of physician burnout and career-based fatigue—the
topic of acute, post-call fatigue and associated patient
disclosure is not addressed.
Where should we go from here?
As we continue discussions regarding surgeon disclosure, it will be increasingly important for surgeons
to lead the way. If we do not advocate for ourselves
and suggest reasonable parameters for surgeon disclosure, it is inevitable that other stakeholders will
develop the rules for us. Because federal intervention
in the disclosure issue is suboptimal when compared
with the development of guidelines issued by surgical societies, the ACS must continue to amplify our
influence in Washington, DC. In light of the recent
attention and congressional investigation of concurrent surgical practices, our continued support
of the ACS Professional Association political action
committee (ACSPA-SurgeonsPAC) remains crucial
in communicating with congressional leaders and
retaining control over disclosure-related recommendations within our own community. Examples of
the efficacy of our investment in the SurgeonsPAC
can be found in the repeal of the sustainable growth
rate via passage of the Medicare Access and CHIP
(Children’s Health Insurance Program) Reauthorization Act of 2015.34
Future policy efforts should focus on developing
guidelines for surgeon disclosure rather than creating strict policies, with the caveat that guidelines
run the risk of temporally evolving into standards
of care, without adequate scrutiny into outcomes.
A guideline-driven approach would be similar to
guidelines directing patient care—general instructions for improving care that should be adapted and
considered on a case-by-case basis. For example,
guidelines surrounding concurrent surgery might
acknowledge that this practice exists on a spectrum
and that banning the practice outright could negatively affect patient care by restricting access to
common procedures that can be performed relatively easily. In addition, a guideline-driven approach
14. Langerman A. Careful, compassionate, concurrent
surgery. The Boston Globe. January 10, 2016. Available
YBNewe5HE6ygL05N27UIxJ/ story.html. Accessed March
15. Mello MM, Livingston EH. Managing the risks of
concurrent surgeries. JAMA. 2016;315( 15):1563-1564.
16. Abelson J, Saltzmann J, Kowalczyk L. Concurrent
surgeries come under new scrutiny. The Boston
Globe. December 20, 2015. Available at: www.
hospitals/6IjRw2Wk DYdt5oZljpajcO/ story.html. Accessed
March 19, 2016.
17. McAlister C. Breaking the silence of the switch—
increasing transparency about trainee participation in
surgery. N Engl J Med. 2015;372( 26):2477-2479.
18. Merriam-Webster. Paternalism. Available at: www.
Accessed March 26, 2016.
19. Rosenbaum L. Leaping without looking—duty hours,
autonomy, and the risks of research and practice. N Engl J
Med. 2016;374( 8):701-703.
20. Bilimoria KY, Chung JW, Hedges LV, et al. National
cluster-randomized trial of duty-hour flexibility in surgical
training. N Engl J Med. 2016;374( 8):713-727.
21. Sharpe JP, Weinberg JA, Magnotti LJ, et al. Outcomes
of operations performed by attending surgeons after
overnight trauma shifts. J Am Coll Surg. 2013;216( 4):791-799.
22. Vinden C, Nash DM, Ranrej J, et al. Complications
of daytime elective laparoscopic cholecystectomies
performed by surgeons who operated the night before.
JAMA. 2013;310( 17):1837-1841.
23. Govindarajan A, Urbach DR, Kumar M, et al. Outcomes
of daytime procedures performed by attending surgeons
after night work. N Engl J Med. 2015;373( 9):845-853.
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