The Surgeon's Schedule: Cutting on More Than One Patient at the Same Time: It's Done but Is It Ethical? (AMA Report 8)
I thought I would move on to an informational report in this series of reports by the the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association.(See the last 4 threads.) It is Report #8-Surgeon’s Attendance During Surgery
It seems that it is common surgical practice for surgeons, especially in teaching institutions, to schedule more than one surgery under their name and all at the same time but to participate not fully in any of them. The Report states:
At its 2007 Annual Meeting, the American Medical Association (AMA) House of Delegates adopted Resolution 16, “Surgeons’ Attendance During Surgery.” This resolution asks that the AMA design policy that requires operating surgeons to “post their surgical cases so that they are actually physically present in the operating room performing or supervising their surgical cases during the majority of the case and during all crucial or essential phases of the surgical procedure.” After discussion with the sponsors of the resolution (the District of Columbia Delegation) and for reasons set forth below, the Council on Ethical and Judicial Affairs (CEJA) has decided that its current policy addresses the issues raised by the resolution.
The resolution is primarily concerned with the effect on the patient-physician relationship when a physician has 2 or more cases posted at the same time. Clearly, the physician cannot be present for the entirety of both cases. The absence of the surgeon from portions or all of a procedure without a patient’s knowledge and consent may have a negative impact on patient trust as well as safety.
However, current CEJA Opinion E-8.16, “Substitution of Surgeon without Patient’s Knowledge or Consent,” addresses these concerns. This policy states that “a surgeon who allows a substitute to operate on his or her patient without the patient’s knowledge and consent is deceitful.” In general, a physician should provide participatory supervision if aspects of the procedure are delegated to residents or other physicians. If a resident or other physician performs the procedure under non-participatory supervision, the patient should be fully informed of this fact.
It is unethical for physicians to post 2 or more cases (ie, not fully participate in any of the cases) without the informed consent of the patient. The Council believes that this Opinion fully answers the directive of the resolution and sees no need for additional ethics policy on this matter.
Well, are all my visitors, all being potential surgical patients, satisfied with the Council’s conclusion? ..Maurice.