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SAN FRANCISCO – The medical community has long debated whether surgeons need to disclose their operative volumes and outcomes to patients when obtaining informed consent, and legal rulings in court cases offer mixed opinions.
Recent surveys administered to patients and attending surgeons have indicated that although patients want to know about their surgeon’s expertise and surgical outcomes during preoperative discussions for informed consent, attendings are significantly less likely to think that such information is important to disclose, Dr. Susan Lee Char said at the annual clinical congress of the American College of Surgeons.
Dr. Char and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey, which presented a hypothetical case of a patient’s undergoing elective partial hepatectomy, asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale (with a score of 1 indicating "completely unimportant" and a score of 6 indicating "extremely important").
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt that this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosing such information may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients, as compared with 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively.
A total of 41% of patients and 5% of surgeons said the patient should be told the number of times that the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed. A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training obtained by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential, Dr. Char added. Patients who were scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than were those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure.
And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
The study was limited because it used a hypothetical case scenario rather than real informed-consent discussions, and it included only one type of surgery. Because most of the patients were well-educated women, the results may not be generalizable.
Dr. Char said she had no conflicts.
This study raises a number of issues and is both interesting and worrying. It illustrates a major mis-match between views of patients and the doctors who are treating them, which uncorrected is likely to be the source of future problems.
Of course the study has limitations in that we are not aware of any previous information that was given to the patients about their procedure or the previous health care experiences of the patients. However, it is apparent that the views of the patients about what they should expect to be told and those of the treating doctors are quite different. This is particularly true of outcome data and numbers of cases undertaken by the doctor.
The UK is still living with the consequences of the Bristol Heart Enquiry in which a number of children died when operated on by teams not experienced with complex pediatric cardiac surgery, who continued despite poor results. One of the messages that came out of this was the need for high quality outcome data that was in the public domain. Cardiac Surgery has responded well with regularly published outcome data which has also seen an improvement in cardiac surgery outcomes nationally. Other surgical specialties have been slow, hiding behind the excuses of lack of resources and case variation and complexity. Again medical complacency was shaken in 2010 when one of our national papers ran a series of articles on poorly performing vascular surgical units.
The message is clear and this study emphasizes it. The patient is our customer and we must listen to what they want; they want information and honesty. Unless we respond to this there will further erosion of public trust in our profession.
Dr. C.P. Shearman is a professor of vascular surgery at University of Southampton, Southampton, U.K. He is one of two new international associate medical editors of Vascular Specialist.
This study raises a number of issues and is both interesting and worrying. It illustrates a major mis-match between views of patients and the doctors who are treating them, which uncorrected is likely to be the source of future problems.
Of course the study has limitations in that we are not aware of any previous information that was given to the patients about their procedure or the previous health care experiences of the patients. However, it is apparent that the views of the patients about what they should expect to be told and those of the treating doctors are quite different. This is particularly true of outcome data and numbers of cases undertaken by the doctor.
The UK is still living with the consequences of the Bristol Heart Enquiry in which a number of children died when operated on by teams not experienced with complex pediatric cardiac surgery, who continued despite poor results. One of the messages that came out of this was the need for high quality outcome data that was in the public domain. Cardiac Surgery has responded well with regularly published outcome data which has also seen an improvement in cardiac surgery outcomes nationally. Other surgical specialties have been slow, hiding behind the excuses of lack of resources and case variation and complexity. Again medical complacency was shaken in 2010 when one of our national papers ran a series of articles on poorly performing vascular surgical units.
The message is clear and this study emphasizes it. The patient is our customer and we must listen to what they want; they want information and honesty. Unless we respond to this there will further erosion of public trust in our profession.
Dr. C.P. Shearman is a professor of vascular surgery at University of Southampton, Southampton, U.K. He is one of two new international associate medical editors of Vascular Specialist.
This study raises a number of issues and is both interesting and worrying. It illustrates a major mis-match between views of patients and the doctors who are treating them, which uncorrected is likely to be the source of future problems.
Of course the study has limitations in that we are not aware of any previous information that was given to the patients about their procedure or the previous health care experiences of the patients. However, it is apparent that the views of the patients about what they should expect to be told and those of the treating doctors are quite different. This is particularly true of outcome data and numbers of cases undertaken by the doctor.
The UK is still living with the consequences of the Bristol Heart Enquiry in which a number of children died when operated on by teams not experienced with complex pediatric cardiac surgery, who continued despite poor results. One of the messages that came out of this was the need for high quality outcome data that was in the public domain. Cardiac Surgery has responded well with regularly published outcome data which has also seen an improvement in cardiac surgery outcomes nationally. Other surgical specialties have been slow, hiding behind the excuses of lack of resources and case variation and complexity. Again medical complacency was shaken in 2010 when one of our national papers ran a series of articles on poorly performing vascular surgical units.
The message is clear and this study emphasizes it. The patient is our customer and we must listen to what they want; they want information and honesty. Unless we respond to this there will further erosion of public trust in our profession.
