"I've never done this operation before"
I heard this on a trailer for Grey's Anatomy. Deja vu!
Trust me every surgical trainee would have said this either out loud or in his mind at some stage of his career when he's told by the senior resident or consultant to "Start the case first" or "Carry on and call me if you have any problems".
Usually when things get too busy or the consultant has overlisted cases on that day or split theatres etc.
It happens all the time. Not very reassuring right? But unfortunately that's the truth. If you go to private hospitals that is much less likely to happen since you don't get trainees running around there. But then surgeons need to be trained somewhere right? My beef is not with trainees (I was one before). My beef is with the training system, the trainers (ie surgeons) and over zealous, gung ho trainees who overestimate their abilities with misplaced self confidence.
There was once a case where a surgical trainee started and continued a thyroidectomy operation. The trainee was doing the operation for the first time alone. The recurrent laryngeal nerve was cut and the patient had voice problems subsequently. The operation was supposed to have been done by the very senior surgeon that the patient had asked for. Well when you're under general anaesthesia you won't know a thing ( in most cases).
Anyway the senior surgeon protected the trainee and told the department that he always quotes to patients undergoing thyroidectomy that their is a risk of recurrent laryngeal nerve damage. He would give them his percentage risk.
Now I felt that it was totally unethical. Although the risk is quoted, the figure applies to the risk in the hands of a well trained surgeon. Not the risk in the hands of a trainee doing the operation for the first time! Is there negligience? Sure there is!
The best way to train surgeons in my opinion is for each surgeon to take on a disciple who assists all the way and progresses subsequently with the master overseeing his development. One master for one disciple. That's how it started, but it doesn't work this way at the moment.
Frankly such instances contributed to my decision that I did not want to become a surgeon. I was never the gung ho trainee that people encouraged me to be. I only did stuff if I was confident. When in doubt I consulted. It was never a case where I was lazy or indecisive and incompetent. It was more that I was unwilling to participate in "helping" the consultant "clear his overlisted cases in another OR so everyone could go home earlier". People told me you learn best from mistakes, so it's "ok" to make them and you should be more "brave" to do more on your own. Excuse me, the mistakes impact on people's lives and their quality of life! It's not a game!
Nevertheless I understand that the training of surgeons is always going to be difficult which is why people pay top dollar for trained surgeons. But sometimes we forget that the price paid by some mistakes is never repaid.
I can't live with that. And as someone told me, "You'd never make a good surgeon then"
Well so be it.