application for appointment to a hospital as a SA or
PA should include the following qualifications and
•Specification of which surgeon the applicant will assist
and of the duties that will be performed.
•Indication of which surgeon will be responsible for the
supervision and performance of the SA or PA.
•Review and approval of the application by the hospital board.
•Registered nurses with specialized training also may
function as first assistants. If such a situation should
occur, the size of the operating room team should not be
reduced; the nurse assistant should not simultaneously
function as the scrub nurse and instrument nurse when
serving as the first assistant. Nurse assistant practice
privileges should be granted based upon the hospital
board’s review and approval of credentials. Registered
nurses who act as first assistants must not have responsibility beyond the level defined in their state nursing
Surgeons are encouraged to participate in the training of allied health personnel. Such individuals perform
their duties under the supervision of the surgeon.
II. RELATION OF THE SURGEON TO THE PATIENT
A. Informed Consent
Informed consent is more than a legal requirement. It
is a standard of ethical surgical practice that enhances
the surgeon/patient relationship and that may improve
the patient’s care and the treatment outcome. Surgeons must fully inform every patient about his or
her illness and the proposed treatment. The information must be presented fairly, clearly, accurately, and
compassionately. The surgeon should listen carefully
to understand the patient’s feelings and wishes and
should answer all questions as accurately as possible.
The informed consent discussion conducted by the
surgeon should include:
• The nature of the illness and the natural consequences
of no treatment.
• The nature of the proposed operation, including the
estimated risks of mortality and morbidity.
• The more commonly known complications, which
should be described and discussed. The patient should
understand the risks as well as the benefits of the proposed operation. The discussion should include a
description of what to expect during the hospitalization and posthospital convalescence.
•Alternative forms of treatment, including nonoperative techniques.
•A discussion of the different types of qualified medical
providers who will participate in their operation and
their respective roles.
The surgeon should not exaggerate the potential
benefits of the proposed operation nor make promises
or guarantees. For minors and incompetent adults,
parents or legal guardians must participate in the
informed consent discussion and provide the signature
for elective operations. Any adequately informed, mentally competent adult patient can refuse any treatment,
including operation. When mentally incompetent
patients or the parents (guardians) of minors refuse
treatments, jeopardizing the patient’s best interests,
the surgeon can request legal assistance.
When patients agree to an operation conditionally
or make demands that are unacceptable to the surgeon,
the surgeon may withdraw from the case.
B. Scope of Surgical Care
Surgical care includes providing preoperative diagnosis and care, educating the patient about the risks and
benefits of operation and obtaining informed consent,
selecting and performing the operation, and providing
postoperative surgical care.
C. Preoperative Diagnosis and Care
Because a team of specialists undertakes much of
modern patient care, nonsurgeon physicians often