The answer to "who's doing my surgery"?

[GreyhoundsRUs]

No way. I haven't read the thread, but it's my understanding - from both law school and DH - that the attending must be in the room for the "critical portion." What the "critical portion" actually consists of is less clear.


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That is my understanding as well. It also ties into billing, too.

[Ladybug]

My understanding is that they need to be present in the room, not sure about opening/closing. Just sent DH a text asking what the legal requirements are. Stay tuned...

[TulipsAndSunscreen]

Legally the attending must be in the room the whole time? I just find that interesting b/c at DH's training situation attendings would run 2-3 rooms at a time with a resident in each. They would time them in such a way that the attending was in each room at the vital time but the residents did the opening, closing, etc.

Yes. This. Especially for cysto, etc. They do the "time out" at the beginning and they move between all the rooms.

[Ladybug]

He still hasn't answered, hopefully because he's supervising a resident during surgery. Today is his OR day.

[JDAZ11]

He still hasn't answered, hopefully because he's supervising a resident during surgery. Today is his OR day.

Ha! Maybe!

Anyway, here DH is totally allowed to run two rooms at once. I know some people do more (and I don't know if that's technically ok), but honestly, there are only two angio-suites, and he doesn't really have the power to get his hands on more than one OR at a time. Except maybe on a weekend. It's a really huge group and a crazy busy hospital.

BUT like someone said above, he does need to be at the hospital. It's a really big deal if they aren't.


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[Ladybug]

DH just said it's complicated question and he'll tell me later. The next text said they're in meetings and he will be late. It feels like a conspiracy.

[peggyfromwastate]

Lol! I think for dh in his training years the attendings were supposed to be in the room. That was I believe the requirement for the whole time. The attendings only have one OR after all, and a resident to assist. If the case was very simple, sometimes the attending would sit in a corner and read or chart or something-- but stay in the room.

Dh I believe stays in the room every time through the whole thing except to step out briefly for phone calls/work questions. He never goes far and he's always closely watching everything. He caught mistakes for super simple procedures, so it's pretty important to him to be right there for the "critical" parts of the surgeries.

I'm curious now about Ladybugs' comment. He's very mysterious, isn't he?

[Deebs]

The issue of supervision is a licensing issue. In Ohio, residents are on a training license and supervision has a stricter requirement than Minnesota, for example. In the ED, that means every patient must be presented to an attending and the attending lay eyes on patient (though it varies from institution to institution as to whether or not that happens). In Minnesota, after intern year, residents can become independently licensed. Residents can moonlight with no attending on premises. It's not a piece of training, necessarily (the EM RRC requires direct supervision of residents, but moonlighting is allowed as long as it is separate and work hours aren't violated), but in terms of the legal aspect, less supervision is required.


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[Ladybug]

So DH said the attending is required to be present for the "time out" when patient is prepped, draped, gassed and a verbal summary of patient, gas and procedure is given. They are to be there for "critical" parts. DH stays there, but my start dictating or emails, see the next patient in pre-op while the resident does skin closing. He never talks to the family though until the patient has been extubated and moved to recovery. He agreed that each case and resident is different, but he's pretty much there and scrubbed until skin closing. I guess there's more leeway than I originally thought. I think in that past incident the surgeon never scrubbed in and just went around talking to everyone. He never stops talking....

[L.Jane]

I did ask the scheduler when I was setting the date to schedule me first thing, and preferably on a day when the surgeon was not on call the night before.

Slight tangent, but honestly, this is my biggest issue. Whether resident or long time attending I really don't want someone doing my surgery if they have had only 1 hour of sleep for the past 36 hours. And yet, this happens daily to patients who have no clue. And in a teaching hospital you have to be really careful with this because if the attending has a fellow, its the fellow who probably did the attending's middle of the night emergency surgery and is the one during the day running on 1 hour of sleep from the previous night because he or she takes the attending's call unless its something they don't feel they can handle.

[TulipsAndSunscreen]

Ladybug - that's actually what my Dh reported. Has to be there for timeout and surgery start and then the "critical parts".

[houseelf]

Great conversation. My advice on picking surgeons is to ask the anesthesiologists. They see it all and can tell the hacks from the good guys.

[alotofyarn]

Great conversation. My advice on picking surgeons is to ask the anesthesiologists. They see it all and can tell the hacks from the good guys.

This is also why the 3 urology wives who are moms have all been delivered by the same OB - they've never had to go repair anything that our OB has messed up.

[Sheherezade]

DH and I had a great conversation about this a few nights back. He agreed on what others have posted. The attending is required to be there when the patient is put to sleep as they confirm the procedure, etc. The surgeon is also required to document in notes WHAT they did specifically.

My husband does run two rooms at a time now. It's a little different for him because he's training fellows, not residents. He says that he lets the fellows operate more independently on benign procedures (hysterectomies, etc) because they'd be doing those alone anyway if they hadn't chosen to continue on in fellowship. He never lets them do cancer work unless he's scrubbed in. He says he bounces between the two rooms and usually coordinates what can be done alone by a fellow with what can't with when he's in and out. Also, in the big cancer cases, they have other specialists coming in (colorectal surgeons, plastics, vascular, etc) so there's supervision for the fellow from some attending if they are in for the whole case while DH is in the other room doing his part there.

Having two rooms is also a big time saver because the nurses don't have to have down time to "turn the room around" between cases. The team can just move from one to the other immediately.

Residents he never leaves unsupervised.

He says there are strict rules in place and documented for the hospital he's now in because years ago there was a lawsuit where the attending wasn't even on campus when something happened.....

[scrub-jay]

Great conversation. My advice on picking surgeons is to ask the anesthesiologists. They see it all and can tell the hacks from the good guys.

This.