A study by researchers at the Beth Israel Deaconess Medical Center and Harvard Medical School in the US has found that most patients are unaware that surgeons sometimes perform overlapping operations, and may object to it if they knew.

This opens up a discussion of whether doctors should inform their patients about such a common practice.

The study surveyed participants about their knowledge of overlapping surgery, their expectations regarding disclosure during the informed consent process and their willingness to have this type of surgery as a patient.

Only about 4% had heard of overlapping surgery

The vast majority of participants – 96% - of the 1,454 people surveyed for the study had never heard of overlapping surgery, while just 31% strongly supported the practice once it was explained. Nearly all of the participants thought that patients should be told before surgery the exact roles of the surgeons and assistants assigned for the operation.

When asked specifically about assistants or trainees, 86% of participants thought patients should be told who would be in the operating room prior to the surgery, and 84% thought the precise role of trainees should be disclosed.

"Surgeons should discuss overlapping surgery with patients beforehand and obtain their consent if this is part of their practice," said lead author Michael Kent.

The study expounded how once overlapping surgery was described, 70% of participants thought the practice might be acceptable in certain circumstances, such as lower-risk procedures or in situations when an emergency occurred in another operating room.

The study chose not to focus on concurrent surgery as it is less widely accepted and practiced by surgeons.

There is no law enforcement to dictate that doctors inform their patients

The respondents from the survey did understand the advantages of overlapping procedures such as increased efficiencies, reduced patient wait times and expand patient access to in-demand surgeons.

"They also understand that complications may occur when a surgeon's attention is divided, and this may have an impact on patient safety," said Kent.

James Rickert, president of the Society for Patient Centered Orthopedics, says that if patients are asked to consent to overlapping surgery, then it would only be done on the day of the surgery.

They are therefore likely to feel compelled to sign because so much has been put into motion. For example, the patient may have taken time off work and had their family bought in.

"I don't think it's fair. At that point, what are they to do?" he said.

Instead, Rickert believes patients should be informed that the physician may leave the room, "as soon as discussion of possible surgery begins" to give patients a chance to select another physician if they wish.

Informing patients: A moral obligation?

Patients are usually not informed because many would not agree to it if they knew their surgeon was dashing in and out between operations. In places where surgeons are paid per procedure, this would reduce their earning potential.

Even with an understanding of overlapping surgery, some patients may intend to stick with a surgeon they trust. However, every patient should have that choice, and that choice is possible only with full knowledge of what to expect from the attending surgeon.

Patients have a fundamental right to know who they have entrusted their care to, especially in such a vulnerable situation. Physicians as well have an obligation to be honest, regardless of whether it complicates the surgery schedule.

Otherwise, patients may struggle to trust doctors in future operations whereas future patients may have a nagging concern that the lead surgeon will not be present throughout their procedure. MIMS

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