When you go to the hospital for a surgical procedure, you expect that your surgeon will be devoting his or her total attention on your operation. But in fact, part of the surgery may be performed by surgeons-in-training, known as residents and fellows. Or the surgeon may be engaging in a practice called “concurrent surgery” – which means doing two surgeries at the same time.
This past September, my mother and I sat anxiously in the hospital waiting room while my father was having surgery to implant a stent in his leg. About two hours into the surgery, the surgeon came out and told us my father was doing great, that the fellow was “closing him up,” and that he would be transferred to the post-op room in a few minutes. Three hours later my father was still in surgery. The surgeon finally came back out to tell us that there had been a complication – the fellow had run into difficulty removing the guide wire from the stent (an almost unheard-of complication). As a result, they had to open him up and do a complete bypass of the femoral artery. Three months later – after multiple complications and two more major surgeries - my father is just now beginning to recover.
New surgeons of course have to be trained in their craft, and my family knew my father was having his surgery at a teaching hospital. But we never asked the right questions to know in advance whether any residents or fellows would be performing surgery on my father and – if they were – whether the surgeon would be right there next to them making sure everything was done correctly.
“Concurrent surgery” is a worrisome practice that is receiving increasing scrutiny. This involves a doctor performing surgery on two different patients - in two different operating rooms - at the same time, moving back and forth from one operating room to the other and relying on assistance from general surgeons or trainees. A recent article in the Boston Globe revealed the results of their investigation about this practice at Massachusetts General Hospital.
There is an ongoing debate in the medical community over the ethics and safety of double-booking operations. Hospitals maintain that this practice allows for greater efficiency and faster access to the sought-after surgeons who might have long wait lists. (This also enables hospitals to bill the full amount for both procedures during a single time period.) Within the medical community, two serious concerns have been raised: 1. Whether patient safety is affected by this practice; and 2. Whether patients have given their informed consent for this practice.
Patients and their family members must be advocates in the medical setting. Don’t be afraid to ask your doctor direct questions about who will be performing the surgery and whether the surgeon will be present for the entire surgery. Also ask, especially if the surgery is scheduled for late in the day, how many other surgeries the surgeon has scheduled that day. I cannot imagine the concentration it takes – and how exhausting it must be – to perform surgery after surgery throughout an entire day. The bottom line: Ask questions, show your concern, and let the surgeon know that you expect to be fully informed about all aspects of the procedure.