons, found that while slightly higher complication rates and longer operating times were associated with residents being part of the surgical team, the patients also experienced decreased mortality rates.
Dr. Clifford Y. Ko, the senior research author at the University of California School of Medicine, said the surgical complications weren’t necessarily serious, plus patients with residents involved in their care were more likely to recover quickly before additional more serious complications could occur. He added that having a team of surgeons rather than just one might well have been a factor that rescued patients from potentially life threatening complications and even death.
In the end though the researchers agreed the positive results of their study or any study were less significant for patients than their relationships with their surgeon. If Patients fully trusted their surgeons, they could roll into the operating room confident their doctor would never hand over the responsibility for their care to anyone else.
The New York Times story about this research hit a nerve with readers. In the first 24 hours after it was published, readers chimed in with 100 comments. How do you feel about surgical residents practicing their skills during any surgery you or your family might undergo?