|
Increasingly we hear talk about the use of groups in medicine, whether it's interprofessional healthcare, error reduction, or team-based treatment approaches. I had a couple of experiences over the past few weeks that have me thinking about another version of team medicine — surgical teams. Now, this may seem obvious on the surface. "Of course there are surgical teams; that's how every surgery works. How is this any different?" Before you write me off as wasting your time, let me set the scene.
For the first five years of my career, I was a solo surgeon. Almost every case I did, whether it was a hammertoe, bunion, or major reconstruction, was done by me without an assistant (besides the scrub tech). I didn't have students, residents, or other local docs to assist with my cases. I didn't have a problem with this; I figured it was part of the job.
Fast forward to the present, where I'm now a professor at Western University, and I have seven other potential podiatrists with which to do cases. A few days ago, I had a surgical case for which I requested assistance from one of my partners, Bora Rhim, DPM. For those interested, this was a pediatric flatfoot/bunion case. I planned an endoscopic gastrocnemius recession, Kidner, Lapidus, and Akin osteotomy on a 16 year-old female (yes, she had closed growth plates). For reasons that I'll not go into, I have trust issues with this particular hospital and wanted an extra pair of eyes to rely on. Hence, my request to have Dr. Rhim help me. As it turns out, the case went very smoothly without any complications. Dr Rhim, was — as expected — an excellent assistant. The patient is recovering well.
The reason I bring up this episode is to highlight the unique advantages of having a physician as your assistant. Dr. Rhim and I functioned as a well-integrated team, moving the case along efficiently, while maximizing our focus on the many details necessary to make this procedure a success. I can confidently say that the positive results obtained for this patient are superior after our team effort than if I had performed the surgery alone.
I started wondering, "Would it always be better if all of our surgeries were done by teams of two surgeons?" This is probably old news to most podiatric surgeons, especially those who do major reconstructive procedures, and pretty obvious. In fact, Medicare reimburses surgeons an assistant fee for certain procedures of greater complexity. However, is there any proof that the results would actually be better?
To answer this question, I turned to the medical literature and did a Pub Med search. Interestingly, I only found one article from the literature that looked at this question. In 2006, Stephens and colleagues looked at the outcomes of esophageal cancer surgery, specifically esophagectomy, comparing the results between individual surgeons and a two-surgeon specialist team.1 The researchers found that a multidisciplinary team and surgical subspecialization significantly improved outcomes for these patients.
When I looked further into the literature I found…nothing. Unfortunately, I was unable to find any other primary clinical research that argued for or against a multisurgeon approach to procedures. We know, anecdotally, that various professions utilize this team approach. Take pathology, for example. Most pathology departments perform peer reviews of patient slides in an effort to improve diagnostic accuracy. Similarly, the morbidity and mortality reviews at most hospitals consist of multiple physicians reviewing cases with complications. Imagine how few of these morbidity cases there would be if there were more than one surgeon on those cases in the first place? Of course, we can't really know that for certain, since there's no research.
I propose a multicenter podiatric clinical study in which patients are randomized to one of two surgical groups, either a single surgeon or double surgeon procedure. Various outcomes and complication rates can be measured. We could also look at surgical times to case completion and overall operative costs, to see if the double surgeon approach is more economically efficient. It would, I think, be a unique study.
Until then, I think I'm going to ask my partners to assist with my cases more often. It was a rare treat to say the least!
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
REFERENCE: 1. Stephens M, et al. Multidisciplinary team management is associated with improved outcomes
after surgery for esophageal cancer. Diseases of the Esophagus, 2006; 19: 164-171.
Get a steady stream of all the NEW PRESENT Podiatry
eLearning by becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you. |
 |
This eZine was made possible through the support of our sponsors: |
Grand Sponsor |
 |
|
| Diamond Sponsor |
 |
|
Major Sponsors
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
