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Live surgery may not be a great idea
As part of his efforts to educate the public about heart health, Frederick Meadors, MD, a cardiothoracic surgeon at St. Vincent Infirmary Medical Center in Little Rock, AR, had planned to perform heart surgery on a patient while 330 people watched the procedure live through a video feed in a hospital auditorium.
However, that plan was scuttled when Meadors' professional group, the Society of Thoracic Surgeons, announced recently that such broadcasts are no longer considered acceptable. The hospital had put six months into planning the event, but officials confirm that the plan was changed abruptly in response to the society's move. Instead of watching the surgery live, the group watched a videotape of a surgery as Meadors explained it in person.
Live surgery broadcasts have grown in popularity in recent years, due partly to technological advances that make them relatively easy to produce and also the public's fascination with medical procedures that in previous years might have been considered unpleasant to watch. But some physician leaders, attorneys, and risk managers are expressing concern that having a surgeon perform live for an audience isn't such a great idea.
In 2006, the American College of Surgeons in Chicago banned live surgery broadcasts at its meetings, and the Society of Thoracic Surgeons did the same in January 2008. The Society of Thoracic Surgeons went a step further by saying that its members should not perform live surgery broadcasts to the general public because they may be distracted from their primary duty to the patient, explains Robert A. Wynbrandt, JD, executive director and general counsel of the society. The society's board of directors is in the process of approving a more extensive policy that addresses a wide range of ways in which surgery may be viewed by others, he says. It includes everything from having residents standing nearby to participating in live television shows. That policy may be published as early as May 2008, he says.
"The tricky thing is that there is no empirical data to base these decisions on. There are no studies that have shown it is risky or not risky to have the surgery broadcast live," Wynbrandt says. "You hear anecdotal evidence about mishaps that people have had during live surgery, but nothing documented. So we have to base our policies on what is good for the patient and where our priorities should be."
Worries about distracted surgeons
The basic concern is that the surgeon's attention will be divided by having to perform for the camera and narrate what he or she is doing, and that this scenario would compromise patient safety, Wynbrandt says. That risk is only theoretical, he notes, and many surgeons argue that they are adept at multitasking. Their attention is divided already, they say, and having a camera in the room does not create any extra risk.
Wynbrandt says the society can't prove otherwise but would rather err on the side of patient safety. There also is considerable concern that live surgery broadcasts can increase the liability risk for surgeons and hospitals, but again Wynbrandt says that still is only a theoretical risk with no cases to show any certain threat.
The potential risk should not be underestimated, says Stacy Gulick, JD, an attorney with the law firm of Garfunkel Wild in Great Neck, NY, and a former hospital risk manager. Gulick compares live broadcasts to the more common practice of videotaping surgeries, which causes much concern among risk managers and defense attorneys for similar reasons. The taping or broadcasting creates a public record of the surgery and, in effect, a great many witnesses, she says. Virtually all broadcasts of a surgery will be taped by someone, so all of the videotaping concerns come into play.
"If anything goes wrong, there is a heightened likelihood that a medical malpractice case will be brought because everyone saw it happen," Gulick says. "And then you have this tape to bring into court and show a jury or judge. That can have a pretty dramatic impact, especially when you're showing something bloody that may affect a layperson much more than a clinician."
Explicit contract required
Gulick says she wouldn't necessarily recommend that risk managers forbid surgery broadcasts, but that the educational benefit should be weighed against the potential risks. The risk manager and legal counsel should be involved in the decision-making process, she says.
Surgeons create broadcast policy
The Society of Thoracic Surgeons recently revised its policy for how member surgeons should deal with the media and whether they should offer live surgery that is broadcast for others to watch. These are some excerpts from the new policy:
"I see a lot of tension between public relations and the risk manager on these issues, but your input is necessary," Gulick says. "If you decide to go ahead with the broadcast, your next step is to oversee the arrangements for the actual broadcast. That means working with a reputable company, limiting the broadcast to your intended audience, and obtaining all the necessary consent from the patient and any staff who will participate."
Agreement must be detailed
The risk manager should ensure that the hospital's agreement with the company doing the broadcast is detailed and protects the hospital, Gulick says. Simply granting permission for the crew to come in and set up a broadcast is not enough. She points out that the hospital must obtain specific consent from the patient to allow the production crew to witness and broadcast the surgery. That consent is in addition to any consent that the production company obtains for their own purposes.
"There is quite a lot of paperwork involved. It can be a big deal," Gulick says. "I get a lot of calls about this kind of thing on the day they want to do the broadcast or the day before, and it's hard to get all the paperwork in place."
Spell out approval process
Meredith L. Borden, JD, an attorney with the law firm of Venable in Baltimore, says risk managers should have policies on surgery broadcasts that prohibit them or lay out all the steps necessary for a surgeon to obtain approval. One of her concerns about surgery broadcasts is that they may interfere with good clinical decision-making. If a surgeon wants to be the subject of a broadcast or is being pushed to make the broadcast more interesting, there is some risk that he or she will choose a more advanced, more interesting procedure for the patient than what normally would be done, she says.
"Very often they are doing quite advanced, technical surgeries using the latest equipment and techniques that are rarely used," Borden says. "There can be pressures from the manufacturers highlighting the equipment and talking about the equipment they are using; so that can be a distraction to the surgeon who should be focused on patient care, especially if this is a new or advanced procedure."