How are patients assigned a surgeon in your residency clinics?

[paradoxofchoice]

The attendings have their own clinics. We also have a resident clinic which is staffed by two semi retired attendings who don't operate. Because of the volume we see from the resident clinic, about half of surgeries from the general service on our monthly schedule come from this clinic. The patient meets the surgery scheduler after their consult who schedules them based on most convenient dates. This means that the patient has never met the operating surgeon or the resident before. Usually they will say hello in preop and again talk to family in PACU, but some attendings come to the OR once the patient is prepped and ready to go. The patient never meets the surgeon. This is mind boggling to me and obviously disturbing for the patient who meets 3-5 new doctors (residents/staff) every visit with us. Is there a quality difference in the care they receive? I doubt it, but enough patients definitely complain about the lack of continuity.

When they come to the postop appointment, they usually don't meet the resident who may have seen them for their preop consult or surgery. Thankfully, they've met the clinic attending before which is a little bit comforting to some patients.

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[bannie22]

Happens. Not all patients are equal.

 

[mimelim]

The attendings have their own clinics. We also have a resident clinic which is staffed by two semi retired attendings who don't operate. Because of the volume we see from the resident clinic, about half of surgeries from the general service on our monthly schedule come from this clinic. The patient meets the surgery scheduler after their consult who schedules them based on most convenient dates. This means that the patient has never met the operating surgeon or the resident before. Usually they will say hello in preop and again talk to family in PACU, but some attendings come to the OR once the patient is prepped and ready to go. The patient never meets the surgeon. This is mind boggling to me and obviously disturbing for the patient who meets 3-5 new doctors (residents/staff) every visit with us. Is there a quality difference in the care they receive? I doubt it, but enough patients definitely complain about the lack of continuity.

When they come to the postop appointment, they usually don't meet the resident who may have seen them for their preop consult or surgery. Thankfully, they've met the clinic attending before which is a little bit comforting to some patients.

At our main hospital, every patient sees the attending surgeon in pre-op because they won't let us roll back until they do and mark the patient. Where I am right now for instance, I can mark the patient, rollback, time-out and start the operation without the attending being in the room. I have had cases where the patient didn't meet the attending until the following day when rounding (they didn't remember us seeing them in PACU). My patients need to feel comfortable with what is happening. I pride myself in spending the time and energy to help them understand what is going on and what the process entails. Every patient knows that I am the resident, but since the vast majority have no idea what that actually means, I get to define that for them. Unsurprisingly, the doctor that sits at their bedside and explains everything to them, answers their questions and shows appropriate confidence and humility is someone that they feel very comfortable with.

 

[LucidSplash]

Our resident clinic is synonymous with our chief service; like you we have a couple non-operating older surgeons who oversee things but it is considered the chief's clinic (whoever is on the chief service at that time). So the patients do meet the chief who will operate on them at the clinic appointment. They typically do not meet the attending who staffs the case until the day of surgery if at all although it is up to the individual attending what their preference is. As a chief at my institution, I can sign the permit for the patient to roll back to the room. As for how we figure out who will staff the case for cases that come in through clinic, technically there is a schedule for that. In reality a lot of the time we bypass it because some of the attendings are so busy that it can be weeks between seeing a patient and actually getting their surgery done. There's a couple attendings who are easier to schedule with and are fine staffing chief cases so we tend to default to them when we can. The patients see the chief again when they come back to clinic.

 

[surgonc2017]

Our resident clinic we staff with the attending surgeons after we see the patient and discuss plans etc. I'll staff with the attending and on the morning of surgery see them again and mark/sign permit to go back. Sometimes the staff see them, sometimes they don't. If it's an outpatient procedure, they may never really meet the attending. If it's an inpatient procedure, the institution requires attending to round at least every 3 days. Some see them daily, some don't. They come back to resident clinic for follow up.


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[DoctwoB]

At ours residents see the patients and book the cases. Residents schedule when case will occur. Which attending staffs the case depends on a mix of scheduling considerations and residents steering cases to the attendings who they want to operate with for that particular case. Attendings generally meet patients in preop area unless a particularly complex case in which case they may staff in clinic.

 

[dpmd]

We had chief run clinics with a different attending staffing each week that would be who the case would go to, but they weren't necessarily present for clinic and didn't necessarily meet the patient even if they were there. We are a two per year program so the final year was all chief year and each chief got half the outpatients and would run their clinic the whole year so they were the person the patient would get comfortable with and the chief would schedule them so in theory could be there for every case (though sometimes the intern or junior might operate with the attending on it if the chief had other stuff going on).

 

[TraumaLlamaMD]

We've got a chief-run clinic that our chiefs each take turns running in blocks of several months. The chiefs are responsible for seeing each patient, deciding who gets booked and when, and for what operation. Usually, unless you're booked at the end of a chief's tenure, that chief will be the same one you meet in pre-op. The junior resident who is your first point of contact in clinic may or may not be the one who gets to scrub in that day. We have a constant clinic attending who is mostly there for backup and advice - "are you sure you want to book that as a laparoscopic case?" and is there on the day of operation but may or may not meet the patient.