Last week the Massachusetts Board of Registration in Medicine ruled that surgeons must chart every time they enter and leave an operating room and who took over for them when they were absent.

BostonMagazine.com reported that surgeons must also tell patients the names of all “participating physician extenders including residents, fellows, and physicians [sic] assistants.” The article went on to say, “Some of the regulations may be prompted by surgeons at teaching hospitals operating on more than one patient at a time, giving students the chance to step in, which, I’m sure as you can imagine, can cause some complications—especially without patient consent.”

[Digression: Regarding the rather awkward 43-word sentence above, I am surprised that a health reporter does not know the difference between a student and a resident.]

The issue of surgeon double booking or overlapping cases was the subject of a 2016 Boston Globe exposé. One such case involved a former major league baseball player who allegedly was injured during a spine operation. He received a$5.1 million settlement from the Massachusetts General Hospital. The hospital’s position was that the poor outcome did not occur because of the surgeon leaving the room, but they paid anyway.

As you might guess, all research on the outcomes of overlapping cases is retrospective, and there are conflicting results.

The rules were criticized by a representative of the Conference of Boston Teaching Hospitals as being burdensome and impractical without going into detail.

With the help of Twitter, here is my take.

The rule that patients must be told who is assisting the surgeon raises important questions. What happens when a resident has worked her allotted hours and must scrub out of a case? Should the patient be awakened and introduced to her replacement?

Surgeons may have to leave an OR for a number of reasons such as to go to the restroom, to eat something or get a drink of water, to view a pathologic specimen under a microscope, to help another surgeon with a life-threatening problem. Do they really need to sign in or out? Will they need a “hall pass”?

How will compliance with this rule be monitored? Will the circulating nurse be responsible for reminding the surgeons to document their goings and comings and who is in charge? On Twitter, @RickvanRijn wondered if managers and auditors would be hired and committees established? “What next, GPS tracking?” asked @CanesDavid.

@schnitzb took it a step further suggesting that all surgeons wear body cameras. I pointed out that cameras would have to be placed on heads because sterile gowns are worn in the operating room.

Cameras in the operating room raise a number of issues. Who pays for and maintains them? Who owns the videos? What about storing them? Are they part of the patient’s chart? How long should they be kept? Will they be leaked to the Internet? What about patient privacy issues like the situation at a hospital in San Diego where female patients were recorded without their knowledge?

@OverTheWire_IR lamented the loss of trust in physicians. He suggests we have been reduced to “Let us know when you go peepee, doctor, and make sure to wash your hands.”

 

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 a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 19,000 followers on Twitter

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