BLOG: Would you be a patient in a live surgery event?
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Our patients share a sacred bond with us as surgeons.
They entrust us to lay blade against flesh, hoping for an improvement in life. They recognize the unavoidable dangers, yet, knowing us only superficially, accept that we will use our best judgment to protect them. Our patients also understand our separate obligation to teach — another ancient bond we share, this one with students. But which duty prevails when these two bonds come into conflict? The duty to teach or the duty to protect the patient?
Live surgery demonstration events — where large audiences watch surgery as it happens — present a real ethical challenge because they often present a greater risk to patients than the benefit derived from the live format of teaching.
Live surgery events do indeed draw large audiences. Usually sponsored by industry, these events give an instant payoff; hundreds or thousands of potential customers will see whatever technology is being presented in a most riveting environment. But is the audience really watching to learn about a new technology, or is this more like a NASCAR race, where much of the audience is just waiting to see an accident?
It’s clear that some patients, who may receive a form of compensation for their participation, are willing to participate as subjects in live surgery demonstrations, but would a surgeon allow him- or herself to be a patient in such a spectacle? A 2021 study in the British Journal of Surgery answers this question and sheds light on the perceptions of surgeons vs. those who know less about the actual risks of these demonstrations.
In the BJS study, 845 attendees at three major conferences were asked whether they would undergo surgery themselves in a live surgery event. Half the respondents were non-surgeon attendees, and the other half were surgeons. Among non-surgeons, 77% were willing to be subjects in a live surgery event. Among surgeons, only 33% would be willing, and they cited perioperative risks and ethical concerns as their chief reservations.
The reasons for these concerns of surgical risks and ethics are many, and most are very difficult to mitigate. Under ideal circumstances, the operating surgeon is working in his/her own OR with their own staff, own instruments, etc, but this is often not the case. Like all human beings, surgeons tend to downplay the cumulative effect of multiple small risks, like doing surgery in the evening for a live event rather than the morning or performing the surgical steps more demonstratively rather than more ergonomically or a last-minute substitution of instruments. Individually, these risks may be immaterial. Together, they can be disastrous. Is it any surprise, then, that most surgeons would not become a patient in a live surgery event but most of the less trained public would?
Knowing that, when should we allow these events to occur? With today’s ease of producing and distributing high-quality homemade surgical training videos, is it really necessary to subject a patient to risk just to offer a live teaching event? A growing number of surgical societies have altogether banned live surgery events, like the Japanese Society of Thoracic Surgeons, which was the first to do so in 2006 after a patient died during a demonstration. The Japanese Urology Association, American College of Surgeons, American College of Obstetricians and Gynecologists and American Association for Thoracic Surgery, along with numerous medical societies in India, have also followed suit.
To me, a proper informed consent involves telling the patient whether we would undergo the same surgery under the same circumstances. And if for most of us the answer is no, shouldn’t we tell the patient?
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References:
- Alkatout I, et al. Br J Surg. 2021;doi:10.1093/bjs/znab297.
- Allmen PV, et al. The demand for aggressive behavior in American stock car racing. In: Jewell RT, ed. Violence and Aggression in Sporting Contests. 2011;doi:10.1007/978-1-4419-6630-8_6.
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