Do you think it's OK to 'have a go' at surgery any more?

RE: Do you think it's OK to 'have a go' at surgery any more?

janine redman — Sat, 09 May 2026 16:48:26 GMT

Although it’s funny that clients who pay thousands in referral fees seem more tolerant of expensive complications than those who have a less expensive procedure in house . Had one dog referred for TPLO that ended up with patellar fracture and repair in addition to stifle CCL repair and accepted the additional few thousand in spite of insurance being maxed out . Whereas wound breakdown following traumatic injury even when predicted and discussed seems to be met with frustration at additional expense

RE: Do you think it's OK to 'have a go' at surgery any more?

janine redman — Sat, 09 May 2026 16:45:29 GMT

Sometime litigation comes from unexpected clients , though I am pretty good at blunt speaking when necessary

RE: Do you think it's OK to 'have a go' at surgery any more?

David Mills — Sat, 09 May 2026 14:07:44 GMT

The one thing to consider is if the client seems at all high maintenance or litigious then refer them. And this is from someone who will do almost anything. It isn't defensive medicine it is simply not worth exposing yourself to that risk and stress for someone who will go after you for the slightest complication.

I find most soft tissue procedures are possible as skills are transferable between ops. However it does rely on a bed of experience in "routine" surgeries to have that degree of confidence. Dissection, tissue handling, ligatures, exposure are all learnt on the slopes of neutering, lump removals, stitch ups, routine gi surgery. It is why I have a degree of skepticism about the experience of some residents and specialists.

Orthopaedics offers less transferable skill application but the basics are not too complex. There is also quite a bit of biological leeway (bones have been healing themselves for millennia without vets) especially in younger animals. Still, much of what we see in 1st opinion is fixable in 1st opinion, and it is a great shame these skills are being lost, legs are being lost, because of some over inflated perception of being punished in some way for trying. Even in referral hands complications are relatively common, it is part and parcel of surgery.

RE: Do you think it's OK to 'have a go' at surgery any more?

David Scarff — Sat, 09 May 2026 08:22:51 GMT

I think this is an excellent summary! Communication, shared decision making and an honest appraisal of our abilities (often better than we imagine with experience) are key.

RE: Do you think it's OK to 'have a go' at surgery any more?

Andreas Ege — Fri, 08 May 2026 21:11:43 GMT

I'm fine with giving something a go (both as a term and actually doing it ;-) ).

Having said that, it all depends on context and communication. If I get to a point where I think somebody else can do it better to a degree it'll likely make a difference to outcome or it seriously moves me out of my comfort zone, I will make that clear and offer or even push for referral. In less obvious situations I'll let the client know I'm confident I can do it but that the risk of complications might be a bit higher than with referral to a specialist. That's what I did with my one and only TECA a few years ago - initially offered referral, client didn't want to for multiple reasons, advised her I'm confident I can do it but risk of complications probably higher.

My first turtle I operated on a sole-charge locum job in my second year in practice after the client refused referral even though I specifically warned that chances were good it will die on my table because I didn't have much experience and inadequate tools and not ideal medications. Luckily they can hold their breath for a really long time (I had forgotten reptiles need ventilation under full anaesthesia) and surgery went well. But just sending it home without doing anything hadn't really been an option in my opinion.

Latest when the question is euthanasia (or concern the animal won't survive transport/ time delay to referral) or "giving it a go" I'm willing to do a lot of things, as long as I think I have a reasonable chance of success. On that basis I've done a successful oesophagostomy on a dog to remove an apple that I could not shift endoscopically - the owner could not afford a late evening emergency referral and the procedure does not look that difficult in a surgical textbook. She knew I had never done it before but that I was confident I could and the alternative would, in all likelyhood, have been a dead dog.

In the end, a not ideal solution might still be better than no or a final solution.

The most important bit, I think, is to communicate risk and benefit clearly (and, I guess, to document it's been done). Sometimes that's a bit of guesswork, of course, because sometimes we only know in hindsight. I have done procedures in hindsight might have better been referred, and I have referred cases where in hindsight the specialist did exactly what I would have done and been comfortable with (all my recent exotics referrals either ended euthanased or had the same treatment I would have chosen had I not referred, but at least I know I didn't miss anything that would have made a difference).

