Anyone had a planned c-section done by a trainee? Reassurance needed.

L

Liquorice

Registered User
I am having a planned cesarean at a public hospital. This afternoon, I went to meet the doctor who will be doing my surgery next week and she is a trainee only. She will be operating without any supervision too, she has told me.

I have had quite a few operations in my life but always done by a consultant or a senior registrar. The doctor today said that senior doctors only work on emergency c-sections or complicated cases and mine is straightforward so only she will be involved.

I am very worried about this now. I appreciate that it might be absolutely fine and I am hoping that she wouldn't be allowed to operate without supervision if she was not capable of doing it, but I can't shake off the lack of confidence I feel and I'm worried that next week I will go into the surgery frightened and apprehensive rather than relaxed.

Can anybody reassure me that this is standard / will be fine / that they had the same and was all very well done?

I think it is too late to try and book a private planned c-section isn't it? Would need to be next week.
 
As long as the doctor you have chosen has rights at the hospital you have chosen and there is an operating suite available, you should be alright. Planned c-sections are quite easy to get organised in HK. And next week is the end of a month/start of new month. If there was going to be a vacancy, that's the best period as the deliveries have been made/scheduled for the month and it's the start of the new month schedules.

Personally, I wouldn't want a trainee performing such a major surgery on me. There are other things to consider apart from the c-section itself!
 
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I would also be really upset or worried. I would have thought that having a planned c-section, they would schedule you with a more experienced doctor. C-sections are major abdominal surgery and just because they happen often, doesn't mean they should be considered routine. If you have had one before, you'll know that there is a lot involved in it. And your recovery depends in part on how well it was performed.

I might be in a similar situation as you in a couple of months. Personally, I would complain and request a more experienced doctor.
 
I understand why you have reservations, honestly, I think I would too. I don't know if it's too late to go private - QM's reply makes sense to me too, I think planned c-sections are the easiest to organise.

Also, maybe you need to know more from your doctor if you do end up planning to go down the public route. I'm wondering if you'd feel any better if you had answers to questions like these... she can't be a trainee in the sense that she hasn't qualified yet? I would imagine that she has already performed a number of c-sections with or without supervision? Will there be a consultant/senior surgeon on call in the hospital when she performs the operation? Maybe you'd feel a bit better if you got more context from her?

Good luck whichever route you go down.
 
as far as i know, if you are going to a public teaching hospital, you can request that ONLY qualified dr perform your checks/surgery etc. you do NOT have to agree to someone who is not fully qualified. that said, i don't think that they would ONLY have her on-hand. that would be completely irresponsible. they would HAVE to have someone senior near-by to call in case of an emergency.
 
I don't think I can request a more experienced doctor. I did ask to see the doctor again after the initial appointment with her (while I was waiting to see the anaesthetist) to ask questions that I thought of after I found out she was a trainee - I only discovered this as we were leaving the room so didn't ask any further questions at the time. Anyway, she said if I wanted a more senior doctor then I would have to go private as this was standard procedure in HK.

She has performed c-sections on her own. I think she is a qualified doctor but a trainee surgeon. Also, there will be a senior doctor around if she needs them but it still unnerves me. I always thought a trainee should be under direct supervision, so there should be someone watching her. In this case then they can prevent her doing something wrong, rather than being called in to try and undo the damage once she has done something wrong...

I just can't help but imagine the worst happening. As they reel off all of the risks before you sign the disclaimer form (damage to internal organs, damage to the baby, removing the uterus in case of complications etc.) and then at the same time tell you that a trainee is doing it because it is routine...
 
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remember, though, that they are residents/attendings for something like 4 years in order to become a qualified surgeon. i really don't think they would put someone on doing surgery without any experience, especially a c-section as you have two lives to worry about, not just one.

really, try to relax, i know it's difficult, but for the numbers of women that go through there having c-sections, i'm guessing that they get pretty good at them fairly quickly. i'm not saying that you shouldn't be concerned, i know i would be too, in your position, i'm just saying that it's not like they've taken a 1st day surgery resident and thrown them in doing surgery. they have to observe a lot, assist a lot and then perform the surgery under supervision a lot, THEN they are allowed to do the surgery not under direct supervision... so she would have a fair amount of "practice" before she would ever be allowed to touch a scalpel to your tummy.
 
