THE MORAL HAZARD OF CONCURRENT SURGERY

Nobel Prize winning economist Paul Krugman described Moral Hazard as “…any situation in which one person makes the decision about how much risk to take, while someone else bears the cost if things go badly”. The fidelity of some surgeons to their patients has been brought into question by recent press reports exposing a practice whereby one attending surgeon will be responsible for two patients undergoing surgery simultaneously. This is variously referred to as Overlapping Surgery, Concurrent Surgery, Simultaneous Surgery, Double-Booked Surgery or Ghost Surgery. This practice entails surgeons in training (residents and fellows) performing varying degrees of the patient's surgery while the attending surgeon is operating elsewhere. In general, the patient is not informed of this substitution. When informed, most would not allow it. Defenders of this practice site surgeon and hospital “efficiency”, independent operating experience by trainees, mass casualty triage and access to “in-demand” specialists. Criti...