Seeing surgeons to safety

By Edwin Jesudason.

Surgeons around the world are videoing their operations to present innovations to their peers at academic meetings. In my paper, I argue that they and their hospitals have an ethical duty to protect patients, which should require the routine videoing of surgery as long as the patient consents. This would provide something like a black box recorder used on aircrafts, and an improvement on the current state of affairs where surgeons select what they video and what they disclose. Big Pharma has long been criticised for selecting which results to publicise, so surgeons should be aware of the need to do better.

It’s estimated that annually there are more operations than childbirths worldwide. But this comes at a cost. Postoperative deaths are reckoned to exceed those from HIV, TB and malaria combined. Postoperative disability will be more common still. Measures to improve surgical safety have often focused on peri-operative strategies, such as checklists, and discussion of human factors. But the operative procedure itself has become less visible compared to times when surgeries were almost literally theatre. As surgery becomes less visible to outsiders, it leaves a big gap in the evidence we can independently examine to improve. Instead, one could sometimes be forgiven for feeling that “what happens in the operating room stays in the operating room”.

So we’re left with the curious fact that we can watch our sports stars and analyse their performances but can’t readily do the same for our surgeons – despite the stakes being higher.

Image provided by Edwin Jesudason.

 

Closing this oversight gap matters to us and our families.  Most of us will need surgery at some point. So let’s consider together, how that might go under current conditions.

Imagine waking from your procedure to see your surgeon’s concerned face. Removing their mask, they bear a striking resemblance to Boris Johnson. Their explanation has a similar feel, so let’s call him Boris for now.

You hear a lot of rather mumbled words and are left knowing that something has gone wrong but not being at all clear what. The surgeon, by now rather crumpled, retreats before you can establish the details. Leaving your bedside, they promise a full investigation and to provide a copy of their notes.

Nursing your injury, you begin to wonder how it happened – and how you could find out. In time, you realise there’s no independent account of what occurred in the operating room and you have to rely on Boris’ word. He’s well spoken and went to a private school. The authorities will believe him – or at least not publicly disbelieve him.

You learn that Boris has operating lists each week with similar cases, but you can’t tell if your outcome is typical. When you ask, you’re told that Boris, rather than the hospital, collects the data on this particular procedure. The hospital reassures you that he is a top surgeon who has presented videos of the same procedure at international meetings. You ask why your surgery wasn’t videoed – only to be told that you never asked. You learn later that Boris is also a senior hospital manager.

My paper argues that both Boris and his hospital have a duty to protect us and patients like us, meaning they should routinely seek our consent for our surgery to be videoed, and show us a reel of Boris, and other available surgeons, doing and explaining the procedure being proposed for us, so we can make an informed choice of both operation and surgeon. The video of our surgery would then be available to help guide if complications arise, and could be used as part of a pooled AI monitoring process to pick up areas where surgeons’ performance ought to be emulated or addressed. In other words, we would help see our surgeons safe.

Paper title: Surgery should be routinely videoed

Author: Dr Edwin Jesudason

Affiliations: Consultant in Rehabilitation Medicine, NHS Lothian, Astley Ainslie Hospital, Edinburgh.

Competing interests: None

Social media account: @Edwin1432

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