Ethics Corner

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

Is this an ethical issue? The committee publishes in each issue of the newsletter a case for a possible ethical conflict and invites members to send their comments. John Lubicky, MD, wrote the ethical question for this issue. Please send your comments to [email protected]. The committee will collect all responses, summarize and publish them in the next newsletter.

ETHICAL QUESTION

Recently, The Boston Globe ran an extensive article on the issue of concurrent surgery in one of the country’s most famous and prestigious hospitals. It related the story of one orthopedic surgeon’s routine use of such a practice, presumably condoned or at least permitted by that hospital. Unfortunately, the report recounts one day’s schedule of this surgeon during which two rather complicated cases were ongoing simultaneously and during which one patient suffered a serious complication. It raised the question of whether this practice is ethical and/or safe. It also brings up issues of informed consent and professionalism. Administrators of other hospitals that allow this practice must have been shocked by this exposé and alarmed about the possible repercussions that might arise from this article in the media. However, that article also relates how this is an efficient and effective use of a busy surgeon, minimizing down time, and maximizing throughput of patients thus providing care to more patients. Surely federal, state and private regulatory entities took notice of this report and are probably poised to impose new sanctions, documentation, and penalties on those involved in this practice. Elimination or severely curtailing the practice would certainly have a significant impact on hospitals that currently allow it.

Dr. X is a busy spine and trauma surgeon. On one of his OR block days, he has two ORs available to him. In one room, he typically schedules several elective spine and trauma cases and in the other, he places incoming or leftover trauma cases. He bounces back and forth between the rooms allowing the residents or fellow to position and start cases in one room while he supervises/performs the critical parts of cases in the other. In between, he goes to the pre-op area, signs the site, and greets the subsequent patients. While he does not specifically explain the operating arrangements, i.e. “concurrent surgeries in which trainees will be doing significant portions of their surgery without him being physically present for the entire procedures”, his patients do know that they are at a teaching hospital and that trainees will be participating in their care (whether they truly understand that concept or not). To be fair, the cases are generally staggered rather than truly concurrent in the usual sense, but this arrangement makes for great efficiency allowing him to complete 10 or more cases in a day though the operating day may last into the evening before all cases are completed.

Although this arrangement has been working well for many years and has not been a source of patient complaints or malpractice issues, is this practice ethical? Or, should he be required to have a more formal disclosure of this practice?

Please send your opinion to [email protected]. The committee will review all responses and publish their summary in a subsequent newsletter.

Chair: Kamal N. Ibrahim, MD, FRCS(C), MA Committee: Brian G. Smith, MD; Oheneba Boachie-Adjei, MD; Paulo J.S. Ramos, MD; M. Wade Shrader, MD; John P. Lubicky, MD, FAAOS, FAAP; Hilali Noordeen, FRCS; Timothy S. Oswald, MD; James M. Eule, MD; Timothy A. Garvey, MD; H. Robert Tuten, MD