The practice of concurrent surgery, or “double-booking,” where a surgeon performs or presides over two patients during the same period of time, has become more popular in recent years. As the practice has become more common, scrutiny by regulators and patient advocates, as well as lawsuits by injured patients, have also increased. These opponents of the procedure say it is unsafe, unregulated, and done primarily to line the pockets of surgeons. Surgeons advocating the practice retort that “double-booking” is a safe and efficient procedure.
Double-booking has been a common practice at teaching hospitals across the country, where senior attending surgeons delegate procedures to residents or fellows. The residents or fellows will perform one part of the surgery while the surgeon operates on another patient in a separate operating room. Because double-booking requires the surgeon to constantly shuffle between operating rooms, the practice is known as “running two rooms” in the medical community. Senior surgeons may also see patients, or otherwise leave the operating rooms altogether.
The practice is, for the most part, unregulated and unmonitored. Medicare billing rules require that the attending surgeon be present during any “critical portion” of an operation – however, surgeons are free to decide which portions of surgery are “critical” and which are not. This leaves the hospitals with the primary responsibility for regulating the practice. Recent studies, and a glut of successful lawsuits against surgeons and hospitals utilizing the practice, suggest that they are not doing a very good job.
A 2015 investigation into Massachusetts General Hospital by the Boston Globe, examining its use of concurrent surgery over a 10-year period, found multiple complications and injuries that may have been linked to the practice. The study detailed instances where patients were waiting under anesthesia for hours while nurses attempted to locate the surgeon, leaving residents to perform surgeries without adequate supervision. The investigation also attributed the paralysis of one patient and the death of two others to the practice.
Lawsuits have, predictably, proliferated. A jury in Seattle, Washington awarded a patient $8.5 million after an abdominal surgery went horrifically wrong and the man ended up with disfigured genitals. Only after the surgery was complete did the man learn that an important part of the surgery was performed by a fellow, not the surgeon. This apparently common occurrence is nicknamed “ghost surgery,” where the patient only learns after-the-fact that his or her procedure was not performed by the surgeon.
Shockingly, a lack of explicit consent is not legally required, and for the hospitals that do require explicit consent, surgeons often ask the patient the day of the surgery (or sometimes the day before) – leaving the patient with little time to consider his or her options. For hospitals that want to continue the practice of double-booking, the impetus to keep the patient uninformed is perhaps understandable since most people want their surgeon performing their surgeries. A recent study by Harvard University found that fewer than 4 percent of people had even heard of concurrent surgery and a mere 31 percent supported the practice.
Patient advocates say this points to a larger problem with concurrent surgery – a complete lack of transparency. Of the 4,700 hospitals that receive Medicare funding, no one knows exactly how many practice double-booking. Likewise, there is no publicly available information concerning how many surgeons, and under what circumstances, practice double-booking.
Advocates of the practice state that concurrent surgery can be done safely, allows more patients to receive medical treatment, and helps train the next generation of surgeons. These surgeons claim that the results of the practice’s safety are mixed and point to a study by the Mayo Clinic that examined 11,000 “overlapping surgeries” and concluded the death rate was not any higher. This, proponents say, is evidence that concurrent surgery can be performed safely.