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Medical Forum / Diseases and Disorders / Prostate Cancer / July 2006

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Disturbing Reality

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From Bob - 26 Jul 2006 15:18 GMT
Many of us after extensive research seek out the finest surgeons /
hospitals, to perform our procedures, whether it be bradytherapy or RP,
etc.

The reality is that in most if not all major teaching hospitals, once
you are given the anesthesia, the procedure is done by a resident, with
the assistance of interns, under the supervision of your "finest
surgeon". This is how young doctors get there training and experience.
Wonder how many problems / side effects are caused by this training
process. This became obvious to me early the morning after my procedure,
when i was visited by the resident / intern staff, and their
participation in the procedure became obvious, upon my questioning.
Fortunately in my case the outcome was satisfactory.
dave perry - 26 Jul 2006 16:28 GMT
This is not uncommon although many of the chosen doctors insist to the
patient that they really are going to do the surgery.  I believe all
teaching hospitals require patients sign a form stating that they (the
patients) are aware this is a teaching facility and that some of the
procedures will be performed by doctors in training under the
supervision --- etc., etc..  While we all want the best treatment which
off the top of our heads can only come from the best, most experienced
people, new doctors have to learn somewhere and rubber dummies and dogs
won't do it.  We haven't sunk so low morally that the interns only work
on (practice on) the indigent.  I believe that for the most part, the
large teaching hospitals have better track records than the
non-teaching facilities and I wouldn't hesitate one second to go to
Stanford, Johns Hopkins, UCSF, or any of the other major teaching
facilities.  On the other hand, there is a saying in medical schools
which goes, "See one, do one, teach one".  This, fortunately, applies
to less major procedures such as lumbar punctures, not prostate
surgery.
Dave Perry

>From Bob wrote:
> Many of us after extensive research seek out the finest surgeons /
[quoted text clipped - 10 lines]
> participation in the procedure became obvious, upon my questioning.
> Fortunately in my case the outcome was satisfactory.
Leonard Evens - 26 Jul 2006 21:40 GMT
> Many of us after extensive research seek out the finest surgeons /
> hospitals, to perform our procedures, whether it be bradytherapy or RP,
[quoted text clipped - 9 lines]
> participation in the procedure became obvious, upon my questioning.
> Fortunately in my case the outcome was satisfactory.

My surgery was done at a teaching hospital and a resident did assist in
the surgery, but I am quite confident that all important steps in the
surgery were done by my surgeon.   He told me he would do it, and I have
faith in his word.  Also, from things that the surgeon said to me and to
my wife and things the resident said to me in the hospital, it was
pretty clear the resident didn't do the crucial parts of the surgery.  I
wouldn't be surprised, however, if he did some of the routine aspects,
such as closing.

It is pretty common in teaching hospitals for most of the hospital
contact outside of the surgery itself to be with the resident.  That
doesn't mean that the resident actually did the surgery.  I'm sure that
happens in some teaching hospitals, but you shouldn't assume it as a
matter of course.
DonC - 26 Jul 2006 23:28 GMT
>> Many of us after extensive research seek out the finest surgeons /
>> hospitals, to perform our procedures, whether it be bradytherapy or RP,
[quoted text clipped - 9 lines]
>> participation in the procedure became obvious, upon my questioning.
>> Fortunately in my case the outcome was satisfactory.

Just prior to my surgery, my Uro introduced an assistant he said would be
*observing* the operation if it was OK with me.  I have no doubt that my uro
performed the operation based on preop and postop conversations I had with
him.
Beverley - 27 Jul 2006 00:01 GMT
Chances are the closing was done by a type of surgical technician. That's
what they do. They are usually not RN's; they are trained just in surgery.
Bev

> > Many of us after extensive research seek out the finest surgeons /
> > hospitals, to perform our procedures, whether it be bradytherapy or RP,
[quoted text clipped - 24 lines]
> happens in some teaching hospitals, but you shouldn't assume it as a
> matter of course.
Clarence Crow - 27 Jul 2006 00:01 GMT
>Many of us after extensive research seek out the finest surgeons /
>hospitals, to perform our procedures, whether it be bradytherapy or RP,
[quoted text clipped - 4 lines]
>the assistance of interns, under the supervision of your "finest
>surgeon".
<snip>
In my 2 cases of surgery, my Senior Consultant Uro used the cutlery!
The Registrars, Residents and Students were all onlookers.
I even chatted to the Consultant DURING my last surgery under a mild
Spinal Anaesthesia.

However the Registrars, Residents and their entourage did the ward
calls to determine how quickly they could kick me out to free up a
bed!

 
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Beverley - 27 Jul 2006 00:09 GMT
My husband had his rad-onc do the brachy along with the rad-onc's head
(#1)resident. I asked the resident just how much he was going to do. He sort
of laughed and said if he was lucky he'd get to insert a few extra seeds.
Hubby was scheduled for 117 seeds and received 121. I figure the resident
had the opportunity to place those 4 extra seeds. I do know that the
resident prepared the seed "tubes" for placement. Remember these residents
are doctors who have decided to put in more time into a specialty so that
when they leave they can do what that doctor does. Theoretically they
already know how to do it. It's really no different than a young CPA or
lawyer going to work for a big firm for a few years before opening his own
office.
Bev

> Many of us after extensive research seek out the finest surgeons /
> hospitals, to perform our procedures, whether it be bradytherapy or RP,
[quoted text clipped - 9 lines]
> participation in the procedure became obvious, upon my questioning.
> Fortunately in my case the outcome was satisfactory.
friend - 27 Jul 2006 01:56 GMT
I had a bypass in Feb. and it was no secret that a Physicians Assistant was
to perform the vein harvest from my leg and prepare it for the bypass. I
have an almost invisable  1" scar near my knee where they got 30cm  from
above and  30cm of vein below the knee with  no other side effects from that
portion of the procedure, PAs are not Drs. but they are well trained and
supervised by the surgeon as are residents who have more training. Anyone
who thinks that the surgeon in charge is doing it all is mistaken.

BTW I had seeds but wound up with the zipper after all, just a little higher
up.

Keep smiling,

Tom
> My husband had his rad-onc do the brachy along with the rad-onc's head
> (#1)resident. I asked the resident just how much he was going to do. He sort
[quoted text clipped - 22 lines]
> > participation in the procedure became obvious, upon my questioning.
> > Fortunately in my case the outcome was satisfactory.
Tom Cular - 27 Jul 2006 02:07 GMT
I have no idea where the name "friend" or that email address came from.

Tom

> I had a bypass in Feb. and it was no secret that a Physicians Assistant was
> to perform the vein harvest from my leg and prepare it for the bypass. I
[quoted text clipped - 37 lines]
> > > participation in the procedure became obvious, upon my questioning.
> > > Fortunately in my case the outcome was satisfactory.

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