A lack of experience in specialist procedures among surgeons is leading to some patients undergoing unnecessary operations, Abu Dhabi doctors have warned.
Dr Emad Al Rahmani, a consultant gastroenterology, hepatology and endoscopy specialist at Burjeel Day Surgery Centre on Reem Island, said he recently took on a patient who was advised to have surgery to remove a large portion of his colon after a doctor diagnosed an abnormal growth.
The patient, Abu Mohammed, 61, visited senior medics at three major hospitals in Abu Dhabi, who all recommended the same procedure.
But after the father of eight went on to visit five other specialists who also advised surgery, he then discovered through Dr Al Rahmani that he could have the growth removed endoscopically rather than through invasive surgery.
Speaking to The National, Dr Al Rahmani said some doctors in the UAE and the US were too proud to admit they lacked the expertise to perform certain operations. He said doctors should always refer patients to specialists rather than risking their lives.
“There is a way of doing this without surgery if patients are referred to specialist centres to someone who is experienced and specialised in removing large growths,” he said.
“Doctors never want to admit that they don’t have the knowledge or experience to do a certain procedure and that someone other doctor can.
“I’m not the only person in Abu Dhabi who can do this surgery – there are others, but the patient was never given the choice. Doctors should be more open-minded and refer patients to other specialists rather than take a shortcut which is surgery.”
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Dr Matthew Kroh, general surgeon and chair of the Digestive Disease Institute at Cleveland Clinic Abu Dhabi (CCAD), agreed with Dr Al Rahmani, saying pride was often a major contributor to the problem, along with infrequent training.
He said that new techniques, particularly in relation to colorectal surgery, developed rapidly and that surgeons must keep up to date.
“It may be appropriate to remove the colon in some situations, but if there is a large growth, many times it can be removed without an incision if the skills and experience of that surgeon is such that they are familiar with that technique and tools used to do it,” he said.
Abu Dhabi does not have a certifying body that gives credentials to sub-specialities. Both doctors and patients have long called for a system that recognises a doctor’s sub-speciality and years of training.
“This system is less established here," Dr Kroh said. "To get a licence to practice surgery here, it is basically a broad based, general, non-specialty exam, but many people practice sub-speciality here based on other board certifications outside the UAE."
He said it was important to go to centres that offer sub-specialities, particularly when it comes to less-common diseases.
“The simplest way is for the patient to ask the surgeon how many surgeries they have done and if there are any other options," Dr Kroh said. "There isn’t a credentialing body or something to look up online. There is basic biographical information at least with CCAD about training and their specialities.”
This information is available at most institutes, “but there isn’t a governing body that would give this information to individuals before time”, he added.
Despite this, Dr Kroh suggested patients should always ask if an alternative form of treatment is possible.
Mr Mohammed, who successfully had his growth removed by Dr Al Rahmani and was sent him home the same day, said he was not offered options by others, but rather was pressured into having surgery.
“They would tell me things like: 'If I were in your place, then I would do the surgery or that my life is at risk if I didn’t have the surgery immediately,'” he said. He was also informed that the growth was cancerous.
Although most colorectal growths – or polyps – do not develop into cancer, all colon and rectal cancers develop from them.
Colorectal cancer is the second most common cancer in the emirate after breast cancer, accounting for 8 per cent of all cases.
The figures show that 85 per cent of cases are in patients ages 40 years and older, and the majority are presenting in advanced stages of the disease. Worldwide incidence rates are 1 in 50.
Dr Zoltan Lackberg, physician and colorectal surgeon at CCAD, said polyps can almost always be removed endoscopically and that this less-invasive procedure was always preferable.
“There are even procedures that can remove very large polyps and save the patient complications afterwards,” he said.
“To remove the colon for a polyp, especially if not malignant, is quite rare at the hands of a specialised colorectal surgeon.”
Dr Al Rahmani added that he comes across cases where patients who do not need surgery are advised to undergo a procedure, or travel abroad because of a lack of “tools”, at least once a week.
He said some doctors will go as far as claiming they don’t have the right tools, rather than admitting a lack of training.
“This is unfortunately inherent in our population – I have the same tools they have," he said.
