A survey of almost 140 surgery patients by the University of Otago has found a “significant gap” between patient expectations and their understanding of the title or training level of the doctor who actually performed their surgery. Three-quarters expected their surgery to be done by a qualified surgeon but most were unaware their surgery was actually performed by a trainee registrar.
The study, published in the New Zealand Medical Journal this week, says the findings raise ethical issues around whether doctors may be violating patients’ autonomy unwittingly by failing to provide the information required for patients to give informed consent to being operated on by a senior registrar/trainee (see ‘Definitions’ below).
It is common in New Zealand teaching hospitals for registrars to perform surgical procedures and the study authors suggest changes to hospital systems may be needed to better inform and empower patients.
“This may include improved identity badges, patient information leaflets or a formalised consent process. which necessitates a written introduction of the name and level of training of the operating surgeon,” said the authors of the study carried out at Christchurch Hospital’s plastic surgery department.
Results included that most patients (61 per cent) believed it was important to know the level of training of their surgeon, but after their operation only 39 per cent knew whether their doctor was a consultant surgeon or a senior registrar/trainee. Of the 62 patients who thought that a consultant had performed their procedure, only 40 per cent were correct.
Seventy-five per cent of patients were expecting that their surgery would be performed by a consultant; however, 68 per cent of procedures were performed by doctors undergoing surgical training. Of the 37 patients who incorrectly believed the consultant performed all, or most, of their procedures, the consultant was available but not present in the operating room in 60 per cent of the cases.
While most patients expected a fully trained surgeon to be operating on them, 85 per cent were open to a trainee taking part in their surgery.
Different doctor terms preferred
The study also found that the most of the patients underestimated how long it took for a doctor to become a fully trained surgeon and were often unclear about the terminology used to describe a doctor’s level of training.
Most patients did not support the current terms used to describe the different stages of training (house officer, registrar, senior registrar and consultant) and preferred instead junior doctor (a doctor with less than two years’ experience), doctor, senior doctor and surgeon.
- Consultant surgeon: The most senior member of the surgical team. A fully trained surgeon with overriding responsibility for patients’ care.
- Senior registrar: A qualified doctor with more than four years’ job experience who is training to become a consultant surgeon.
- Trainee: Generally a senior registrar on a specialist training scheme, overseen by the Royal Australasian College of Surgeons. This term is used inconsistently.
- House officer: A newly qualified doctor in their first few years of work.
- Vocational registration: Doctors who have completed their training and been awarded the postgraduate qualification in a sub-specialty (i.e. plastic surgery) allowing them to work as a consultant. (i.e. consultant plastic surgeon).