I think once people have a good grasp of the basics, e.g. surgical principles, one can do a lot by following a textbook or case report. And on youtube one can find good videodemonstrations about almost everything, I have the impression.

Obviously, it sometimes does go wrong, though I think I have seen that happen more often with more experienced vets, especially with orthopaedics, than with recent graduates.

I had a dog die on my operating table because I misdiagnosed an intrathoracic bleeding for an abdominal one (in hindsight I think the diaphragm had been pushed caudally and lifted the liver). I suspect somebody better in using ultrasound would possibly have figured that out in time. Will never know if it would have made a difference in outcome But I'm sure the dog would not have survived to arrival at a more specialised clinic, which was the reason the owner and I decided not to refer but attempt surgery.

I've not much of an opinion how often that gets done these days, especially by younger colleagues.

RE: Do you think it's OK to 'have a go' at surgery any more?

Clive Ansell — Thu, 07 May 2026 15:03:51 GMT

[quote userid="2100" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248830#248830"]My question was whether there are many vets who are still prepared to do that at all, especially younger ones.[/quote]

As a new grad (1996), I would have attempted almost anything. I enjoyed surgery, enjoyed a challenge, and had a very supportive boss. Options and limitations were honestly discussed with clients, and referral was a fairly new concept at the time, mainly universities only.

Fast forward 30 years, and I am much more reluctant to leave my comfort zone, main reasons being difficult clients with ridiculous expectations (wanting a Supervet outcome at Yorkshire vet prices), much greater access to high standard referral work, and lack of support or back if things go mammaries up.

[quote userid="2100" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248830#248830"]And if not, what are the barriers to DIY (which I also don't mean flippantly!). Is it fear of the DC, of comeback from the client, or just the way things are going?[/quote]

Not really the RCVS DC, because their only remit is that of misconduct, which would only apply if one had been dishonest in any way.

It is more unrealistic client expectations, greater availability of referral and specialist surgeons, and a lack of support from colleagues and management if things don't go as planned.

RE: Do you think it's OK to 'have a go' at surgery any more?

Arlo Guthrie — Wed, 06 May 2026 18:01:34 GMT

[quote userid="29221" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248714#248714"]I hate the phrase "giving it a go". To me, "giving it a go" is like being asked to pick up a tennis racquet and try to hit the ball and see what happens, with no consequences and no preparation.[/quote]

Davina Anderson - A poor choice of words on my part, because I didn't mean 'have a go' as flippantly as that.

I guess what I meant was doing it alone for the first time (or perhaps only the 2nd or 3rd).

In other words, being prepared to take a bit of a leap and perform a procedure without much direct experience, and charging less for that lack of experience.

Not without preparation, though, and of course anyone in their right mind is going to do some research, phone a colleague etc.

My question was whether there are many vets who are still prepared to do that at all, especially younger ones.

And if not, what are the barriers to DIY (which I also don't mean flippantly!). Is it fear of the DC, of comeback from the client, or just the way things are going?

RE: Do you think it's OK to 'have a go' at surgery any more?

Judith Joyce — Wed, 06 May 2026 13:08:17 GMT

Its all changed so much.

Clients don't just google, they have much higher (often unrealistic) expectations, different attitudes and perceptions now. It must be massively intimidating to newer graduates to attempt new procedures.

I think our training and environment was much more sympathetic to testing our boundaries and carrying out new procedures

We were taught in tiny groups by lecturers who knew we would have to cope with everything presented to us.

Referral wasn't an option for anything acute or urgent. Clients couldn't travel the distances for referral and six week waiting lists at vet schools to take cases

Mentoring and support was readily available from very experienced colleagues and employers who would encourage. Employers with 'skin in the game' made great mentors, even if they could be a bit curmudgeonly about it

Easy to blame the current demographic but if they are not happy enough with the profession to stay in it more than 6 and 1/2 years on average) can they ever hit their stride to try new procedures safely and effectively

Agree that pressures from RCVS, litigations clients and corporate employers wanting to sweat the CT and MRI assets and encourage internal referral deters pushing personal clinical boundaries but does that make newer graduates a bit too comfortable, or conversely unstimulated 'or bored.

RE: Do you think it's OK to 'have a go' at surgery any more?

