Calling out Teo was like killing Bambi, but my concerns were justified

Back in May 2019, I expressed concerns about the large numbers of patients of Dr Charlie Teo seeking donations to help pay for the costs of surgery on the crowdfunding site GoFundMe. I don’t think anybody could have predicted that, four years later, he would be found guilty of unsatisfactory professional conduct by the Health Care Complaints Commission.

I was drawn to browsing the GoFundMe site after I saw a TV news piece that drew attention to the plight of yet another child for whom donations were urgently needed to enable life-saving brain cancer surgery.

I remember finding it difficult to reconcile why in Australia – where universal healthcare exists through Medicare – so many desperate patients and their families would be seeking donations to pay for urgent brain cancer surgery from just one individual surgeon.

It is well recognised that if surgery is to be routinely allowed in public hospitals, it must have sufficient evidence to demonstrate that the balance of risk, benefit and cost can be justified.

It is not so well recognised that, should evidence be lacking, individual cases can be supported through discussion and recommendation by multidisciplinary cancer meetings or through clinical trials approved by hospital human research and ethics committees. These options are designed, in part, to ensure innovation is not stifled and boundaries can be pushed in the treatment of our patients.

But I certainly never expected the backlash that came with the publication of just two tweets that questioned the validity of surgery – as it did not appear to be permitted in the public hospital system – and the notable number of campaigns asking for donations specifically for surgery to be performed by Dr Teo.

These questions were not political in nature nor were they personally attacking Dr Teo. However, rationality fell to the winds and his fan base immediately took this to task with religious fervour. It was humbling to receive countless messages of support from numerous medical and nursing professionals who had been quietly concerned about the same matters I had raised or had expressed negative experiences in assisting in the care of his patients’ post-surgery. It did make me wonder why so many healthcare professionals would be so reluctant to publicly raise their concerns.

Curiously, I was told how brave I had been and I certainly came to understand what this meant. I quickly learnt that Dr Teo has an army of adulating fans, many of whom included high-profile members of the media and Australian sport and business. I had unwittingly committed a crime that was akin to killing Bambi and it was now abundantly clear why any comment interpreted as criticism of Dr Teo was to be avoided.

The surgery performed by Dr Teo is controversial. There are valid questions in his field about whether the risks are outweighed by the benefits and exactly how a positive or negative outcome is assessed. In particular, research outcomes that include patient-reported outcome measures and patient-reported experience measures would be essential.

I have always argued that surgeons who perform new procedures, or who push the boundaries for indications for surgery, have a professional duty to present their results for peer review and to share their experience. In June 2019, neurosurgeon Dr Graeme Brazenor pleaded with Dr Teo to allow an independent review of the outcomes of his last 100 cases. This did not happen. If Dr Teo were to present his results of operating on “inoperable” brain tumours, I genuinely believe that this could go a long way to earning the respect and support of his profession.

Criticising Charlie Teo was once considered to be brave, such was the ferocity of his fan base.Credit: Media-Mode

Since the professional misconduct finding, many healthcare workers have reached out to me and expressed relief that I had been vindicated for my original comments. But I don’t think there is anything to celebrate here.

Dr Teo had a lot to offer and I honestly lament that it has come to this. In his recent interview with Spotlight on 7News, he offered his own analysis of his professional demise. I have a different assessment of it, but I would totally reject his assertion that this is linked to him being Asian. Race has nothing to do with it. Coming from me is enough said on that.

Much of the focus of his support base is on his technical skills. As surgeons, we recognise that we could easily teach the majority of individuals with above-average fine-motor skills to perform complex robotic-assisted cancer surgery to a high level of technical competence.

But no amount of technical skill training can replace the ability to solve problems and the clinical judgment necessary in patient selection and encountering any variation as a result of individual anatomy or tumour characteristics during an operation.

Being a surgeon is much more than being skilful with the technical aspects of our craft. The Royal Australian College of Surgeons defines 10 surgical competencies of which technical skill is only one. When things go horribly bad in surgery, it’s not usually because of a lack of technical skill. Usually, it’s the non-technical skills such as collaboration and teamwork, professionalism, communication, leadership and management.

It is a list to which all surgeons must aspire.

Professor Henry Woo is an academic urological surgeon affiliated with the Australian National University.

The Opinion newsletter is a weekly wrap of views that will challenge, champion and inform your own. Sign up here.