Do you think I was treated by a specialist?

[Violet159]

I'm considering whether to get a second opinion after a negative lap, because my symptoms are persisting and very endo-like, but I don't want to get my hopes up or waste my money as I don't really have the support of my GP and will probably have to go private for it. I'm unsure whether I was actually treated by someone with special interest/expertise in endo and am wondering if anyone can weigh in on this?

I only met the surgeon on the morning of the op and he did speak in a way that gave me the impression he was familiar with the disease. I had asked the hospital whether I would be seen by an endo specialist long before the op and was told they try to get all suspected endo cases seen by those with special interests in it. The hospital has a decent BSGE centre attached and the surgeon I was going to have before (that op was cancelled due to Covid) happened to be one of their BSGE consultants. However I wonder if they relaxed this policy a bit to get people seen sooner because of Covid?

I can't find any info on my surgeon online at all. He did mention he was a very new consultant - I think he had only been a consultant like a month or so before my op. I know consultants go through years of training but I don't know if this would be enough to give someone expertise in endo? Does anyone know if someone could have special training and experience in endo at this point in their careers?

[Lindle]

After leaving med school the training for a consultant is 7 years. They then go on the specialist list with the GMC. In the last two years (ST6 and ST7) of the training they have to elect to do advanced training is specialist areas. These are called ATSMs (Advanced Training Skills Modules) or sub specialism. The sub-specialism that includes endo is Reproductive Medicine. A sub-specialist is entered on the GMC register as such so they are identifiable. Those who do ATSMs aren't so they will appear as general gynaecologists so the only way to know if they have done relevant advanced training that covers endo in more depth is to try and find a profile that mentions it or by asking.

So in answering the question as to whether someone so new would have the necessary training there are two answers:

Has the person does advanced endo training? - well if they have done one of the two ATSMs that cover endo or sub-specialism in RM then in theory the answer is yes.

Have they got expertise in endo? - That is a quite different question and needs considerable practice and experience.

A problem is that the message from the 2017 NICE guideline that requires anyone that treats endo to have a special interest hasn't got through in a lot of cases. When surgeons are allocated on the day they are taken from a general list and it is up to the department lead to make sure they have the right training. But we are seeing many women still having laps with general gynaes with no special interest. We are even admin staff allocating surgeons which is a bit worrying.

So the only way to find out whether the surgeon had the right expertise is to ask what specialist training they have - what ATSMs have they done in endo or have they got sub-specialism in RM and how long since they completed their training?

Pm if you want more info on where to find the training modules. x

[Violet159 in reply to Lindle]

Thank you so much - that's so helpful!! Thanks for making all that effort and detail, I really appreciate it!! Xx

[Violet159 in reply to Lindle]

Mind if I bug you with a follow up question? (Sorry!) I managed to track down the surgeons linkedin, which doesn't have much info on it but it does put the last year as:

ST7 obstetrics and gynaecology

Registrar in O&G. Interests include - laparoscopy, hysteroscopy, gynaecology ultrasound and pelvic floor surgery

That's all he has on there, so it doesn't mention endo but does this give any clues at all do you think?

[Lindle in reply to Violet159]

They have to qualify in two ATSMs in ST7 so one must have been in obstetrics that doesn't include endo. The other must have been in gynaecology but there are quite a few under that. All gynaecologists have to have basic lap skills so from the list he has given I doubt whether there is any endo specialism as such.

The link below gives all the ATSMs. Scroll to page 26 (Part 2). The ones that include endo are 'ATSM Benign Abdominal Surgery - open and laparoscopic (BASOL)' and 'ATSM Subfertility and Reproductive Health (SRH)'

rcog.org.uk/globalassets/do...

I would get a copy of your lap report as has been suggested as that might give some clues. PM me if you need any more guidance.

The guidance is below (click the link to download the pdf):

bma.org.uk/advice-and-suppo...

x

[Violet159 in reply to Lindle]

That's amazing, thanks again you're a star! Xx

[Moon_maiden]

Apply to the hospital for a copy of your records, this will give you more info on what was done, etc, and be helpful if you do see someone else. A new consultant may have had training under the BSGE team, you could contact PALS to find out.

It’s defiantly worth looking into for your piece of mind.