Mark Holmes — Tue, 05 May 2026 21:49:42 GMT

Vets develop their confidence by working in a stretched position and that means getting comfortable with the less familiar. One surgery builds on the next and whilst you might not be familiar with procedure B you can see that’s it’s not so different from procedure A which you have a lot of experience with.

There are limits but more important than THE procedure is the amount of time you get in theatre doing a variety of procedures.

Over the years I’ve done most things at one time or another from rhinotomy, perineal hernias, a variety of thoracic. Abdominal and orthopaedic procedures. Many have been on a giving it a go basis and most of those have worked out well. It’s a shame the days when this was more common are over…. these days of protocols and pathways, SOPs and policies feel suffocating, automated and any opportunity to think and just figure it out as you go - are limited.

Main barriers tbh Nurses and new grads - who have not really experienced that environment complaining. Expecting that everything should be referred.

RE: Do you think it's OK to 'have a go' at surgery any more?

Clare Tapsfield-Wright — Sat, 25 Apr 2026 18:10:02 GMT

It isn’t having a go if you have built up your surgical skills and are then faced with a unique set of surgical challenges or faced with doing a procedure for the first time. If you have the transferable skills and a plan then you should be able to decide if you are capable of performing the surgery . It’s not like being on a desert island and doing your own appendectomy. If you don't have the experience then you should definitely not just have a go and hope for the best.

One of the problems that vets face in the first few years is that they need the opportunity to perform complex surgery with the support of a more experienced surgeon. It takes a great deal of patience to be a mentor and a generosity too , to be willing to give your time when you could do it in half the time it takes to supervise.
in the midst of all the striving for work life balance etc I think the gift of gaining confidence through working with and watching colleagues can be lost. The more surgery you do in the first few years the more skilled you become and the more confidence you have . Treasure the opportunity to work with a generous experience colleague even if it is on your own time would be my advice to a young vet . Then you are not just having a go sick with worry but with experience and the skill to perform a procedure safely and confidently.

RE: Do you think it's OK to 'have a go' at surgery any more?

sue dorey — Sat, 25 Apr 2026 13:03:07 GMT

When vets first qualify they have often never done,or done once maybe, most operations.We've learned the principles and use them.I remember it being quite scary often and was often thrown in the deep end to get on with it .Looking back I think,for me,that was a good thing or I may never have done certain ops and never got better at them over time .Once the principles are learned I think it's not wrong to read up,watch some videos,until we are confident to do an op and then do it .I wouldn't call that 'having a go'.

Do owners now get told their pet is being operated on by a newly qualified vet who hasn't done it before?I'm wondering how it works now?I qualified in 1984 and often it might be me and a locum together doing for example out first perineal urethrostomy with a book beside us as it just had to be done,no referral places really apart from the vet schools which were miles away.

I often,as everyone does or did before advanced scanning,used to come across a situation which was unexpected( or maybe they don't ),as we didn't have ultrasound even.I remember a neck lump unexpectedly being attached with a big blood supply to the aorta and literally using my finger to stop a big bleed until I sutured it closed .

I think the more people do the more confident we become.

I'm not doing surgery anymore and sometimes miss it,apart from the most difficult fat bitch spay which were often a nightmare!Don't miss those,I honestly think it's the hardest op to do sometimes .

RE: Do you think it's OK to 'have a go' at surgery any more?

Davina Anderson — Mon, 20 Apr 2026 14:17:24 GMT

I hate the phrase "giving it a go". To me, "giving it a go" is like being asked to pick up a tennis racquet and try to hit the ball and see what happens, with no consequences and no preparation. In our clinical practice, we should research, study the anatomy closely, read about the indications, complications, risks, strategies, phone a friend, ask a colleague for their thoughts, call a Specialist and ask for advice - and then decide if we feel we can offer that treatment. it is stressful and a lonely business doing a surgery you have never done before, but that does not mean it should not be done ever. Even Specialists will be doing procedures they have never done before, and we do exactly the same preparation and research as the primary care vet does before they try something new. And so long as you have informed owner consent and you understand what peri operative and post operative care that patient will need and are fully prepared, then there are many situations where it is OK to go ahead and do a procedure for the first time. That goes for the bitch spey, cesarean, GDV etc. etc. I have had 1cm mast cell tumours referred to me (on the flank of a retriever) and I have no idea why that patient has been referred. If you can demonstrate that you sought advice, did your homework and had informed owner consent, you are not being "negligent" by not referring a case. If you are taking care to document all that you are doing to prepare the owner, patient, surgeon then you are providing reasonable care - and contextualised care is just this. Looking at the circumstances that are in front of you at that moment in time.

