Public hospital surgery

Patient guide

Who may be involved in my care?

Understanding the roles of specialists, doctors in training, medical students and others involved in your care.

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Key things to know before your consent discussion

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Language switching is included to demonstrate how this guide could support different patients. Translated versions are not currently enabled in this prototype.

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Narration

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Professional audio is available section by section and for the full guide.

Natural professional narration only. The guide will not switch to a robotic device voice.

How to use this guide

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This guide explains who may be involved in your operation, when care may also involve teaching, and the choices and questions you may want to discuss before giving consent.

Explore the guide

Your care journey

Work through the guide in order, or go straight to the section most useful to you. You can return at any time.

Chapter 01 · Your team

Your surgical team

In a public hospital, your operation is usually carried out by a team rather than one person working alone. The team may include specialist surgeons, fellows, registrars, house officers, nurses and anaesthetic staff. Medical students may sometimes also be involved.

Key point

A registrar is a qualified doctor, not a medical student. Doctors in training provide a large amount of day-to-day care in public hospitals.

Who might be part of my surgical team?

Consultant or specialist surgeon

A doctor who has completed specialist surgical training. A specialist may have overall responsibility for your surgical care even when other appropriately qualified surgeons perform parts of the operation.

Fellow

Usually an experienced doctor gaining additional subspecialty experience. Some fellows are already fully qualified specialists.

Registrar

A qualified doctor who may be completing specialist surgical training. Registrars range from relatively junior doctors to highly experienced surgeons approaching completion of training.

House officer

A qualified doctor at an earlier stage of postgraduate practice. House officers are part of the hospital clinical team and may assist with your care.

Medical student

A person studying to become a doctor who is not yet a registered doctor. Medical student involvement is different from care provided by qualified doctors in training.

Next: When care also involves teaching

Chapter 02 · Care and teaching

When care also involves teaching

Having a registrar or fellow involved does not automatically mean you are being used for teaching. A qualified doctor may be providing care that is already within their skills and competence. At other times they may be extending a skill with active teaching or direct supervision.

Understanding the difference

Providing care within existing skills

A qualified doctor carries out work that is within their existing skills, competence and clinical role. This is part of providing your healthcare and does not automatically mean that active teaching is taking place.

Active teaching

A doctor is learning, developing or extending a skill while being taught or supervised by a more experienced doctor. If active teaching is proposed, this may require a more specific consent discussion.

The role can change during one operation

A doctor may move between ordinary service delivery and active learning during the same procedure. It may not always be possible to predict every step in advance, which is why a meaningful explanation is more useful than a simple tick box.

What this can mean during an operation

What might a registrar or fellow actually do?

Depending on the operation and the doctor's experience, they may assist the specialist surgeon, perform particular parts of the operation, perform much or all of an operation with appropriate supervision, or operate alongside another surgeon as part of a team.

Who is responsible and how does supervision work?

Your service should explain who has overall clinical responsibility for your operation. The amount and type of supervision a doctor needs depends on their experience, assessed competence and the procedure being performed. A doctor may be able to perform some work independently while needing direct supervision for other parts.

Can roles change during the operation?

Yes. Surgery sometimes requires the team to change roles in response to what is found, complexity, staffing or what is safest for you. You should still receive a reasonable explanation beforehand of the expected team and their general roles.

Next: What should I be told, and what choices do I have?

Chapter 03 · Information and choice

What should I be told, and what choices do I have?

Before giving consent, you should have enough information to make a decision that is right for you. The detail needed will depend on your operation and your individual circumstances.

Your information and choices

What should I be told before my operation?

Depending on your circumstances, this may include who is expected to perform your operation, the general roles of the surgeons involved, whether doctors in training will be involved, whether active teaching is expected, what supervision is planned, whether medical students or observers are expected to be present, and anything about the team that is especially important to you.

Do I need to know who will perform every step?

Not necessarily. It may be difficult to predict every individual step before an operation. The aim is a meaningful explanation of the expected team and roles, while allowing enough flexibility for safe clinical care.

What choices do I have?

