Who is a Fellow? Why do some doctors and surgeons have the title "Fellow"? What does all this mean for patients?
In an otorhinolaryngology (ORL) ward you may meet a Fellow carrying out various treatment and care roles including the outpatients clinic. They may be involved in treating head and neck cancer, caring for people pre and post surgery, and undertaking some surgery.
In New Zealand, Teaching Fellows in ORL are qualified surgeons, who have trained and are registered by the Medical Council and the Royal Australasian College of Surgeons (RACS). The Fellows are in training to become senior surgeons/specialists/consultants. Fellows apply for Fellowships at various hospitals, often overseas, to develop their skills. Fellows are at all times under the supervision of registered senior surgeons in the ORL field of surgery.
If you are having surgery, and a Fellow is to be involved, you should be informed in advance. You will be told by your senior surgeon of the identity of the Fellow, and how they will be involved in your surgery. You can decline to be treated by a Fellow. This is one of you rights under the Patient Code of Rights. You can decline to be involved in any teaching or research. (Right 6(1)(d).)
The Medical Council advises all doctors to "Obtain consent before involving medical students in the care of patients. Inform the patient about the extent of the involvement of the student and the student’s experience." (32) This advice applies to Fellows in training.
All University training units involve registrars and Fellows at various stages in their training. Whether a Fellow should be involved in your case is dependent on the judgement of the senior surgeon. The senior surgeon takes into account the trainee's level of expertise.
Before your surgery it is important that your treating senior surgeon documents in writing your consent to treatment by a Fellow or your decision to decline treatment. You and your senior surgeon should determine whether the Fellow should be involved at all, how much they should do. If you are comfortable you can agree that they can carry out some or all of the surgical procedure. It all depends on you.
A decision from the Health and Disability Commissioner helps us to further understand the role of the Fellow.(1) "Obviously doctors need to learn the skills required to perform their job, including the practice of clinical skills. However, such training must comply with the Code and with relevant professional standards. For a trainee to be allowed to practise on an anaesthetised patient without the patient's consent is wrong - ethically, professionally, and legally."
Why is any of this important? In writing about medical and bioethics, Barbara Meier says, (2) "I am my body...in pleasure and in crisis. My "body" is my narrative of my life, my expression of my life's story."
You remain at all times in charge of your body. If you are unable to make medical decisions, or give informed consent, your family or designated support person will be consulted to make those decisions. You can sign an Enduring Power of Attorney for just this situation. If you don't have one, doctors have some power to act in your best interests. (Right 7(4) Code of Patient Rights.)
You have the right to decide who does what to your body. When treating your body to eliminate illness, and to ensure good health and function, those you treat you are granted a privilege by you to increase their knowledge and experience. Those surgeons who undertake complex head and neck cancer treatment and care should be fully trained and experienced. If you choose to involve a Fellow, you should be very clear about what you are approving in terms of your procedures.
The important points to take away:
- Fellows are in training. They are already well trained and experienced surgeons. They are developing their skills intreating head and neck cancer.
- You should be informed by your surgeon of any proposal to involve a Fellow in your treatment.
- Before you sign your consent form for your surgery, ask if there will be any surgeons in training involved in your surgery.
- You must give your consent in writing to the involvement of a Fellow in your surgery.
- You have the right to decline to have a Fellow involved in your treatment.
- If you don't feel comfortable, or do not feel fully informed, then you are probably best to decline a Fellows involvement.
2. Maier, B., & Shibles, W. A. (2010). The philosophy and practice of medicine and bioethics: a naturalistic-humanistic approach (Vol. 47). Springer Science & Business Media.