This alarmed me too but on reading further, I think it could be wording that is creating more fear than is probably necessary. This lady is definitely a qualified doctor and could well be a pretty experienced surgeon in other areas, but is a 'trainee' in this aspect of surgery. 'Trainee' can simply mean she hasn't finished all her hours, which I suspect would number hundreds to be considered fully qualified, she might reach her requisite number of hours and 'qualify' next week for all we know. I am sure as carang said, she has put in hours upon hours of supervised practice and her seniors must think she is able to carry out operations alone or she wouldn't be doing them. HK is a conservative and cautious society, it's just part of the culture to not even want to try in case one fails! You see this in students even so I highly doubt this lady who knows she will have at stake, two lives and her future as a doctor, would even agree to perform surgery alone if she wasn't up to it. Please try to speak to her again if you can but please don't put too much in the 'title' she has been given, I know a doctor, Chinese guy but Australian-trained, who graduated medical school, did his internship, went the surgical route, trained and practiced for years, who then came to HK to work as a 'trainee' in another area of surgery at QMH...but he was years past medical school and no doubt had performed many many surgeries in Australia by that time. I hope that helps.
 
Hi Liquorice,
Today I met one of the senior pediatric surgeons at QMH (father of playground kid my son plays with). I was asking him what a trainee meant. He said it means that they haven't completed their training or passed their exams yet. He said that to be a surgeon they had to complete (an additional) 4 years of training. He said he didn't know much about obstetrics but he found it strange that you would be having a surgery with only a trainee, but said that maybe they considered caesarians very easy and common surgeries, and it seemed he did too. Being a senior surgeon, it seems he himself seldom performs common surgeries but is on call when more junior doctors are performing them lest they require his assistance.
I also asked if maybe they were already a surgeon in another field and were going into this field. He said that doctors didn't really do that.
I don't know what you have decided, but i would still complain about this to the hospital. It's not like you're getting your appendix out or anything.
 
Liquorice, what the senior surgeon has told Shenzhennifer is correct but please do not be alarmed at the information. The college of obstetricians in HK controls very tightly how many c-sections need to be done by a trainee BEFORE they are able to do the procedures independently, and although it may not seem like it to you, an elective c-section it is a pretty routine procedure with very little variability (unlike transplant surgery/brain surgery/emergency c-section).
Unfortunately the senior staff rarely do routine procedures unless it is to teach the new batch of trainees but they are absolutely within arms reach should they be required. You won't be able to insist upon having a fully qualified person (who has passed all exams/ completed all aspects of the training) as a public patient, it is the structure of government hospitals here and also in Australia, that these are teaching institutions,and one can not insist upon it but you are stratified according to your risk profile, if they deemed that you were high risk you would be assigned to someone more senior or someone who has specific experience in whatever condition you had i.e. delivering eclamptic mothers, so perhaps that may in some way give you comfort (i.e you are low risk).
I think other people who have delivered in the public hospitals will have been delivered by trainees (most of the time unless they were lucky/had a special reason) whether they knew it or not, and all has gone well.
Things are different here in HK though, in Australia, although you can't choose your surgeon, obstetrician, they are almost always in the room when the procedure is done unless the person has passed their exams/major hurdles in major teaching hospitals. But the political and cultural climate here in HK is also different, and the allocation of budget. I have seen the figures for the HA hospitals here and they are run on a very lean budget compared to Australia/UK and of course the US, so they have had to make some adaptation to make up for the shortfall. Also personally, I have noticed this is an extremely capitalistic society, so that there is an acceptance here that the government supplies you with a very basic entitlement BUT anything extra you must (or your family must) pay for. It is what it is. I don't think it is any better nor worse a system than that seen in many of our home countries.
Try to put your mind at ease, there is a system in place, it may not be what you are used to BUT it is a system that services >90% of the 8 million inhabitants in HK. Frankly speaking, to be able to find a bed in the private for a c-section right now would be near impossible, AND you may end up in worse situation, having someone who has none of your antenatal records, understands nothing about your history delivering you at the last minute...and if you've read the other posts, most obs/private hospitals who/which are good are cracking busy, so the ones who would take you on at short notice (unless you have some significant connections or friends) may be likely to be quiet for a reason.
I hope this helps.
 
One more thing to add, if someone is having a genuinely emergency appendicectomy, especially if it is complicated with an abscess or if it has burst, that is much more complicated than a routine c-section....you'd be wanting the senior surgeon in on it then.......