You have the right to receive the information you need to make an informed decision about your care. If active teaching is proposed, you can ask what it will involve and discuss whether you are comfortable participating. You can express a preference about who provides your care, and you can refuse or withdraw consent to services.

Can I insist that a particular consultant performs everything?

Not necessarily. Public hospitals provide care using teams. A preference should be considered where practicable, but this does not always mean that a particular specialist can personally perform every part of the operation.

What if I do not want to take part in active teaching?

Tell your surgical team as early as possible. Depending on the operation and service, another arrangement may sometimes be possible. In other circumstances, avoiding a planned teaching role could mean changing the team, moving to another list or delaying treatment. Your team should explain the realistic options and consequences.

What if the surgical team changes?

Teams sometimes change because of emergencies, illness, availability or unexpected findings. Where practicable, you should be told if the people expected to perform your operation change before the procedure. Not every change can be predicted in advance.

What about medical students and observers?

Medical students are not registered doctors. Their involvement in patient care is considered teaching. You should be told about proposed student involvement and be given a meaningful opportunity to decide whether you agree. If a student is expected to do more than observe, you should receive enough information to understand what they are being asked to do.

What about intimate examinations or procedures?

Extra care is required when an examination or procedure is intimate or involves exposure of your body. You should know beforehand who will be involved and what their role will be. Consent should be obtained before sedation or general anaesthesia affects your ability to make a new decision.

Important information

Before you consent

Raising a concern or asking questions about teaching is part of the consent conversation. This guide does not record your consent.

Next: What matters to me

Chapter 04 · Your priorities

What matters to me

Different things matter to different people. Choose any that are important to you. Your choices stay on this device unless you decide to share or email them.

What matters to you

What would make treatment worthwhile?

Choose any priorities that feel important. Your selections stay on this device and appear in your consultation summary.

Next: Questions for my surgical team

Chapter 05 · Prepare for the conversation

Questions for my surgical team

Discuss with your healthcare team

Questions worth asking

Save any that would help you understand your own situation.

Questions are expected. Save any that would help you understand who will be involved in your operation and what is planned before you give consent.

Or write your own question

Where are my questions saved?

Saved on this device. Nothing is sent automatically. If you choose to email your questions from My questions, your own email app will open a draft for you to review and send.

Important information

Email my questions

When you are ready, open My questions from the Guide button. You can review your saved questions and What matters to me, then create an email draft to the demonstration surgical team. Nothing is sent automatically.

Before you meet your surgeon

Ready for your consultation?

Review what matters to you and the questions you want to discuss. These stay on this device and nothing is sent automatically.

Your consultation

My questions

Keep track of anything you want to discuss with your healthcare team.

What matters to me

No priorities saved yet.

Things I want to discuss

Nothing flagged yet. If a section raises something you want to come back to, choose “I want to discuss this”.

Questions to discuss

No questions waiting to be discussed.

Add a question

Questions already discussed

Ready to send them?

Email my questions

Create an email to the clinical team containing the topics you flagged, your saved questions and your priorities.

Nothing is sent automatically. Your email app will open first so you can review the message before sending it.

Your care

Your rights as a patient

When you receive healthcare in New Zealand, you are protected by the Code of Health and Disability Services Consumers' Rights. This includes your right to be treated with respect, to receive information you can understand, to ask questions, to make an informed choice about your care, and to have a support person with you where appropriate.

Read the full Code of Rights

About this guide

About this demonstration guide

This demonstration shows how a reusable Loupa chapter could explain surgical team roles, clinical teaching, supervision and patient choice before a public hospital consent discussion.

It is designed to support patient understanding and preparation. It does not record consent and does not replace the individual discussion with the treating healthcare team.

The content has been drafted from the Health and Disability Commissioner decisions on informed consent and teaching, and the Council of Medical Colleges submission on informed consent. Final wording would require consumer, clinical, legal and Health NZ review before clinical use.

Guide information

Clinical governance

Guide: Who may be involved in my care?
Clinical content: Demonstration content, For stakeholder review
Service: Public hospital surgery demonstration
Patient education platform: Loupa Patient Education
Version: 0.2
Status: Draft patient guide
Review cycle: Requires clinical, consumer, legal and Health NZ review before use

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