Multi-tasking More Common Among Surgeons Than Expected
Double-booking surgeries is a more common practice than one would think. Oftentimes, concurrent procedures are booked, particularly in teaching hospitals, where senior staff can delegate certain portions to fellows or residents. Patients are left unaware that their surgeries will be performed alongside others, commonly with periods of time without the supervision of a senior physician — a practice which has been met with scrutiny by advocacy groups.
The U.S. Senate Finance committee, which oversees Medicaid and Medicare, is one such group that has questioned the safety of double-booking, particularly in the most critical situation, such as cardiac surgery or neurosurgery. However, currently Medicare billing criteria allows for it. Some hospitals, such as University of Virginia’s, have decided to discontinue the practice, and ultimately, the decision regarding whether to allow concurrent surgeries is left to the discretion of hospital executives.
All patients “deserve the sole and undivided attention of the surgeon, and that trumps all other considerations,” said Michael Mulholland, chair of surgery at the University of Michigan Health System, which discontinued double-booking ten years ago and instituted a computerized program that documents every time a physician enters and exits the operating room.
“It doesn’t do any good to check out your surgeon if they’re not even going to be in the room,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project. “We all know about the dangers of multitasking. This adds a layer of danger if you have the most expert person coming in and out.”
Indiana orthopedic surgeon James Rickert said the common practice continues to be allowed only because patients are largely unaware it is happening. “The only reason it has continued is that patients are asleep,” said Rickert. “Having a fellow so you can run two rooms helps augment your income. You can bill for six procedures: You do three and the fellow does three.”
However, there are those who believe double-booking is necessary to ensure all patients receive care in a timely manner. “It’s extremely important for us to make sure [all surgeries are] done with the highest quality,” said Peter Dunn, Mass General’s executive medical director of perioperative administration who has claimed records have “never traced back a quality issue” back to the common practice of concurrent surgery. Robert Cima, a colorectal surgeon and medical director of surgical outcomes research at the Mayo Clinic, agreed. He said that double-booking it common and has been used safely since the clinic’s inception more than a century years ago. He even co-authored a study which found 11,000 overlapping operations at Mayo did not have a higher death rate than non-overlapping surgeries.
One might argue, never proving that double-booking has caused a quality issue doesn’t necessarily mean the practice was never at fault. There have been incidents in which patients have attempted to sue for paralysis and other complications after discovering that their surgeries were performed alongside others. In January of this year, a jury in Boston, Massachusetts, found that a spine surgeon running two rooms was not responsible for a 45-year-old patient’s subsequent quadriplegia.
Perhaps, in this particular case, it could not be proven without a reasonable doubt that the paralysis stemmed from the doctor’s decision to multi-task, but it certainly could have had something to do with it. One thing’s for sure, if it’s a concern, patients would be wise to specifically ask whether the facility at which they plan to undergo surgery allows for double-booking.