Secondly, the reason why the public hospitals won't allow you to insist upon having the fully qualified specialist (they are all qualified doctors) do your procedure is because at times, there is only 1-2 of these training the trainees who outnumber them by sometimes 5 to 1, so you can imagine if everyone came through the door insisting this what would happen to the public hospital system and by necessity what would have to happen to the tax rate. So personally, I wouldn't complain, you'd just be giving a hard time to someone who can't change the system (and as far as many are concerned the system does not warrant changing).....it's just that our expectations are different.
 
Hi Shenzhennifer, thanks for asking your paediatric friend - very much appreciated. Reassuring that he considers c-sections easy and common...

Hi Mummymoo, thanks for your response also. Your words are reassuring too. My first reaction was to try and get a private delivery, but I am so close to the scheduled delivery date (Monday) I agree that I will find it hard to find somewhere to do it, and also I think it would be quite stressful to change everything around now.

In terms of 'getting what you pay for', I can appreciate that this might be the attitude and indeed understand why. Looking back, I just hadn't appreciated the real differences between public and private. If I had, then I would have paid for private. We decided to go with a public hospital because we thought the quality of care in a public hospital was just as good, if not better than, private hospitals and that it was only the bedside manner, private room and other such "luxuries" that were missing. I still believe that the potential quality of care is excellent in public hospitals (e.g. medical facilities, neo natal units, specialists etc.) but I see now that this doesn't necessarily mean that every individual will benefit from that potential. The quality of care that I will receive will be nowhere near as good as if I had gone private and chosen an experienced, skilled consultant.

Anyway, there is nothing that I can do now except listen to the reassuring words of yourself, Shenzhennifer and other posters and convince myself that it will all be fine. I am sure it will.
 
i must say that i disagree with you wholeheartedly. i've had two VERY, VERY complicated pregnancies and while the bedside manner can leave a lot to be desired, the MEDICAL care i received was FANTASTIC.

i grew up next door to an OBGYN (he actually delivered my brother and 3 weeks later moved in next door), whom i still call "uncle". when i was pregnant (both times) i was on the phone to him almost weekly giving him updates on EVERY test, procedure, and piece of advice given me. his conclusion ws that the medical care i received here was virtually identical to what i'd receive in canada.
 
Carang, you missed my point. What I was saying was that the quality of care in the public hospitals can be excellent if you have access to the specialists and senior doctors, but that it is not necessarily the case that you will have access to these doctors / this care. As is seen in my case where a trainee is doing my surgery with no supervision when I would prefer a more experienced doctor.

What my doctor at the POW told me was that the consultants and senior doctors work on the complicated pregnancies, not the routine ones like a planned c-section. This would mean that, as yours were "VERY VERY complicated" pregnancies, then presumably you would have had access to some of the best doctors rather than a trainee.

My point was that had I known I would be operated on by a trainee then I would have preferred to pay to have a much more experienced doctor perform the surgery.
 
Totally agree and empathize with you, Liquorice. I feel the same way as you, but am further off from my cut than Monday:0
Well put about the potential of hk public hospitals. I too used to feel rather optimistic about the care here...until I actually got it. But my pregnancy is uncomplicated and boring and so therefore I will probably have your trainee operating on me in a couple of months.
Quote from nurse at MCHC the other day(read very fast):
"so any symptoms or complications that might make you want to see the doctor no well that's good so any questions no well good so see you in 4 weeks time bye bye"
Another priceless exchange with a different nurse that day, upon seeing me walk in with my stroller and boy:
"who will take care of your baby?" "me." "well, tell him to sit down on the chair." as my boy is in the middle of settling himself on the chair, "sit properly!" "he is not a dog. Don't speak to him like that!"

Yes, looking forward to my next appointment.
 
Liquorice, truly you are in good hands. The POW is only one of two university teaching hospitals in this town and the doctors there of all levels are usually the brightest in their year. Don't fret too much, just await the wonderful arrival of your new baby. It's a great time in one's life.
 
Well I'm certainly sorry if the information I provided was incorrect, maybe pregnancy is addling my memory, hope your c-section goes without a hitch.
 
To be clear, a trainee surgeon IS a qualified doctor.

'After having obtained the MBBS degrees, all medical graduates are required to undergo one year of housemanship in a public hospital before they can practise as licensed doctors in the territory. Completion of the basic medical training opens the door to a multitude of career options in medicine, e.g. public hospital doctors, private practitioners, university doctors who are involved in clinical teaching, research and services, and health administrators. To be a specialist, the medical graduate should be prepared for more years of postgraduate training and more examinations.'
 
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