Will Your Surgeon Be Double-Booked?

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There are many dirty little secrets in the world of medicine that are not shared with patients.  One of them was recently the subject of a thorough discussion in the Washington Post.  It is the practice of some surgeons to schedule two surgeries at the same time and to move from operating room to operating room while allowing a resident to perform the operation while the surgeon is gone.  Not surprisingly, most patients reasonably expect the surgeon whom they have chosen to perform their operation to be in the room while the surgery is ongoing.  Unless trouble develops patients of surgeons who are double-booked rarely learn that their surgeon has left the room.

The practice of double booking or running concurrent surgeries occurs at teaching hospitals, of which there are about 1,000 in the United States.  Surgery residents are doctors at teaching hospitals who have completed medical school and who are now enrolled in what are usually three year programs where they learn the skills needed to be a surgeon. During the residency, the residents will perform surgeries under the supervision of the primary surgeon.  As the resident develops more skill and has more experience, he or she will be given more to do during the surgery.  At all times, however, the primary surgeon should be present to watch and teach and to address any emergencies which may develop.

Surgeons who defend the practice of double booking claim that it is important to train the next generation of surgeons and that patient safety is not compromised.  The latter contention is not one on which there is general agreement.  Some studies have found an increase in poor patient outcomes (think surgical errors causing death or injury) while others have found little difference in outcomes. Those who oppose the practice note that it occurs for the convenience and financial benefit of the primary surgeon. They also note that it likely would not happen if the patient were not asleep.

Many hospitals which permit double booking are now requiring that patients give specific permission for the practice and that they give that permission at least a week or two before the surgery.  These hospitals disapprove of the practice of including language about double booking in the paperwork presented to a patient on the morning of surgery when the patient is unlikely to notice the language, unlikely to appreciate what it means and would be reluctant to refuse to go forward with the surgery, if they disapproved.

As a patient, you should discuss with your surgeon whether he or she will be physically present in the operating room during your surgery.  Ask about it when you meet the surgeon for the first time and are deciding whether this is the surgeon you want performing your surgery.  Write it on the consent forms.  If the surgeon tells you that he or she will be “immediately available,” you should ask what that means and refuse to use that surgeon, if it means they will not be in the room with you the entire time.  As more than one doctor has noted, double booking is not something that happens to the spouse or family member of a surgeon because surgeons would never tolerate that for their families.  You deserve every bit as good a care as the family member of a surgeon.  Be sure you get it.

Posted in disclosure of medical mistakes, Health Care Costs, Informed Consent, medical errors, medical ethics, medical mistakes, Secrecy, Surgical Errors |