Quote:
Originally Posted by firstkill
el duderino, you would be okay to have a cardiothoracic fellow do your mothers bypass? maybe the senior resident dig out a vein for a graft? or the intern put in a central line?
post op care is great at large academic/university center which i completely agree with.
my concern for the OPs mother is just who is actually doing the technical parts vs who is observing. All in all, important questions to ask.
fk
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I would be happy for the cardiothoracic fellow, in concert with the attending surgeon, perform the bypass surgery. How in the world do you think the attending him/herself learned to do the surgery in the first place? I cannot envisage a scenario where the fellow would be left to do the surgery on their own. In my area of head and neck surgery, the fellow will often--with the attending--perform microvascular anastamoses for free tissue transplants -- one could argue this is technically far more challenging than a bypass given the caliber of vessels involved and the complex anatomy.
As far as senior residents harversting vein grafts -- yes, I'm totally ok with this. Harvesting the vein is straightforward and not technically demanding.
Having once been an intern who placed several central lines without incident -- again, I would be ok with this so long as it is a supervised procedure which, in my experience, it always is.
I understand your concern for the OP's mother -- however, please realize that the optimal outcomes in teaching facilities is not only due to resident participation in post-op care. Indeed, residents and fellows are involved in some of the most complex OR cases in virtually every large teaching hospital. I cannot think of a single incident where the fellow or resident is to blame for a poor outcome secondary to "technical" deficiencies.
Again, I ask, how do you think the attending staff learned all the "technical" aspects of the bypass surgery? By standing around and observing?
The key question to ask is, "As the attending surgeon, will you be present and participating in all the KEY portions of the surgery," to which any answer other than "yes" should have you looking for someone else to operate.
El Duderino