Editorials

editorial

Patients owed full disclosure on concurrent surgeries

Patients who opt for surgery at Massachusetts General Hospital make some basic assumptions, beginning with the expectation they will receive some of the finest medical care available anywhere in world. They should, however, also be able to trust that the doctor signed up to perform the operation will be present during the full procedure — unless they are explicitly told otherwise.

A Boston Globe Spotlight Team report published Sunday found that is not always the case at the Harvard-affiliated Boston teaching hospital, or at some other medical centers around the country. A small percentage of MGH surgeries are carried out concurrently, meaning the same doctor is involved in overlapping procedures taking place in different rooms. According to the hospital, the attending surgeon is always involved in the most important aspects of each operation, and patients are not put at added risk.

Double-booking is intended to improve efficiency, give more patients access to specialists who are in high demand, and allow doctors in training to get invaluable real-time experience. In recent years, the practice has sparked internal debate at MGH and hospitals in other cities. Concurrent surgeries also have led to lawsuits from patients who allege malpractice, claiming they did not know their doctor would be performing overlapping operations.

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MGH, which is owned by Partners HealthCare, says its analysis of orthopedic procedures over a two-year period found concurrent surgeries were just as safe as those in which the surgeon was not double-booked. An inspection at the hospital conducted by the state Department of Public Health also did not find anything troubling. In a letter posted on the hospital’s website, two top executives — Peter L. Slavin, its president, and Thomas J. Lynch, chief executive of the Massachusetts General Physicians Organization — said that, after external review, MGH’s overlapping policy “is considered one of the strongest in the nation.”

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Some doctors and other medical professionals still question whether concurrent surgery constitutes “best practice,” and the courts have yet to weigh in on the validity of several related lawsuits.

There should, though, be consensus on one aspect of double-booked surgery — patients must be told about it in advance. Such a disclosure is not mandatory at MGH. A spokeswoman said doctors are “encouraged and expected” to tell patients if they expect to be involved in operations that overlap. That kind of language leaves too much room for interpretation. The consent form patients sign prior to surgery is similarly vague. It says “other medical professionals may perform some aspects” of a procedure.

It’s understandable why hospitals may be reluctant to make advance consent a condition of double-booked surgeries — given a choice, few people would agree to let their surgeon shuttle between operating rooms, effectively ending the practice. But patients have a fundamental right to know who they have entrusted their care to — especially at such vulnerable moment — and physicians have an obligation to be candid, regardless of whether it complicates the surgery schedule.