Simon came to my office with an invitation he had received to attend an international surgical conference in Europe. He had recently developed a new surgical technique in “keyhole surgery” that offers significant improvement on existing approaches.
The organisers of the meeting have asked him to demonstrate the technique and operation on a large surgery link to the 2,000 delegates with direct questions and answers during the operation. Simon was delighted to have the opportunity to present his new surgery on a world stage.
There were, however, several problems for Simon about this offer. He would be operating in a strange (and foreign) environment, and not using his usual equipment. Staff would not know him and his needs. And English was not their first language.
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Of even greater concern was the fact that the patient would be unknown to him. How could informed consent for a new procedure be gained from a patient when they don’t share the language? The organisers had assured Simon that the patient was very keen to have the new operation done by a world expert — without having even heard of the benefits or risks of the surgery.
Of even greater concern was the idea of performing in front of a 2000 plus audience. Surgeons are routinely asked to demonstrate procedures to medical students, trainees and colleagues, but this occurs in familiar surroundings with three to five spectators. If the operation planned needs to be changed or abandoned, this is easily done and no expectation is present that the procedure will be completed.
What pressures exist if 2000 surgeons are watching to see the procedure? How easy would it be to alter or abandon the surgery knowing the programme was built around the demonstration of the new technique? Even if it proceeds, what of the questions and answers while trying to concentrate on the task at hand?
Simon wanted some advice. My views to him can be best summarised as:
- The patient must come first.
- Surgery is not for public entertainment.
- If it is a less than optimal situation then surgery should not be performed.
- Surgeon/patient relationship is important no matter how willing the patient is to be a guinea pig.
- Follow-up of outcome and complications needs to be provided by the surgeon.
If the audience really wanted to understand the procedure, a well-edited video of the surgery presented to the meeting with open discussion, was far more acceptable. Watching the gladiator fight the lion in real time can only be seen as little more than modern day blood sport entertainment.
Unfortunately, Simon was so enthused by the offer to present to international surgeons he accepted the invitation. On his return he described the event as the most stressful operation he had ever performed. The patient was really not suitable and in the end he had to abandon the surgery. His excellent technique was brought into question along with his own abilities. Fortunately the patient did not suffer.
The lesson: live surgery must not be turned into reality TV for professional meetings.