Sunday, 15 January 2012

Which surgeons are the safest?

A study in France looking at the effect of surgeon age on outcomes after thyroidectomy has received world wide coverage this past week.
It is an interesting topic and very relevant to my specialty of cardiac surgery. To be a perfect cardiac surgeon requires qualities that probably peak at different ages - stamina, patience, clinical judgement and wisdom, as well as surgical virtuosity. A study several years ago showed that outcomes in the first two to 4 years after becoming a cardiac surgical consultant were probably not as good as they should be.  In my opinion, this reflects poor training. Many newly qualified surgeons operate on everyone referred to them, thinking that the referring cardiologist has made a judgement that that particular patient is suitable for surgery. The only person who can make that judgement is the surgeon himself. It is said that a good surgeon knows when to operate and a wise surgeon knows when NOT to operate. The latter skill is one that comes with experience and is one which trainees do not possess.
One way this surgeon dependant variation in outcomes could be mitigated is through teamworking where patients are referred to a team consisting of surgeons of different ages, skills and expertise. This sadly is not the British way!