Overlapping surgery has been controversial since it first ended up in the headlines two years ago and health professionals need to take steps to restore patient trust in the practice, according to a doctor and lawyer.
But that will require several actions by both doctors and hospitals, wrote Michelle M. Mello, J.D., Ph.D., of Stanford Law School, and Edward H. Livingston, M.D., of the Department of Surgery at the UT Southwestern School of Medicine in Dallas, in a viewpoint piece for JAMA.
They differentiated the practice of overlapping surgery from concurrent surgeries. In overlapping surgery, operations are performed by the same primary surgeon, with the start of one surgery overlapping with the end of another. A qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery. But during concurrent surgeries, the critical parts of operations that require the primary surgeon occur during the same time.
One recent study found that 69% of 1,454 patients opposed overlapping surgeries and 44% said they would not have chosen a surgeon had they known that they were scheduled for overlapping procedures. So how can doctors change that negative perception on the part of many patients? Mello and Livingston say the following three actions must happen:
1. Researchers must perform stronger, prospective observational studies and randomized studies to demonstrate the safety of such surgeries.
2 .Doctors must fully inform patients about scheduling practices well ahead of a surgery. They should disclose the likelihood that the operation will involve an overlap, a description of who will perform which parts of the operation and what their qualifications are. They should also tell patients their options if they object to the practice. Patients must have the right to decide to have surgery at another hospital or at a later time, they wrote.
3. Hospitals must ensure that surgeons fulfill the responsibility to patients to personally perform the critical parts of an operation. “Abdication of this responsibility constitutes noncompliance with federal billing regulations. More importantly, it exposes patients to unacceptable risk,” they said.
Doctors have not always disclosed the practice to patients. A Seattle-area health system was double-booking surgical procedures unbeknownst to the patients being treated, according to a report earlier this year. Some of the top neurological and spine surgeons at Swedish Health ran multiple operating rooms at a time, leaving less experienced doctors who have undergone specialized training to handle parts of the procedure. Patients were kept in the dark about the practice.