The United Kingdom Thyroid Multi-Disciplinary Team; a National Survey of Services and Comparison to Guidelines

[helvella]

With no experience of any surgery at all, I find it difficult to comment. But it does seem so very sensible to choose (insofar as choice is available) a surgeon who has current, active experience.

CLINICAL EXPERIENCE

The United Kingdom Thyroid Multi-Disciplinary Team; a National Survey of Services and Comparison to Guidelines

Anya Selwyn, Jeremy Davis, Robert Hone

First published: 23 August 2021

doi.org/10.1111/coa.13853

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/coa.13853

Abstract

1. We have identified ambiguity in the current guidance on thyroid MDT’s, and have also found nationwide variation in compliance with this.

2. We recommend:

a. All thyroid surgeons should complete a minimum of 20 thyroid procedures per year, and this should also form part of surgeons’ annual appraisal.

b. All surgeons should contribute data to UKRETS (unless prevented by local legal frameworks) and this should form part of surgeons’ annual appraisal and be audited by individual MDT’s and regional cancer networks.

c. Thyroid MDT’s should be held weekly where possible, with a minimum frequency of fortnightly.

d. The core membership of thyroid MDT’s (stand alone and joint) should include thyroid surgeons, specialist radiology, endocrinology, nuclear medicine, nurse specialists, histopathology +/- cytology and clinical oncology.

As so often, information potentially of great importance to patients is locked behind a paywall.

onlinelibrary.wiley.com/doi...

[tattybogle]

well , if we can't read the juicy bits yet , we will just have to wonder whether some thyroid surgeons have been not practicing on thyroids very often , not being assessed on it annually , not handing in their results data to be audited, . and also be left wondering who it is who hasn't been invited to attended MDT meeting's when they can be bothered to have one.

(sorry , ... have been a thyroid patient too long , so now suffering from rampant cynicism and random outbursts of sarcasm )

[shaws Administrator in reply to tattybogle]

I think the majority on this forum would agree.

[endomad]

My surgeon was excellent although the needlework after was hideous, 14 huge blanket stitches. All healed well but no one told me I would need thyroid replacement! My first blood test after TT was 4 years later. Needles to say I nearly died.

[helvella Administrator in reply to endomad]

Sounds like he got a student to sew up!

(Or is that from seeing too many television medical soaps?)

[TSH110 in reply to endomad]

You think they could take more pride in their finishing off skills if they are so good where light will never enter or their work be visible. Perhaps it is like a signature and theirs was very ugly.

[tattybogle in reply to TSH110]

my OH used to work as Auxilliary Nurse in the ward next to A&E... he always say's they were allowed to practice amputations on a sunday afternoon as long as it was below the knee.... i think he's only joking , but TBH never been 100% sure ... wicked gleam in his eye when he says it...so who knows who they let 'finish you off' whilst the clever surgeon hurries off to his Golf Club.

[shaws Administrator in reply to endomad]

Not to tell a patient who is going to undergo an operation (for any condition) and to remove an essential part of the body, especially one that enables it to function from head to toe accounts for negligence.

[ShatteredofLee]

Yes the ‘stapling’ on my partial thyroidectomy 23 years ago made me look like Frankenstein. I asked for painkillers before the staples were taken out and the doctor refused. The poor nurse nearly cried as it made her job that much harder. It seems pretty sensible to insist surgeons get their practice in regularly and show the paperwork confirming they’re not screwing up.

[shaws Administrator in reply to ShatteredofLee]

Patients who've had the same op as yourself must be horrified if they look into a mirror after the op. Not to be given painkillers makes the surgeon sound like a robot who has no sympathy or feeling due to patient's distress after an operation.

[shaws Administrator]

I agree. We do put our lives in their hands when undergoing operations and we don't even know how many of similar ops they've done and whether or not the patient was content after the operation or horrified or painful.

[Poniesrfun]

In the US, the magic "minimum" number of procedures for competency is 25, though we prefer higher. Don't know that it's actually written anywhere. There's a great video by Dr. Julie Ann Sosa where she mentions this minimum:

Stanford Surgery

8th Annual Ignatius Lecturer Dr. Julie Anne Sosa, the recently-appointed Chair of UCSF's Department of Surgery, presents "The Rise of Thyroid Cancer and its Evolving Management: When is Less More?"

youtu.be/_uzjzqSv5jc(Not working as expected?)

Patti in AZ