Ethics Corner

Kamal Ibrahim, MD, FRCS(C), MA
Ethics and Professionalism Committee Chair

The committee publishes, in each issue of the newsletter, a case of possible ethical or professionalism dilemma and invites members to send their comments. Please send your comments to [email protected]. The committee will collect all responses, summarize and publish them in the subsequent newsletter.

In this issue Robert Tuten, MD presents an ethical dilemma that could be faced by any surgeon and was not previously explored.

Dr. Smith and Dr. Jones had a conversation at the monthly Pediatric Orthopaedic Surgery Journal Club meeting in their town. They both have had a similar experience. A 13-year-old patient with a 35-degree curve has traveled out of state for a second opinion to a prestigious medical institution. Both patients were told the curve had increased dramatically in one month and a posterior spinal fusion was necessary. Both families were strongly encouraged to schedule surgery as soon as possible at this prestigious institution prior to heading home. Both families returned to their hometown scared and confused. When the hometown surgeon repeated the X-rays in their clinics (the prestigious institution would not send their X-rays), the large curve could not be reproduced. The focus of primary concern are the professional issues involved:

1.  Is this behavior acceptable?

2.  How should a situation like this be handled?

 If you have had a similar experience please tell us how did you handle it

Please send comments to [email protected], which will be archived and published in this “Ethics corner” Sept 2017 issue

Comments from some of the Ethics Committee members:

• If the family signs a release of information document, I believe the institution is legally obligated to release the X-rays.  At the very least, the family should have the ability to obtain the X-rays themselves and bring them for review.  If the X-rays show a non-operative curve, it would not be unreasonable to get the family's permission to discuss the case with the other physician to elicit his/her line of thinking.  If it still seems that an inappropriate decision was made and the other surgeon does not acknowledge it, then other avenues to address a departure from the standard of care would be the other surgeon's Division Chair/Department Head or even at the professional society level, such as the SRS.
• I don’t believe as an individual physician you should pursue this with the other surgeon who recommended inappropriate surgery. This should be dealt with through the SRS and/or AAOS ethics mechanism. As upset and strongly as one may feel about the situation, you could put yourself in potential legal trouble. This is best left to an organization and its professional standards to initiate an investigation
• I agree with you. To clarify, communicating with the other physician is not about confronting them. It's about establishing his/her thought process. Theoretically, there's a remote possibility this could be ignorance rather than malicious disregard for standard of care. If it seems there is willful negligence on the other surgeon's part, then these other mechanisms ……..so far, we're only going on what the family has told us. I think it might be prudent to get all sides of the story without casting any blame on anyone.
• …….This is a difficult problem and is a scenario we've all witnessed first hand at least a time or two in our careers. It is incumbent for the hospitals granting surgical privileges to monitor via peer review the performance of its physicians, seek appropriate external consultation and impose disciplinary action as needed

Chair: Kamal N. Ibrahim, MD, FRCS(C), MA Committee: John P. Lubicky, MD; Hilali Noordeen, FRCS; Brent D. Adams, MD, Jason Bernard, MD, FRCSorth, MBchB; Ryan D. Muchow, MD; Timothy S. Oswald, MD; James M. Eule, MD; Timothy A. Garvey, MD; H. Robert Tuten, MD; B. Stephens Richards III, MD; Jochen P. Son-Hing, MD, FRCSC