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If you’re inexperienced, should you tell patients?
Informed consent an issue in robotic surgery death
A recent Tampa, FL, lawsuit involving a patient who died after robotic surgery to remove a cancerous kidney has raised informed consent issues regarding new technology.
"The conventional surgery was basically jettisoned, and this robotic surgery was not only suggested but really pushed," said a lawyer for the patient’s family in a lawsuit filed against the hospital.1 St. Joseph’s declined to comment beyond a statement from the CEO.
With new technology, it’s critical to discuss the reason for using the technology, says Steven Schwaitzberg, MD, director of the Minimally Invasive Surgery Center at Tufts-New England Medical Center in Boston. "When the choices affect the approach to the surgery significantly, such as robotics, then those issues need to be discussed with the patient," he says.
First, the surgeons must have the reasons for use of the new technology firmly planted in their own minds, "because unless that occurs, it’s hard to have a coherent discussion with the patient," Schwaitzberg explains.
With some technology, such as laparoscopes, the advantage is obvious, even if you just consider cosmetic issues, he adds. "The advantage of using a robot is less obvious for routine procedures such as cholecystectomy but may have a clear role in more complicated procedures," says Schwaitzberg.
The point to make with patients is that you want to provide a procedure that is of equal or greater benefit with new technology, but warn them of the possibility of unforeseen outcomes, advises Mary H. McGrath, MD, MPH, FACS, chair of the committee on emergency surgical technology and education at the American College of Surgeons and professor of surgery in the division of plastic surgery at the University of California San Francisco Medical Center.
"If I’m trying a new device, a new complex device that I’m not so familiar with, I would share that information," she says.
Honesty is the best policy, Schwaitzberg affirms. If you’re doing something for the first time, the patient should be informed, he says.
"Although it seems daunting to tell someone [he or she is] going to be [the] first, patients respond better than you can imagine in most cases," Schwaitzberg adds.
1. Greenway v. St Joseph's Hospital Inc., No. 0311667, Division G Circuit Court for 13th Judicial Circuit for Hillsborough County, FL (Dec. 16, 2003).
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