RE: Do you think it's OK to 'have a go' at surgery any more?

janine redman — Thu, 16 Apr 2026 22:53:55 GMT

There is always the first spay , the first neuter , the first enucleation, the first dental extraction. No mass removal,is the same either and 30 + years in some ovariohysterectomy patients are more tricky than others . You certainly cannot refer all caesarean sections and there has to be a first one of those to !
it was easier in the 90s because referral options were so limited but I used to pin cats legs often monthly , learnt to plate simple fractures , even though I am not orthopaedically inclined . If something needed doing you researched it and worked on the basis of first principles . Even now I am tweaking some surgical procedures like enucleation. Gary England taught me my first approach back in 1988 !
someone on VV asked about referral,and CT for a rabbit which needed incisor extraction. I have been doing those since the early 90s and whilst CT is nice it’s not essential. As long as patient welfare isn’t compromised surely if the client is presented with options and its within your skill set, there should be encouragement to expand surgical skills.

Femoral head and neck excisions are another issue in cats , I have done several , including my parents cat . Are they tricky , yes , but with anatomical knowledge a reasonable surgical skill set , perhaps cadaver practice and a good you tube video they can be attempted . I even did a bilateral op on a young golden retriever back in the early 90s .

contexualised care is what I have always practiced , treat the owner / pet in front of you and be open about what you can or can’t do

RE: Do you think it's OK to 'have a go' at surgery any more?

Dinu Catilina — Thu, 16 Apr 2026 12:56:47 GMT

You are of course right Alasdair, having a bash once and never again is not the way. Unfortunately, what I sometimes see is that doing something for the first time is classed as giving it a go or having a bash even though you could be well prepared and reasonably competent in similar procedures.

I heard of intestinal foreign bodies being referred. TECA is for many a specialist only procedure. Multiple practices don't have a single vet who can do a lateral suture and that's not orthopaedic surgery. It's probably easier than spaying a bitch.

I also heard that if there is someone doing the procedure better then we should refer. In absolute terms this means further deskill. And at what point is the better relevant for most patients? I do 1-2 TPLOs a week. I am certainly not as good as a specialist who did hundreds and hundreds. Should I refer them all?

RE: Do you think it's OK to 'have a go' at surgery any more?

Alasdair Hotston Moore — Thu, 16 Apr 2026 07:29:21 GMT

[quote userid="5408" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248690#248690"]I did my first TECA-LBO in 1992 after watching an In Practice VHS video (I think it was Stuart Carmichael doing the surgery ). Admittedly, my incidence of facial nerve paralysis and draining tracts was higher in the first few years than it is now, but after performing the surgery on over 400 cases [/quote]

This is a key point. You didn’t didn’t do one TECA and not another ever. You did the first one and then learnt to master the procedure. I see this as different from someone having a bash when they’ll never do enough to develop the tricks to mastery.

RE: Do you think it's OK to 'have a go' at surgery any more?

David Bentley — Wed, 15 Apr 2026 21:09:39 GMT

I feel sorry for the current crop of graduates who never get the chance to do much more than basic surgery, as anything more complicated than a lumpectomy or neutering ends up being referrred . When I qualified there were no referral practices and once you had reasonable experience on how to handle tissue, if a patient needed an operation you had never done before, you would read your surgical textbook, discuss with the owner and more often than not they would trust you do your best and more often than not, the outcomes were good.

I had a persistent right aortic arch in a 12 week pup about 10 years ago (the first in my career) which I operated on with an excellent outcome. During the surgery, my assistant vet came in and asked if I was operating on it because it wasn’t insured- my answer was that it was insured, but the surgery isn’t too complicated and I was happy that I could do it despite never having performed the surgery before. My assistant was quite surprised, thinking that I should have referred it because it was insured.

