The Mesh story. Part 1.

So the senate mesh enquiry report came along this week without much fanfare.

Those hoping for heads to roll or more drama will have been disappointed.

They found that a lack of training and experience was a big contributor and I'd say thats pretty obvious.  It was amplified perhaps by the system in Australia where there is no clear hierarchy or leadership of doctors especially at a grass roots level.

I did my medical training in the NHS of the UK where the Professor is not someone you said "no" to.  Professors of O+G in England are usually short men from Scotland with many complexes and who would assassinate your career as soon as look at you.  When I came to Australia I was shocked at how benign Professors were here and how little authority they had.

This allowed self appointed grandees to spring up, often with experience but with little training in research, audit or critical thinking.  What I am saying is they could do the operation well but didn't know when to do it or who it was suitable for.

And that has been the crux of the mesh fiasco - stories of women in their 20's having implants for prolapse shock me to the point of disbelief.  Someone properly trained should not have even considered it.

With the Australian system the busiest doctor in town is often a mix of most approachable, word of mouth, reasonably priced, and best advertiser in the area.  I don't think training or experience figure so highly until people have had a problem.

In the UK the busiest doctor is usually the most experienced and highly skilled ...period.  When I worked in Manchester Royal Infirmary the busiest vascular surgeon was a miracle worker but notoriously grouchy and rude.  But the patients would say "I only want him to fix me - not talk to me" 

Obviously these are extremes at the end of the spectrum but my point is that the mesh story has exposed big issues with training in our speciality that I doubt the senate enquiry will fix.

For example when I returned to Newcastle in 2006 after completing the UK urogynaecology subspecialist training program in Sheffield England I tried to pass on my knowledge to a young trainee.

My technique for TVT's ( I avoid performing the TVTO variant whenever possible ) was learned in a centre of excellence in a major city and when I tried to teach it to my trainees the answer was a flat  "No - I have my technique already that I learned in Belmont hospital..." 

Wow - OK - Belmont.

This tunnel vision, arrogance and lack of seeing the whole picture is classic when registrars do not move around during their training or do not go off and do extra training called fellowships. 

To be contd.