SPOOKY: Do Ghosts Really Perform Surgery?

Ever heard the phrase 'ghost surgery'? It can be a very scary topic.

Ghost surgery exists whenever an individual performing an operation is not the same person that the patient expected to be wielding the scapel.

In some busy practices the patient is led to believe (let's simply say 'underinformed') that their hotshot superstar surgeon will perform the procedure. Hotshots often charge more than what is covered by insurance and patients are willing to pay the difference in order to benefit from Dr. Hotshot's advanced skills and experience. Sadly, Dr. Nobody may actually operate on the unknowing (asleep) patient. This is a deeply unethical medical practice.

Ghost surgery can also arise in the training environment. Young surgeons in need of experience sometimes develop their techniques on unsuspecting patients who believed that the attending staff surgeon was in charge. This, too, is unethical. It does not involve reimbursement revenues but it corrodes the trust patients put in their doctors.

Now, let's be realistic. Residents have to learn how to perform surgery somewhere, right?!? A well-structured clinical residency program is the ideal environment for senior surgeons to train their successors. Standing side-by-side the staff and resident surgeons collaborate to get the best results for their patients. If portions of a case are too precarious or too unfamiliar to the young protegé the more experienced attending surgeon typically takes over. The patient is protected every step of the way.

It is the responsibility of the attending surgeon to approach the patient and ask this important question. If a patient declines to have a surgeon-in-training scrub-in the choice needs to be respected. Fortunately, this is a rare occurrence.

Here's a neat secret: If you are ever brought to the hospital in the middle of the night needing surgery, and they offer you two options: Surgery Chief Resident (cub) or Chief of Surgery (lion) go with the Chief Resident! As a general rule, that young doctor has recently performed an enormous volume of surgical procedures and knows the latest and greatest ways to fix you up. The Chief of Surgery spends a lot of time going to meetings and performs far less surgery.

So, how do most folks feel about a resident serving as primary surgeon with staff supervision? A recently published study collected patients' feelings on the subject with the use of an anonymous survey distributed to 106 preoperative patients needing cataract surgery. Here's what they found:

• 96% felt that they should always be asked (no ghost surgery)


• 83% claimed that they would agree to let the resident assist the attending surgeon perform the eye operation


• 55% felt that the standard pre-op consent form was adequate disclosure (who reads those anyway?!?)


• 49% claimed that they would allow the resident to be the primary surgeon

If you or a loved one is anticipating surgery make sure you clearly understand all options. Make sure that ghost surgery is not tolerated in your hospital. Specifically ask who will serve as primary surgeon and their level of proficiency. Do not abdicate that decision to anyone!

REFERENCE: Archives of Ophthalmology, September 2008, pages 1235-1239.

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