October was not a good month for Massachusetts General Hospital. A group of MGH anesthesiologists published a study showing that about half of the patients operated on in that institution suffer a medication error.
But the big blockbuster was a Boston Globe exposé highlighting some adverse patient outcomes associated with a single surgeon operating on two or possibly three patients at the same time.
The issue is not simply staggering the starts of operations—an acceptable practice, but rather concurrently performing multiple complex spine procedures.
The article described a concerned orthopedist’s attempt to convince the MGH administration to halt concurrent or double booked surgery. That orthopedist was vilified and eventually forced out of the hospital.
The justification for double booking was that a spine surgeon who was a “star” needed to get all of his cases done, and the only way to make that happen was to have them occur simultaneously by delegating some portions of each operation to fellows or residents.
The article brought several questions to mind. Is there no one else in Boston, a Mecca of sophisticated medicine, capable of doing major spine surgery? Does an orthopedist need to make $73,000 in one day, which was allegedly what the spine surgeon collected for three procedures? What happens when the star surgeon leaves for a job in another city, which he did? Someone else (or maybe several other surgeons) must have picked up the slack.
“Does an orthopedist need to make $73,000 in one day, which was allegedly what the spine surgeon collected for three procedures?”
Dr. John Mandrola, blogging on Medscape, summarized the Globe piece and offered a dim view of the goings-on at MGH. One of his concerns was that involved patients were not told of the simultaneous cases or the level of participation of others in their operations.
According to the Globe, double booking has been going on for years. Last October, MGH attempted to address the situation. The following sentence now appears in its more than 500 word consent form:
“My doctor or an attending designee will be present for all the critical parts of the procedure/surgery, although other medical professionals may perform some aspects of the procedure as my doctor or the attending designee deems appropriate.”
You may want to read that again to make sure you understand it.
One wonders whether an unsophisticated patient would comprehend it. And why would any patient sign a consent form that gives his attending surgeon permission to designate another attending surgeon, who the patient has possibly never met, to be his substitute “for all the critical parts of the procedure/surgery”?
That seems like quite a bit of leeway to me.
At a time when surgeons are experiencing intense scrutiny regarding complications, double booking cases at one of the most prestigious hospitals in the country is troubling.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.