Re: Who actually does the cutting when you have surgery . . .

"Tom Williams" <[EMAIL PROTECTED]> wrote in message
news:[EMAIL PROTECTED]
> Question: My doctor, a urologist, arranged for my prostatectomy
> surgery, he didn't say who actually was going to do the "cutting", he
> was there when I had the surgery done (is in surgery gown, etc.), he
> visited my hospital room post-up each day, often wearing said surgery
> garb . . . doctor has, I believe it is called, "staff privileges" at
> Nothwestern University Hospital in Chicago . . . would the medical
> staff or residents of the hospital do any of the actual "cutting"? Or
> is this solely the province of my doctor?  He did appear to have his
> own uroglogy "resident" working for him (I asked my doc about the
> "resident", and he said that the young doctor was employed by him),
> who also visited me each day post-op in the hospital.  I also saw this
> young doctor post-op and post-hospital-stay on a follow up visit to my
> doctor's office. Is it likely he did some of the cutting?  Regardless
> of who does the cutting, do hospital "medical staff" doctors work with
> doctors who are private physicians with privileges at the hospital,
> during surgery?  I.e., if you have your surgery done at a hospital
> with a good reputation for surgery in the particular type of surgery,
> are you more likely to get a good procedure done because the
> particular medical staff is thereby good and does interface with your
> doctor during surgery?

Surgical training programs such as at Northwestern University have the
responsibility of teaching resident surgeon how to do surgery, and surgery
is a "learn-by-doing" art. That urology resident will learn very little if
he just watches the operation.

The actual level of his participation will vary by training program policy,
his particular stage of training, the inclination of his supervising
physician. Depending on these and several other variables, the resident may
only watch the operation, assist the surgeon, do part of the operation, or
perhaps do all of the operation with the surgeon assisting and supervising.
It is the nature of medical education and has been since the time of Galen.

Resident physicians learn by taking increasing responsibility for patient
care with decreasing levels of supervision. High quality training programs
such as Northwestern take their responsibility to their patients very
seriously, just as they take their educational responsibilities very
seriously. Sometimes it's a difficult thing to balance. Patients at these
training insitutions have to trust their surgeon to balance these things and
assure that optimal quality is applied. In a responsible training program
quality of patient care does not suffer for their educational and training
obligations.

Residents are graduate MD's or DO's who have elected to specialize in a
particular area and spend 3-8 years training in that specialty after medical
school to learn all of the things they need to learn so that when they are
done, they will be competent to care for their own patients. They are
employees of the training program, not of any individual surgeon. All
residents are supervised by qualified doctors in that area who have been
through the same chain of training. In medicine, they say "see one, do one,
teach one". It would be unrealistic to think that such residents could
accomplish their training by simply watching prostatectomy after
prostatectomy for 5 years, then on the day they graduate go out and do one,
never having done one by themselves.

Northwestern's reputation as a high quality institution is generally
well-deserved. I'm sure you received excellent care. If a person is bothered
by the concept of having a surgical trainee participate in their care, and
cannot completely trust their surgeon to make sure that his/her operation
will be conducted according to the highest standards, then that person would
be better off seeking their care from a doctor in private practice not
affiliated with a training program and not supervising resident physicians.

HMc