Most surgeons feel pressure to operate in emergencies, even when patient won't benefit, study finds

Researchers at Baltimore-based Johns Hopkins University School of Medicine found most surgeons feel pressure to operate under severe emergency situations, even when they think it won't improve the patient's condition, according to a study based on conversations with 20 hospital-based surgeons.

Seven things to know:

1. "Conversations and decisions about surgical interventions and their risks are never easy, but they're even more difficult in emergency situations, and our study was designed to better understand — in a qualitative way — surgeons' thought processes during these times," said study author Fabian Johnston, MD. Few tools are proven to be effective in objectively measuring surgeons' decisions during these situations, Dr. Johnston said.

2. The study authors conducted interviews with 20 surgeons specializing in trauma, vascular medicine, surgical oncology and other areas to better understand how they make decisions during life-or-death situations.

3. All  participants practiced at two large academic medical centers: The Johns Hopkins Hospital in Baltimore and the Medical College of Wisconsin in Milwaukee.

4. During the interviews, the researchers asked surgeons what factors they found most important to consider when choosing whether to operate on a patient who has a potentially nonsurvivable injury or other acute medical issue.

The researchers presented the surgeons with two hypothetical case vignettes and 13 questions on what they would choose to do as well as what factors would go into the decisions.

5. Five themes emerged in the researchers' analyses of the conversations:

  • The importance of surgeons' judgment,
  • The need for surgeon introspection
  • The various pressures to operate: from the surgeons themselves, from the patients and/or their families, from colleagues or institutions and from society and our culture
  • The costs of operating — medically, financially and emotionally
  • The concept of futility and uncertainty around a decision to operate or not

6. Overall, the analyses revealed most surgeons leaned toward operating on patients despite or because of the uncertainty of perceived futility of treatment.

"As much as we internally believe when situations are futile and procedures shouldn't be done, that just goes against the grain of the pattern of practice in many parts of the hospital," one participant said. "So I think in those scenarios, I can't really say no to operating."

7. By laying out what factors concern surgeons most, the study could help in the development of objective tools that assess patients' risk, which could lead to more confident and patient-centered decision-making, Dr. Johnston said.

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