Dr. C.P. Shearman is a professor of vascular surgery at University of Southampton, Southampton, U.K. He is one of two new international associate medical editors of Vascular Specialist.
SAN FRANCISCO – The medical community has long debated whether surgeons need to disclose their operative volumes and outcomes to patients when obtaining informed consent, and legal rulings in court cases offer mixed opinions.
Recent surveys administered to patients and attending surgeons have indicated that although patients want to know about their surgeon’s expertise and surgical outcomes during preoperative discussions for informed consent, attendings are significantly less likely to think that such information is important to disclose, Dr. Susan Lee Char said at the annual clinical congress of the American College of Surgeons.
Dr. Char and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey, which presented a hypothetical case of a patient’s undergoing elective partial hepatectomy, asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale (with a score of 1 indicating "completely unimportant" and a score of 6 indicating "extremely important").
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt that this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosing such information may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients, as compared with 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively.
A total of 41% of patients and 5% of surgeons said the patient should be told the number of times that the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed. A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training obtained by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential, Dr. Char added. Patients who were scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than were those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure.
And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
The study was limited because it used a hypothetical case scenario rather than real informed-consent discussions, and it included only one type of surgery. Because most of the patients were well-educated women, the results may not be generalizable.
Dr. Char said she had no conflicts.
SAN FRANCISCO – The medical community has long debated whether surgeons need to disclose their operative volumes and outcomes to patients when obtaining informed consent, and legal rulings in court cases offer mixed opinions.
Recent surveys administered to patients and attending surgeons have indicated that although patients want to know about their surgeon’s expertise and surgical outcomes during preoperative discussions for informed consent, attendings are significantly less likely to think that such information is important to disclose, Dr. Susan Lee Char said at the annual clinical congress of the American College of Surgeons.
Dr. Char and her associates surveyed 353 adult patients at their first postoperative clinic visit and 85 attending surgeons at hospitals affiliated with the University of California, San Francisco. The survey, which presented a hypothetical case of a patient’s undergoing elective partial hepatectomy, asked respondents to rate the importance of receiving or conveying various items of information on a 6-point Likert scale (with a score of 1 indicating "completely unimportant" and a score of 6 indicating "extremely important").
In all, 79% of patients said it’s essential to know if their surgeon would be doing a procedure for the first time on them, but only 55% of attending surgeons felt that this was important information to disclose. A total of 63% of patients considered it essential to know the number of times a surgeon had performed a particular procedure and the outcomes in those cases, compared with just 25% and 20% of surgeons, respectively.
"The data suggest that surgeons do have an ethical obligation to disclose volumes and outcomes and if it’s the first time [they’re] doing a procedure," said Dr. Char, a surgical resident at the university who is also a lawyer. "This has possible legal implications."
The main barrier to surgeons’ disclosing such information may be a practical one, she added. Surgeons often don’t have data on the volumes and outcomes of their procedures.
Patients’ and attending surgeons’ perceptions of the importance of other types of information also differed significantly. A general description of the procedure was rated as important by 65% of patients vs. 58% of surgeons, and technical details of the procedure were important to 48% of patients, as compared with 13% of surgeons. Disclosure of risks and benefits of the procedure were deemed essential by 77% and 71% of patients, respectively, compared with 72% and 65% of surgeons, respectively.
A total of 41% of patients and 5% of surgeons said the patient should be told the number of times that the procedure has been done by other surgeons, and 44% of patients and 20% of surgeons said other surgeons’ outcomes should be disclosed. A total of 64% of patients and 31% of surgeons believed it was important to discuss any special training obtained by the surgeon doing the procedure. Some 64% of patients said they would want to be informed about the surgeon’s special training for a standard procedure, compared with 68% for a laparoscopic procedure and 71% for a robotic procedure.
Technological innovation made a difference in whether patients deemed certain information essential, Dr. Char added. Patients who were scheduled for a laparoscopic or robotic procedure were significantly more likely to want information than were those undergoing a standard operation.
In all, 63% of patients said they would want to know the number of times that a standard procedure had been done by their surgeon. That percentage rose to 66% for a laparoscopic procedure and to 68% for a robotic procedure. Outcomes information was considered important by 63% of patients for a standard procedure, 66% for a laparoscopic procedure, and 67% for a robotic procedure.
And 24% of patients, compared with 6% of surgeons, said the patient should be told if the surgeon planned to publish an article including the case. Disclosing whether a surgeon is a paid consultant was less important to patients (5%) than to surgeons (40%).
The study was limited because it used a hypothetical case scenario rather than real informed-consent discussions, and it included only one type of surgery. Because most of the patients were well-educated women, the results may not be generalizable.
Dr. Char said she had no conflicts.
Major Finding: Only 55% of surgeons believed they should disclose that they would be doing a surgery for the first time on a patient when getting informed consent, compared with 79% of patients.
Data Source: Surveys presenting a hypothetical case to 353 patients at postoperative clinic visits, and to 85 attending surgeons.
Disclosures: Dr. Char said she has no relevant conflicts of interest.