I did my first TECA-LBO in 1992 after watching an In Practice VHS video (I think it was Stuart Carmichael doing the surgery ). Admittedly, my incidence of facial nerve paralysis and draining tracts was higher in the first few years than it is now, but after performing the surgery on over 400 cases I am proud of the fact that my complication rate over the last 20 years is less than in the published literature. We all have learn in the beginning and I feel that with the attitude of referring nearly everything and being a wage slave for a corporate, the job satisfaction and professional satisfaction of being a vet today is far less that it has been for me.

RE: Do you think it's OK to 'have a go' at surgery any more?

Alasdair Hotston Moore — Wed, 15 Apr 2026 13:50:43 GMT

[quote userid="9239" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248679#248679"]Holy Trinity[/quote]

I don’t see that as the Holy Trinity. As an example, if a TPLO isn’t right in one circumstance then a lateral suture might be

having a go means different things to different people. I wouldn’t have a go at a Y fracture myself. Not my skill set. Significant risk of poor outcome. But I’ve seen untrained vets have a go at them for two or three hours and I think it’s a bad idea

RE: Do you think it's OK to 'have a go' at surgery any more?

Dinu Catilina — Wed, 15 Apr 2026 13:33:27 GMT

[quote userid="8663" url="~/f/clinical-questions/31341/do-you-think-it-s-ok-to-have-a-go-at-surgery-any-more/248675#248675"]right procedure, right surgeon, right place[/quote]

Yes but we keep forgetting that we are not health care providers, we look after animals, and the Holy Trinity above does not take cost in consideration.

What does having a go mean? If I read some books, some articles and watch a couple of webinars before doing a procedure, is it really just having a go?

RE: Do you think it's OK to 'have a go' at surgery any more?

Alasdair Hotston Moore — Wed, 15 Apr 2026 10:20:25 GMT

Times have changed of course. Contextualised care includes on site options (DIY, peripatetic service), referral within the business or outside.

Is 'have a go' acceptable? Yes and no. yes if the client has been given the chance to give truly informed consent: the level of experience and support on site, the reason for this choice and what they should consider in a accepting it.

I'd rather look at either from the patient's end using the phrase:

right procedure, right surgeon, right place

Part of referral is actually about the first question (what to do here) and that is forgotten as much as the rest of it

RE: Do you think it's OK to 'have a go' at surgery any more?

Lesley Strong — Tue, 14 Apr 2026 15:09:42 GMT

Def see much less appetite for trying something unfamiliar but I can undrtstand it to a degree especially the worry over being sued or crucified on social media.

I also think the big groups also "encourage" people to use their referral hospitals or peripatetic surgeons

40 years the options were v limited unless you had a Vet School nearbye or wanted to travel hundreds of miles to Willows or Dick White. Now there are referral places on every street corner and vastly more insured clients

But clients had lower expectations and seemed more able to accept"sub optimal" outcomes like a slightly wonky fracture repair that was none the less a functional limb

I also worked on an island so it was give it a go or a trip to the West Country. We had to take our xray plates to the local General hospital to be developed and did caesars under Immobilon with the owners doing the anaesthetic!!

Amazing how often it didnt go wrong and owners thrilled

RE: Do you think it's OK to 'have a go' at surgery any more?

Rhona Campbell — Tue, 14 Apr 2026 12:04:35 GMT

I'm on an island, 3 hours away from some referral options and 5 hours away from the rest. We do have a bridge. I also used to work on another island when referral options were the veterinary school (ie before the advent of referral practices.). You had to get a ferry and we had no XRay or ultrasound let alone other fancier equipment. This honed my palpation skills (though I would have liked XRay...) I did pinnings for bone #s there.

Cost has always been an issue re referral of uninsured animals...So being a 1985 grad I have had a go on many occasions, my fave success being a successful fixation of a lateral condylar fracture of the humerus in a working collie which still works on the hill 10 years later! I was talked through that one by a vet friend who is a vet orthopaedic specialist.

I have recently become aware of an organisation called VVS which is offering specialist support for vets in practice on a per case basis. I am interested in this and so have no financial declarations in mentioning them here!

www.vvs

RE: Do you think it's OK to 'have a go' at surgery any more?

david kemp — Tue, 14 Apr 2026 11:23:04 GMT

If referral is an island that clients do not want to or cannot reach then some treatment is better than no treatment. Informed consenting adults making a choice-isn’t that what “contextualised care is all about.