But there are ethical considerations on the other side as well—many patients need surgery urgently. “As a head and neck cancer surgeon, I see lots of patients in clinic who need to get in the operating room,” said Dr. Langerman. “They’re sort of this ticking time bomb with their cancer, and we want to get them cared for. So it’s always a struggle: How can I care for as many patients as possible?”
Explore This IssueDecember 2016
He is working on a study on how to assess what it means for a step in a surgery to be “critical,” requiring the attending surgeon to be there. Until hard data exists, “attending judgment is the best we have,” he said. He underscored the importance of getting to know your trainees, leaving wiggle room in your schedule, and being honest with patients.
Influence of Increased Regulation
James Denneny, MD, executive vice president of the AAO-HNS, who stressed that he was speaking personally and not on behalf of the Academy or any other organization, said that the issue of overlapping surgeries is more important today than it was 20 years ago because of increased regulation, the push for quality and value, and other factors.
Risks associated with the practice include added stress for the physician, the possibility of unexpected problems in one or both rooms, the difficulty of accurate record keeping at the end of a long day of overlapping surgeries, physician fatigue, and potential confusion while moving from case to case. “If you’re doing 20 or 30 cases in a morning, it’s difficult sometimes to remember who’s who,” he said. “When I’m a patient, I want to know you know what my problem is.”
Patients are concerned that they’re paying for a particular surgeon to be there from start to finish, that the surgeon may not be available if something goes wrong, and that rushing can lead to mistakes and an increased risk of infection, especially if a surgeon isn’t careful about washing, said Dr. Denneny. If a surgeon chooses to perform overlapping surgeries, he added, the process should be transparent all the way through, the needs of a patient need to be evaluated individually, a qualified back-up should be identified in advance, and all demographics should be treated the same.
Thomas Collins is a freelance medical writer based in Florida.