PROFESSIONMiddle-of-the-night elective surgeries: First do no harmEthics Forum. May 5, 2003. Scenario: Whose job is it to decide when postponement has gone on too long? It is 2 a.m. in a large regional hospital. A patient has been waiting since midday for a gastric bypass operation for morbid obesity. The surgeon, who has been operating nonstop for19 hours, wants to begin the gastric bypass. The operating room nursing team says they can cover it. The patient has been NPO for over 24 hours and wants the surgery done. The one in-house attending anesthesiologist is also responsible for obstetric coverage and for emergent/urgent intubations throughout the hospital. Should the anesthesiologist begin the case or tell the surgeon and patient that it must be put off until there is a full OR staff in case of trouble? Reply: This complicated scenario is faced not infrequently in the business-oriented medical milieu in which surgeons now work. The surgeon must consider the primary duty to serve the patient, the duty to himself or herself, and the duty to the medical institution. Let's look at the problem from the points of view of all of those involved. From the patient's point of view, this has been a bad day. The patient, who suffers an eating disorder, has fasted and probably been "bowel-prepped," and has now waited until the middle of the night for the procedure to start. She will be distressed and confused, as will her family. Any suggestion to postpone will no doubt result in more distress, if not outright anger. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2003 American Medical Association. All rights reserved.
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