Some people can’t walk and chew gum at the same time.
Then, there are highly skilled surgeons who can perform complex and risky procedures on two patients, in two separate operating rooms, over the same scheduled time period.
It’s called concurrent surgery, and how it plays out at Massachusetts General Hospital was detailed in an extensive Globe Spotlight Team report. The Globe investigation, which focused on specific malpractice litigation, revealed that double-booked surgery is accepted practice at MGH. Surprisingly, there’s no obligation to tell the patient that it will be happening — even though some top medical professionals question the ethics of it all.
The MGH response to the findings also showcased an institution sorely in need of an antidote to arrogance. “We haven’t found a single case where the concurrency has caused harm, so I don’t think patients should be alarmed by it,” Dr. Peter Slavin, Mass. General’s president, told the Globe.
If that’s the case, why not tell patients about it, so they can give truly informed consent?
Maybe this is why: Some patients would not sign off if they knew their surgeon was dashing between ORs during spinal cord operations. As a matter of math, that would reduce double-bookings, and with it,
According to the Spotlight report, only 3 percent of MGH surgeries — about 1,000 a year — involve “procedural overlap,” where there is one patient with an open incision while surgery on a second patient is underway. But the report, which focuses on orthopedic cases, also notes the “business-like approach” of Dr. Harry Rubash, the department head since 1998, who “introduced an incentive system that paid doctors more if they generated more profits.”
As the Globe also reported, the orthopedics department has one of the highest rates of concurrent surgery at MGH: One quarter of all orthopedic surgical procedures have some overlap, compared to 15 percent hospital-wide. According to Rubash, concurrent surgeries did not become more common during his tenure, but other doctors told the Globe they did.
The practice sparked a heated debate, led by Dr. Dennis Burke, a star orthopedic surgeon who battled against double-booking. Others also expressed concern, including a group of anesthesiologists.
Burke no longer works at MGH; he was terminated for violating hospital policy after providing (redacted) patient records to reporters. As of 2012, MGH updated its overlapping surgery policy, which the hospital calls “one of the strongest” in the country. Yet disclosure to patients remains a case-by-case call, made at the surgeon’s discretion.
That should change. Even with an understanding they are not the sole focus, some patients will stick with a surgeon they trust. But every patient should have that choice, and that choice is possible only with full knowledge of what to expect from the attending surgeon.
Doing two things at once, like texting and driving, can be bad for your health and for others around you. But for highly skilled professionals, some multitasking is acceptable.
Still, if you’re Whitey Bulger, do you want to be represented by lawyers who are dashing between courtrooms as they simultaneously represent another accused serial murderer? If you’re Dzhokhar Tsarnaev, do you want to share defenders while you are facing the death penalty? If you do, you will at least know it’s happening. Unlike the OR, a courtroom is open to the public, from opening argument to verdict.
How far should doctors push the envelope, given the stakes? Is it really worth the extra money to have people wonder if billable hours in the operating room now take priority over patient care?
That’s the real question for MGH. In the meantime, patients should at least know their attending surgeon may also be attending someone else.