The answer to "who's doing my surgery"?

[DrBandMe]

Yes, midline catheter! That's what it was called! (Duh, of course you would know that)

That's part of the reason they want a line and not an IV...the whole getting blood without sticking me again bit. I think a big part of it, actually. And also that they can't push fluids fast enough in the IVs they have historically been able to get in me. The biggest on ever so far for me was a 22g. It took EONS to get a bag of fluid into me.

There's a bunch of other crap too but I think those are big ones.

[MrsC]

A slight tangent, but many patients have no idea that their "anesthetist" for surgery is a nurse, not an anesthesiologist. This is especially important where CRNAs (Certified Registered Nurse Anesthetists) can practice independently without any anesthesiologist oversight. They are billed for "anesthesia services" just the same. You'd have to just know that an anesthetist is not a physician.

Yes! This happens all the time. I'm glad we got out of NY state in time. It's a whole other thread but this is far more serious IMO, than a resident failing to mention that they're actually a resident in training.

Most of the teaching hospitals I've been to have been good about this. They always introduce themselves as residents.
For my c-section, I think the chief resident did most of it, I'm not sure. It didn't bother me since the attending was right there.
The only odd experience I had was with a dermatology fellow here who told me she had to go talk to her "staff". She called the attending her staff?! It was weird.

[TulipsAndSunscreen]

a resident failing to mention that they're actually a resident in training.

So I'm not talking about people not knowing residents are involved. The patient is always introduced to the residents, etc. and will likely have way more interaction with them than the attending. People (unless they're paying literally NO attention) should know there's a resident. I'm saying that when they asked who is doing their surgery, they usually don't know OR they believe it's the attending. And the party line is that the resident is "assisting" even if doing 90% of the surgery.

[MrsC]

I think most patients just want the professionals to do their thing and wouldn't want to get into the specifics of who's doing what.

[Sheherezade]

It's my impression from my DH that every case is different. Some attendings allow residents to do more, some less. Some are in the room but don't hover. Some are on the phone. Some don't let the resident do a damn thing. And....all that can change depending on what you run in to during the case. If there are a ton of adhesions, if some anatomy isn't normal, if something goes awry, obviously the attending is stepping in and doing more.

My point -- I think -- is that it might be hard to tell the patient who was doing what if they don't know until they are in there. If they leave it as it stands legally, the patient had a clear understanding of the possibilities. The attending is ultimately responsible, and the resident IS assisting. They aren't flying solo. If they intend the resident to do the case alone, I'd think the hospital would have an obligation to tell the patient. I'm fairly certain that isn't the case at most institutions.

[poky]

I'm trying to figure out my feelings on this.

I had heart surgery at a teaching facility while DH was in med school. My cardiologist recommended the surgeon, I met with the surgeon, and I'm ASSUMING he was the one who actually ran the daVinci robot to fix my valve, but I don't honestly know if he was or not, and I don't know how much I care. I didn't ask that specifically, that I remember. I don't remember meeting any surgery residents or fellows, so maybe my surgeon hogged the robot? I also don't know who did the anesthesia - I'm guessing probably a resident. I think they introduced themselves as I was being wheeled in to the OR. I did ask the scheduler when I was setting the date to schedule me first thing, and preferably on a day when the surgeon was not on call the night before. Everything went well. If it hadn't, I'm sure I'd have scrutinized things more, but it would have been too late, too. I trusted, and it worked out.

[OrionGrad]

It's my impression from my DH that every case is different. Some attendings allow residents to do more, some less. Some are in the room but don't hover. Some are on the phone. Some don't let the resident do a damn thing.

...And some leave the room altogether to grab lunch downstairs while the case is still going on.

For me as a patient, having the attending leave the room entirely is where I would draw the line and get pissed. Of course most people never know.

[alotofyarn]

Hubby used to tell his patients that he would be doing the cases and his attending would be supervising, and he was told to stop saying that, that he had to tell them the attending was doing the case. Even his cysto cases which he does primarily alone.

On the topic of my own care, I asked not to be managed by an intern for my delivery. A PGY3 was on when I went in and I really liked her, then someone else came on and I assumed she was also an upper level. After delivery I learned she was an intern, but I didn't care at that point. My actual OB was there for delivery and did the suturing afterward, and that was the important part. I think a chief or some upper level anesthesia resident did my epidural, but there was an attending there too.

[GreyhoundsRUs]

This becomes a problem at some of the private hospitals in Chicago (and I'm sure elsewhere). VIP patients demand attending-only care, and residents just stand and watch (or hold a retractor). Kind of a crappy experience for the residents.

As far as my own care, specifically L&D, we have a strict "no med student" policy, but that's it. My first delivery was staffed by a senior OB resident and an attending. My second was staffed by a PGY4 Ortho resident

[Sheherezade]

...And some leave the room altogether to grab lunch downstairs while the case is still going on.

For me as a patient, having the attending leave the room entirely is where I would draw the line and get pissed. Of course most people never know.

Yeah, I'm with you on that. I think they at least need to be on the same FLOOR. yikes. I'd imagine ABGME could regulate that.

[peggyfromwastate]

Interesting. We were always told in military teaching hospitals that an intern, an attending, a resident etc would be doing the surgery/procedure. We've had a few surgeries over the years (I think 6-7 total) and every time I've known who did it. The last go around the attending was on OR alone and I asked dh if he'd be OK doing tonsils, bc the sub specialists get out of practice from doing tonsils. (Those are usually junior resident or intern level). Hubs looks at me like I'm crazy and says "it's like riding a bike." Hmmmm.

Anyway here the attending always does the surg. That's just the way they "operate" on attendings kids. So both of the Twins had attendings do their tonsils, and when ds10 gets tubes and adenoids it's going to be an attending. Dh has med students do tubes sometimes. Of course dh is right in there ready to take over, but still...

Interestingly the most irrational patients he's had were from Childrens in DC where he was rotating as a pgy 2. The patients demanded the attending saying they wouldn't be seen by a resident, just the attending. That's it. So dh told them that they'd just have to wait until the attg was available. Same thing happened as a sleep Med fellow at Stanford. The patients wanted the expert, and were willing to wait. Then the expert would call dh into the room to answer any surgical questions. Lol.

[Ladybug]

Legally, the attending must be present in the room. We had a plastic surgeon we started around the same time with that left the room. Big reprimand, job threatened. Absolutely not allowed here. I agree with Angie that each case is different and determined by the complexity and confidence in the resident's skill and experience. They have to learn some way. Patients need to trust the attending to identify where the resident's skills and learning end, and their own expertise begins. Nobody wants to be left holding the legal bag for a residents lack of experience.

[SuzySunshine]

Legally the attending must be in the room the whole time? I just find that interesting b/c at DH's training situation attendings would run 2-3 rooms at a time with a resident in each. They would time them in such a way that the attending was in each room at the vital time but the residents did the opening, closing, etc.

[JDAZ11]

Legally the attending must be in the room the whole time? I just find that interesting b/c at DH's training situation attendings would run 2-3 rooms at a time with a resident in each. They would time them in such a way that the attending was in each room at the vital time but the residents did the opening, closing, etc.

No way. I haven't read the thread, but it's my understanding - from both law school and DH - that the attending must be in the room for the "critical portion." What the "critical portion" actually consists of is less clear.


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[alotofyarn]

No way. I haven't read the thread, but it's my understanding - from both law school and DH - that the attending must be in the room for the "critical portion." What the "critical portion" actually consists of is less clear.


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I believe they just need to be readily available, like in the hospital, for the cases to go here.