Nguyen Tuong-Nam, Silver David, Arthurs Bryan
Department of Ophthalmology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Que.
Can J Ophthalmol. 2005 Feb;40(1):34-7. doi: 10.1016/S0008-4182(05)80114-0.
Surgical teaching seems to be in conflict with the contract between surgeon and patient. We carried out a study to determine the prevalence of consistent disclosure to patients that a resident will perform part or all of their cataract surgery procedure. A second objective was to investigate the effect of such disclosure on patients' willingness to undergo the procedure.
We sent a survey to all 20 ophthalmologists working in our university-affiliated hospitals, inquiring about their practice of disclosure to patients regarding residents' involvement in surgery. Staff physicians were also asked to record their patients' consent to an operation performed partly or entirely by a trainee while under supervision.
Of the 20 surveys sent, only 5 (25%) were returned. Those who declined to participate in the study mentioned several reasons, including that such disclosure might increase a patient's anxiety level, that they might lose potential patients as patients might be reluctant to have trainees perform their surgery, and lack of time to talk to patients about these issues. Of the five ophthalmologists who completed the survey, four were part-time affiliated staff and one was a geographic full-time physician working in our institution. Four of the five ophthalmologists said that they do not consistently disclose residents' involvement to their patients. Of the 49 patients enrolled, only 8 (16%) agreed to undergo the procedure after being informed that a trainee would be actively involved.
It is crucial to inform patients that residents may be involved in their surgery in order to avoid possible litigation. However, our results suggest that such disclosure may have a negative effect on surgical education because it could limit the number of cases available to trainees.
外科教学似乎与外科医生和患者之间的契约存在冲突。我们开展了一项研究，以确定向患者持续披露住院医师将参与其部分或全部白内障手术过程的情况的发生率。第二个目标是调查这种披露对患者接受该手术意愿的影响。
我们向在我们大学附属医院工作的所有20位眼科医生发送了一份调查问卷，询问他们向患者披露住院医师参与手术的情况。还要求主治医师记录他们的患者在接受监督下同意由实习生部分或全部进行手术的情况。
在发出的20份调查问卷中，仅5份（25%）被收回。那些拒绝参与研究的人提到了几个原因，包括这种披露可能会增加患者的焦虑程度，他们可能会失去潜在患者，因为患者可能不愿意让实习生为他们做手术，以及没有时间与患者谈论这些问题。在完成调查的5位眼科医生中，4位是兼职附属工作人员，1位是在我们机构工作的全职地理医生。5位眼科医生中有4位表示他们没有始终如一地向患者披露住院医师的参与情况。在登记的49名患者中，只有8名（16%）在被告知实习生将积极参与后同意接受该手术。
为避免可能的诉讼，告知患者住院医师可能参与其手术至关重要。然而，我们的结果表明，这种披露可能对外科教学产生负面影响，因为它可能会限制实习生可获得的病例数量。
