resident to perform RP

Possibly.  I think it's sometimes done without the patient even knowing. 

At least you know going in.

In my husband's case we found out that interns would be doing a lot of the work when he was minutes from surgery, laying on the gurney. We'd been told by the surgeon that he did the RP, but that morning the 2 interns seeing him said they would be doing much of the work, although the important part, "presenting" the prostate, would be done by the head of urology, who at that moment was still in his office. We had a mini freakout and nearly walked. They called the surgeon who came down to preop and spoke with both of us. The interns present had 5 and 7 years of experience, the head surgeon around 30. My husband decided to go through with it, although he nearly disconnected the lines already in his arm and walked. Lousy time.

Apparently it's often the case with open RP, and even the heavy hitters have others in the room assisting, especially in the teaching hospitals. Get your surgeon to be specific about what part is done by whom in the operating room. May put your mind at ease, or you may look elsewhere. Good luck...

It can be ugly when the reality of cancer treatment and the fantasy that many people hold dear collide.....

Purg he is likely relating to the twilight zone of reality of PCa vs. our perceptions of how wonderful it is with all these experts at our fingertips. "It is a jungle out there...i.e. it is unreal and beyond your belief at times."

Post Edited (zufus) : 1/15/2011 11:38:39 AM (GMT-7)

Tell the surgeon you only want him. Put that info on the consent form in big letters at the top. My surgeon did mine except for closing me up. He had a resident do that. That was ok with me.

How does a top-notch doctor get to be that way? Practice, likely on us. As in any field, we can expect the juniors to be doing most of the work with the expert on hand for crucial parts of the procedure. At least I hope that's how it is...

Tud,
It's very interesting that you point that out. I know from my experience that technicians actually perform most radiation therapies as opposed to the radiation oncologist who prescribes it or the physiologist who designs the therapy. It would be interesting to see if the qualifications matter for those who actually operate the machinery.

That would indeed be an interesting piece of information. I mean would you want the technician doing their 1st administration of radiation or the one who has been in that lab 10 years?

Tony

Tony -- all my radiation was administered by technicians, and the actual people would change from day to day.  of course there was a doctor on site and i saw him once a week during treatment but i never saw him during treatment.  when i had my seeds implanted the rad doctor said he would do the whole procedure.  he said my procedure was a piece of cake and would take him about 20 minutes.  he did four procedures that day and was assisted by my urologist.

before BT my doctor asked me if i minded if two people observed the procedure.  i asked him if they would assist and he said they were not doctors; they worked for the company that supplied the seeds.  i had to sign a waiver.

i think we do our due diligence but at some point we have to trust the people we select to treat us.

ed

I had my surgery at a teaching hospital, by choice, not because of insurance. I just chose the best surgeon that I could find. I had an agreement with my surgeon that he would do the critical parts of the procedure, but I left it up to him as to what those critical parts were. Of course there were residents involved. I'd rather have a well supervised resident doing parts of the procedure, than an unsupervised fully trained surgeon with questionable skills or judgment. Once a urologist finishes his training, and has gone into private practice, they have the right to operate whether or not they are any good at it. Some are excellent, some are not.

I've had an excellent outcome. Based on statistics (and what people post here), I'm well ahead of the curve in continence, ED, and cancer control. For example, incontinence is something I haven't experience for a instant. I chose the best guy to do it. I figure teaching residents just forces him to be at his best at all times. Plus, being a professor at a major medical school demonstrates that he/she has proven abilities and accomplishments, and also that he/she's not just in it for the money.

Concern about residents participating is appropriate. I'd want the attending surgeon there in the room at all times, and I'd want to establish a relationship of trust with the attending. But, under those conditions, an academic urologist will often be a great choice.

Tony -- they did not use gold markers on me either.  they used three tattoos.  the techs would place me on the table and my legs would go into the personalized mold.  then one tech would get on either side of me and would line me up by pulling the sheet back and forth.

then they would leave the room.  the table would then shake a bit as it made the final adjustment....and then you know the rest of the procedure.  a tech told me the margin for error was 1mm.

my buddy started radiation a couple of weeks after i finished.  he received straight IGRT, which was i think 44 sessions vs. my 28 sessions.  they used gold markers on him.  i really never asked the doctor why the difference but i will next month if i remember.

ed

 

My surgeon, with 700+ procedures, flat out told me he'd be doing the surgery and his equally experienced partner would be the patient side assistant. I felt pretty confident and the results are panning out as expected. I have all along wondered though, someone has to be the first patient. If new doctors do not get the necessary experience, the next generation of PCa victims are going to be SOL.

Good deal Ed,
I also have another resource who was a resident at Harvard's radiation oncology center. He specializes in IGRT technology technologies. He has already been emailed...I have asked about what the process is for when the technician discovers that the target has repositioned itself...

Tony