[0x456]

Apparently surgeons can do something similar. The experienced surgeon you talked to is just there you get to you agree to surgery, without explicitly telling you a first year (poorly/un)supervised resident will do all the cutting.

[UseStrict]

I'm not sure it's that straightforward, if it's their name on the case and they was totally absent, that would be a huge liability for them and the hospital.

Newbies need to learn, there's only so many cadavers you can cut into before you need experience on living flesh. Experienced surgeons are often observing the procedure, and step in as necessary if there is a complex part, or if the junior isn't doing something correctly.

Beyond just the surgeon there is a good number of incredibly professional secondary staff who are running the whole operating theatre, from imaging, instrument preparation, to labs and vitals. When you speak to a surgeon you're not just getting them, you get their entire team, junior to professional.

[notatoad]

but that's exactly the same scenario as software - the experienced guy isn't just there to be a pretty face to make the sale, he's there because he's staking his reputation on the ability of his juniors to get the job done. if the juniors can't get the job done, the senior and the consultancy firm lose credibility.

[prasadjoglekar]

100%. True experience with ACL surgery in New York: It's an assembly line with the junior surgeons cutting open and patching up. The main guy goes OT to OT and does the most critical part and then moves on to the next one. They schedule 6-7 surgeries at once; the whole process is quite impressive.

Exactly the same process for my mom's knee replacement in India. By the time the actual knee guy walks in, patient is knocked out, opened up and ready for the heavy hitter.

[MrBuddyCasino]

I'd say thats something different: letting others do the time-consuming routine parts, so the senior surgeon can concentrate on what he does best. This is actually desirable: more patients benefit of his skill that way.

[namdnay]

That’s standard practice in nearly all hospitals worldwide.

In the UK, the most senior doctors are actually called “consultants” - they consult on the work being done by the others

[mlac]

This happened with my wife’s anesthesiologist during labor - the resident did his first epidural on her. I didn’t love it, but everyone has to learn at some point - and calling it out at the time could have caused more frustration, concern, and delay in the procedure (missing the window for getting one due to contractions). I also didn’t ask how many he had done, but I overheard it prior to him starting. I think asking him about his experience could have caused him to get nervous.

It turned out fine.

[mike_ivanov]

Experienced that. I was under a local anesthesia, so I could hear the surgeon hissing at that poor fellow things like "no, not there! here! - this is how you cut it!".

[rswail]

I would be suing the surgeon and reporting them to the surgical regulatory authorities if something like that happened.

[karlding]

This does pose a sort of chicken-and-egg problem for residents, although I would hesitate to call it a bait-and-switch.

In a vacuum, everyone would choose the best care available to them. Of course this is expected. How can anybody be expected to do otherwise when it's their life (or family member's) at stake?

Atul Gawande talks about this experience in Complications: A Surgeon's Notes on an Imperfect Science [0], where his son had been cared for by a full team of cardiologists, ranging from fellows in specialty training to attendings who had practiced for decades. However, due to certain complications, they needed to choose a pediatric cardiologist with which to schedule follow ups and decide on what procedures would be necessary in the future. One of the fellows, who had been the one putting most of the time in caring for his son, proactively approached them the day before discharge and suggested setting up an appointment.

It's common for fellows to receive patients this way, and at any teaching hospital, an attending is there to supervise and take over if needed. The entire system is set up such that residents and trainees are given opportunities to learn.

He says:

> A resident intubated him. A surgical trainee scrubbed in for his operation. The cardiology fellow put in one of his central lines. None of them asked me if they could. If offered the option to have someone more experienced, I certainly would have taken it. But that was simply how the system worked—no such choices were offered—and so I went along. [...]

> The advantage of this coldhearted machinery is not merely that it gets the learning done. If learning is necessary but causes harm, then above all it ought to apply to everyone alike. Given a choice, people wriggle out, and those choices are not offered equally. They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor's child but not the truck driver's. If choice cannot go to everyone, maybe it is better when it is not allowed at all.

[0] https://www.goodreads.com/book/show/4477.Complications

[nmfisher]

If everybody refused to let junior surgeons operate on them, juniors don't get the experience to become seniors. Fast forward 15 years, suddenly there's zero seniors left to operate on anybody.

Juniors have to learn somewhere. The reality - in Australia, at least - is that juniors learn in the public system where patients don't really have a choice.

[h0h0h0h0111]

I've never had surgery - how would you know? Is it even against regulations? (I imagine this is country dependent)

[pjerem]

You would know just before the surgery. The surgeon is supposed to be there before you are put down. At least it's what happened to me twice.

Last time I had a different anesthetist than the one I saw before. But I was happy because I did not have affinity with the one I met and the one I had was very welcoming and kind. Which is a really good trait for the person that is responsible to supplant your vital functions for some hours.

[voakbasda]

Bait and switch is illegal everywhere, right? If the surgeon stated that they were the one that would be doing the job, they are guilty of this.

[mattkrause]

It depends on how you’re defining as the job.

The nominal surgeon usually does the “heart” of the procedure: replacing your ACL, removing a tumor, etc. Their assistants just get you into/out of the state where that happens.

Surely you don’t expect the surgeon to personally do everything related to the case, right? Wash the drapes, prep the instruments?

[goguy]

They most likely didn't though as it would be a flat out lie. He probably explained the procedure etc but never commited to doing it himself specifically.

Or maybe something more important came up just prior. Ultimately people have the learn and have a go at some point - with your attitude they would be no more doctors.

[derangedHorse]

There doesn't have to be any deception on anyone's part for their to be new surgeons. If a new surgeon is doing the operation, he/she should be the one to meet the patient and explain the operation

[zo1]

Exactly, there are "teaching" hospitals where the entire premise is that it's for newer doctors to learn. They're usually cheaper as well and people know this.