Q: What are overlapping or concurrent surgeries? How are they different?
These two adjectives, "overlapping" and "concurrent," sound very much the same but don't be fooled. They're vastly different. The American College of Surgeons provides definitions for both, as well as their ethical beliefs surrounding the two.
"Concurrent or simultaneous operations occur when the critical or key components of the procedures for which the primary attending surgeon is responsible are occurring all or in part at the same time. The critical or key components of an operation are determined by the primary attending surgeon. A primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is inappropriate." -The American College of Surgeons Statements on Principles (link)
Overlapping Operations "Overlap of two distinct operations by the primary attending surgeon occurs in two general circumstances.
The first and most common scenario is when the key or critical elements of the first operation have been completed, and there is no reasonable expectation that the primary attending surgeon will need to return to that operation. In this circumstance, a second operation is started in another operating room while a qualified practitioner performs noncritical components of the first operation—for example, wound closure—allowing the primary surgeon to initiate the second operation. In this situation, a qualified practitioner must be physically present in the operating room of the first operation.
The second and less common scenario is when the key or critical elements of the first operation have been completed and the primary attending surgeon is performing key or critical portions of a second operation in another room. In this scenario, the primary attending surgeon must assign immediate availability in the first operating room to another attending surgeon. The patient needs to be informed in either of these circumstances. The performance of overlapping procedures should not negatively affect the seamless and timely flow of either procedure." -The American College of Surgeons Statements on Principles (link)
Q: Can I refuse to have a resident or fellow provide service?
This is a loaded question which brings a swell of considerations.
First, notice that the question says, "service," not "surgery." In a teaching hospital, every department will have residents, fellows and attendings. People go to a hospital for all types of service, most visits aren't invasive and don't put your life in jeopardy. So, we believe residents and fellows SHOULD provide service, lots of it. They're doctors, just newer doctors who need continual experiences to develop their craft, thus turning them into experts.
But what about surgery? What do we believe?
We believe RESIDENTS AND FELLOWS, SURGICAL OR OTHERWISE, ARE AMERICA'S INVESTMENT AND WE MUST INVEST IN THEM. Therefore, as Jack's parents, our stance doesn't change. We will continue to believe in teaching hospitals and seek treatment from them. However, outside of of all specialties (with the exception of emergency room doctors), we think surgeons need the most guided practice, the most field experience and the most supervision. We also think out of all specialties, these two specialties (ER doctors and surgeons), carry the most responsibility.
These specialties differ from the others in that the patients coming to them may already be in grave peril. Quick, split decisions must be made in highly stressful environments. Teaching physicians in these areas MUST use Jack's story to reflect on their own gradual release model. We don't have enough background experience to give suggestions to ER teaching attendings but we believe surgical teaching attendings should never allowing a surgery to go unsupervised without the patient's consent and without the resident or fellow proving independent proficiency at least a dozen times prior to release.
The statements above are just our opinions and don't answer the question. We'll try to do that now but know the answer isn't as clear cut as you'd think. We think this article does a GREAT job of explaining but here are a few general thoughts you need to consider. -In regards to many surgeries, attendings SHOULDN'T perform them without helpers; not just because extra experienced hands save lives, but it's necessary for accountability purposes.
-If you've been admitted into the hospital and the care or treatment you're receiving from a specific resident or fellow isn't working out, you have every right to say you'd prefer if that specific doctor no longer be part of your treatment. There are a few people you can contact to make the request...the nurse manager (every floor has one), a patient advocate (every hospital has one), or the attending physician in charge of your care. If you do this, you need to have a valid reason and it should be shared with the staff member you speak with. First, because this is a doctor practicing medicine, working on becoming an expert and feedback will help with that expertise. Secondly, because you're putting the credibility of a new doctor on the line who just spent 8 years in college and may have 0-3 years of experience on the floor...be fair.
-If you absolutely don't want a resident or fellow providing care, then go to a private hospital. Just be aware, it's possible even private hospitals likely have language in their forms allowing your care to be delegated or even having medical students assist.
-We can tell you as parents of three children that we'll choose a teaching hospital any day over a private one. The few times we took our children to private hospital due to proximity, they referred us to our local Children's Hospital...a teaching hospital. Why? Because unless the private hospital is specifically FOR children, your child isn't going to get the specialized care he/she needs. Pediatric doctors are just that. Pediatric doctors. It's a specialty in every sense of the word.
Q: How prevalent are ghost surgeries, really, in teaching hospitals?
As of now, they aren't formally tracked so it's hard to say. If we had to take a guess, hundreds to thousands of them happen a day simply because of how the informed consent is set up. Attending surgeons aren't always necessary to do certain procedures. For example, a fellow with seven years of surgical experience could easily remove a ganglion cysts off of a patient's wrist without needing the attending watching over. But the key here is informing the patient. Hospitals shouldn't advertise a product and then sell something entirely different. That's called fraud.
Ghost Surgeries, LLC.m PO BOX 908 Milford, OH, 45150