Your life in their hands

These are the people we trust the most.

Doctors, surgeons and nurses always rate highly in those annual surveys asking who are the public’s most-trusted professionals. But would you have the utmost faith in them going beyond the bounds of what you have given them approval to do?

When a patient is wheeled into an operating theatre, this is  most likely an extraordinary event in their life. Their future is clearly in the hands of the medical professionals. But for the surgeons, anaesthetists and nurses in theatre, the operation will mostly be something routine.

Even during an everyday visit to the doctor, patients trust their GP will diagnose ailments correctly and prescribe the right remedies. In effect, even in this less frenetic and momentous environment, patients are trusting them with their lives.

This huge responsibility over others’ lives is why prospective doctors are these days tested to ensure they have the empathy, collectedness and resilience to deal with life-and-death situations. It is why they are well paid. On the other side of the coin, it is also why many doctors and nurses suffer anxiety and some burn out, like the rest of us.

There have of course been cases of when doctors go bad, when they take matters into their own hands and go too far without listening to colleagues’ cautions. When this happens, those incidents generally become high-profile and attract media and public interest.

It is this small number of events that may make members of the public uneasy at the thought of a surgeon going further during an operation than a patient has given consent for. Yet, because such issues arise in a tiny percentage of cases, this is a red herring that should not be allowed to get in the way of rational debate on what are known as "incidental findings" during surgery — the unexpected discoveries such as suspected cancers or leaking blood vessels.

Individuals will have their own strongly held views on whether a surgeon carrying out an operation who discovers another operable but unrelated health issue should also deal with that at the same time. But two studies by University of Otago researchers, published in the New Zealand Medical Journal, conclude that, in the main, patients and doctors are in favour of treating the unexpected problem during the other surgical procedure.

This is not, however, straightforward. Many doctors are unclear if consent forms signed by patients permit them to carry out unforeseen surgery. Going ahead without approval may mean a surgeon has to face disciplinary proceedings.

The researchers looked at consent forms here and overseas, and asked patients, surgeons and the public if incidental surgery should take place. Of the respondents — 331 members of the public, 368 patients and 151 surgeons — most said they would prefer this to happen in 75% of the hypothetical scenarios.

The academics also found most would support a clause about incidental surgery being included in the patient consent form to ensure surgeons clarified beforehand with patients what they should do about it.

Many surgeons will consider taking unexpected action if they find something which may threaten the patient’s health and when the extra procedure is low-risk. But the nebulous area is at either end of the bell curve — with surgeons who would perform risky operations on low-impact abnormalities without patient consent, and with those unlikely to operate when the risks are slight but the anomaly is serious and needs urgent attention.

These findings are unsurprising, and an addition to the form along the lines suggested would be common sense. That inclusion, to prompt the discussion between patient and doctor or surgeon, is a more sensible first step than a clause which, if ticked, could give inappropriate licence to surgeons to holus-bolus treat any other issues they come across.

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