Indexing Title:

ROJOSON’s Medical Anecdotal Report [05-03]

 MAR title:

To Ask for Assistance or Not in Operations and Standby Surgeons

 Date of medical Observation: April, 2005

 Narration:

 April 25, 2005, I have a 39-year-old female patient admitted for a wide resection of a soft tissue mass on the abdominal wall and mesh grafting.  There was a palpable mass on the left lower quadrant of the abdomen, about 4 cm in its greatest diameter, and non-movable.  The CT scan showed the mass to be in the anterior abdominal wall very near and encroaching to the iliac crest.  My impression was a desmoid tumor.

 On the night of the operation, I was deciding whether I should call for an orthopedic surgeon to help me or not.  I was not sure whether the mass was really encroaching on the iliac crest that would necessitate a bone surgery.  I was caught between needing help and minimizing expense for the patient who has to pay the service of an orthopedic surgeon if I call in one.  Initially, I decided to text an orthopedic surgeon and asked him if he was available on a standby basis.  Upon receiving a negative response (he would not be available), I decided to go for it alone.

 Intraoperatively, I was able to do a wide resection without having to do bone surgery to remove part of the iliac crest.  A mesh was used for reconstructing the abdominal wall defect.

 INSIGHT (physical, psychosocial, ETHICAL) (discovery, STIMULUS, REINFORCEMENT)

 Often times, in the practice of surgery, a problem-solving and decision-making situation involves the question whether the primary surgeon should ask for help or not in his forthcoming operation.

 As a rule, if one is quite sure and confident that he can do it alone, then no help is needed.  If one is quite certain that he cannot do it alone, then help is needed.  These are the clear-cut scenarios in which decision-making is easy.

 It is when there is uncertainty on what will be the intra-operative findings that will make a surgeon feels uneasy and would consider asking for help.  The decision really rests on the surgeon –  amount of operative experience, the risk the surgeon is willing to take,   expense to be incurred by the patient, availability of the surgeon to assist, ethics, habit, etc. 

Regarding the issue of compensation of a “standby” surgeon, the question is, should a standby surgeon be compensated and if yes, how much, that is, if the standby surgeon was never involved in the operative proper.   Or should there be no more standby surgeon and just have the surgeon scrub in and give him an assistance fee?  I have not charged before when I served as a standby surgeon for obstetrician-gynecologists.  

 Welcome feedback on “standby surgeons.”