ate harm to the patient, I agreed that surgery should proceed.
But the team member was obstinate and insisted on the ring
removal. Several minutes of unusual pain and patient suffering later,
the ring was eventually removed, albeit with great difficulty.
What was the best action for the patient? Who is to assume leader-
ship? Effective leadership would not allow undue pain and suffering
when no realistic threat is present. Conversely, when there is a real
threat, it needs to be conveyed to all team members.
• Consent. Informed consent is an essential element of providing
responsible care to patients and protects them from overt unseen,
aggressive surgical insults. As a shoulder surgeon, I am careful to
include "SURGICAL ARTHROSCOPY" in my consent with the intent of
including possible procedures that may ensue during the course of a
surgical arthroscopic procedure, such as debridement, chondroplasty
and bone spur contouring. The conversations I have with my patients
pre-operatively explain the likely and not-so-likely findings possible
during surgery and the expected course of action.
Some team members dissent when they perceive surgical treat-
ment exceeds the purview of the consent. Thankfully, such a well-
intentioned approach will prevent an irresponsible surgeon from
making large open incisions when the consent read "ARTHROSCOPY."
However, should there be an issue at stake when the surgeon elects
to remove a loose body, not seen on imaging, when the terms "LOOSE
BODY EXCISION"
are not listed on the surgical consent? Similarly, if the
surgeon encounters an incidental small rotator cuff tear, again, not
seen on pre-operative scans, should it be repaired even though "CUFF
REPAIR"
is not expressly listed on the consent? Is it better to forgo
treatment if concerns exist about disclosure and risk another anesthe-
sia?
Cutting Remarks
CK
1 2 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 6
