public health justification, or both…. By reducing
health care decisions to a series of mandates lawmakers devalue the patient- physician relationship.
The ACS’ role
To address the challenges regarding surgeon disclosure limits, the American College of Surgeons (ACS)
has facilitated extensive discussion on disclosure and
patient consent through statements released by the
Board of Regents and via articles published in the
Specifically, the ACS has released statements on the
disclosure of a variety of issues, ranging from hepatitis to HIV status, which do not need to be disclosed
when universal safety precautions are taken, to the
presence of health care industry representatives in the
OR, which should be disclosed to patients, and the
delegation of parts of an operation.
At press time, concurrent surgery was receiving a great deal of scrutiny, and the Senate Finance
Committee was investigating the practice.
15, 32 As
a result, the ACS convened a 10-member panel to
develop guidelines on this practice.
16 The new guidelines, added to the ACS Statements on Principles in
April, reiterate that the attending surgeon has primary responsibility for the patient, and although
part of the operation may be delegated to “
qualified practitioners,” including residents, the “primary
attending surgeon’s personal responsibility cannot
be delegated” and recommend that the patient be
informed of any overlap in operations during which
the attending may delegate a part of the operation.
The College also has published guidelines on the
effects of fatigue and methods to mitigate these problems, but the question of disclosure to a patient is
26 Additionally, duty hour restrictions
for trainees, mandated through the ACGME, were
meant to alleviate the ill effects of fatigue on trainees
and patients alike.
9 Although the American Medical
Association (AMA) has launched the well-received
online training program AMA STEPS Forward—
which assists in the identification and prevention
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Common program requirements. 2011. Available at:
www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed March 29, 2016.
11. Ulmer C, Wolman DM, Johns MME, eds. Resident Duty
Hours: Enhancing Sleep, Supervision, and Safety. Washington,
DC: National Academies Press; 2008.
12. Rothschild JM, Keohane CA, Rogers S, et al. Risks of
complications by attending physicians after performing
nighttime procedures. JAMA. 2009;302( 14):1565-1572.
13. Blum AB, Raiszadeh F, Shea S, et al. U.S. public opinion
regarding proposed limits on resident physician work
hours. BMC Med. 2010;8: 33.
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Mandatory disclosure will adversely affect an already burdened
emergency care system, as surgeons will have to choose
between providing emergency care overnight and scheduling
daytime elective surgery.