Fighting the Locum Surgical Reg

As a surgical trainee, there is always a constant, nagging pressure for numbers, numbers, numbers! Looming ever-present in our subconsciousness is the next stony-faced ARCP panel member peering over the top of their glasses and demanding an explanation for exactly why our numbers are so disappointing. Unfortunately, this pressure can on occasion lead to the rather undignified business of sharking - ie getting involved in an operation that another surgeon feels should be 'theirs' by virtue of the rota, groundwork with the patient or relationship with the consultant.

Yesterday I found myself at somewhat of a loose end (not counting my overflowing in-tray of admin paperwork). Thankfully, just as I was about to grudgingly settle in for a session with the dictaphone, I got a call from one of the consultant to say that a cholecystitis patient on the ward was getting a little septic, and he needed someone to book her onto the emergency list for a cholecystectomy. I dropped my paperwork like a hot potato, and got on the phone to the theatre co-ordinator. 

I was just scrubbing, the patient asleep on the table, when in stormed one of the locum registrars. Not to typecast, but like many locums he was an older gentleman with an unconvincing grasp of the finer details of NHS practice and culture. My only interaction with him to date had been to notice him sleeping in the mess or sloping off early. He had however been assigned to emergency theatres on the rota for that morning, and accordingly I had let him know that I was booking this case. 

Now he was apoplectic that I was stealing 'his' operation. Grudgingly, I was forced to concede that I had perhaps sharked an emergency laparotomy from him the week before (I have a solid argument for why actually I had every right to be involved, but I won't go into that here). After a little backpedaling and apologies, we agreed that he could operate and I would hold the camera for him and got on with it.

We were about 30 minutes in, and he was really making a hash of the operation in my opinion. This put me in a difficult position, as although I had already thoroughly rubbed him up the wrong way, I could see that he wasn't making progress, and I was conscious of the potential for a patient to suffer as a consequence my bruising of his ego. My subtle hints went unheeded, and therefore I asked a scrub nurse to call the consultant. He interjected that everything was absolutely fine and that he did not need help, but thankfully she listened to me over him and within a few minutes the consultant had arrived.

Seeing the mess of blood and bile on the screen, the consultant angrily demanded to know why on earth some locum registrar was operating in his theatre! Thankfully, no harm was done to the patient, but afterwards the consultant took me aside in the coffee room for a chat. He explained that he had invested time, sweat and tears in teaching me, and knew my capabilities after many hours of operating together. Perhaps the rota did assign the locum to theatres that morning, but in the brutal words of the consultant, the reason he was still locuming in his 50's was because he had failed to make it as a surgeon! He told me in no uncertain terms that to avoid the same sad fate, I needed to become harder, more bullish and accept that along the way I would have to trample over many other similar middle grades to succeed in a competitive world. 

Regrettably, I accept that my consultant is probably right. It would be better for everyone if the system was less combative, less dog-eat-dog and more conducive to structured, measured surgical training. But the reality is that currently, despite strides forward in the recent past, the only was to get trained is to go and sniff out every possible opportunity to operate, increase your skills and challenge yourself. Despite being called a 'Training Program', the system relies on trainees performing the same amount of service provision as the non-training registrars, and then the good will of consultants to provide ad-hock training in the little gaps in between. There is no Program. There is no structure. There is simply no space for the niceties of considering a locum's need to also keep up his operating numbers.