I personally think it is not the job of the Anesthesiologist to judge the competency of the surgeon. It is hospital's duty to hire competent surgeons. If anesthetist is concerned he should raise concern with the senior most surgeon on duty about the surgeon in question, but if the senior surgeon is satisfied with the competency of the person in question you write all the conversation in chart of patient and go ahead with the case. But be prepared as people will be raising concerns about your competency in future to your seniors as well and similar documentation will be seen in charts of patients. Mutual respect and confidence on colleagues is required but doesn't supersede patient safety. If you have witnessed any negligence or not happy with competency of certain person, highlight that in departmental meeting and take collective action so you could not be victimized.

Habib,

Great question. I have personally experienced this moral dilemma. I have switched assignments with others that didn’t have the same opinion (or the assignment change benefited them with an earlier release time). I have also made my concerns known to the registrar to avoid potential conflict. On occasion, I was able to identify a reason that the case could be canceled. Yasir is correct in that you open yourself up to potential criticism (and attack) for taking such a stance. Political strength (of the surgeon, his friends and allies) can be difficult to overcome. It is difficult to navigate but not impossible.

Move forward with moral strength! Good luck.

Christopher

I would be very careful to pass judgement on a colleague's competency in a speciality other than my own. Are you qualified to judge? are you a trained surgeon?

What would you achieve by declining the case - are you protecting the patient, or yourself? If he is truly incompetent and you decline the case, will your place be taken by an anaesthesiologist who is unaware of the surgeon's incompetence? In this situation the patient might be in even greater peril.

Another issue is what are the results of the surgeon's incompetence? Is there an obvious problem such as increased mortality or morbidity - do his cases bleed more and more often require transfusions? How do you see his incompetence in the OR - is he clumsy, does he perform the wrong procedures? (assuming you would know what the correct ones are). Does he have an increased rate of emergency reopening? etc., etc.

You are potentially opening a can of worms. It is important that you share your concerns with a senior colleague.

This sort of situation is best dealt with quietly and confidentially by a hospital board of senior, experienced clinicians to whom you might express your concerns and seek advice.

Sir

An anaesthesiologist definitely do not have surgical knowledge as a surgeon has in surgical field or skill. But it is also true that he is observing few surgeons in the same field. If a surgeon is slow, clumsy, I think it is not a problem rather than just few more minutes or hours of anaesthesia exposure. But, I personally have come across surgeons, whose patient has very high comorbidity, re-exploration including mortality.

I fully agree with you all that the situation should be handled by the chief in a board meeting or hospital council meeting. But unfortunately such facilities are many a time not present or not feasible.

In this case can anaesthesiologist counsel the patient? or can the anaesthesiologist refuse the case? Is there any such rule? At the end of the day, we all work for the betterment of patient. If this is in stack, an anaesthesiologist being known to it becomes part of it; what is the ethical and legal implication?

In the UK we are under increasing pressure from our ruling body(General Medical Council) to voice concerns about the relative abilities of our colleagues,together with dire warnings about the consequences for anyone who,knowing of an issue with a colleague's abilities,then does not voice that.

I think that we as anaesthesiologists are well placed to witness the skills of a wide variety of surgeons,and in some cases may have "seen" more cases than the surgeon has actually done.

It is a HUGE can of worms to open such discussions,and as both Christophers(!) have already said,it is very important to get the backing and consensus of other colleagues before going down that road.

In my own experience some years ago,this particular situation was found,and luckily a very clear consenus reached between the disciplines of anaesthesiology and surgery....for the most part though,such agreements can be difficult to find.

It is better for the patient and the surgeon to do that.

Kind of takes me back to the Stephen Bolsin case. Interesting parallels though he didn't categorically pick on a particular surgeon. How his life changed in the aftermath is testament to potential persoanl and professional outcomes.

Dear Habib Md Reazaul Karim Sir. I think this is a valuable issue in respect of safety and outcome of the patient. We face this sort of scenario not very infrequent during our day to day practice, specially in case of emergency or at odd times, when the senior surgeons are not available in position and they allow the juniors (as part of training) or those who are the subject of this discussion - to proceed. Sometimes, it becomes difficult not to raise this issue softly before going to anesthetize the patient.

I honor the valued opinions of my Sirs... Christopher C Rout , Christopher A Smith , Ian Ewart ... It is bitter, no doubt. Very logically, we all are concern about opening a can of worms, indeed. But, it should be vise-versa... if the surgeons don't feel comfortable and secured with their anesthetists...what should they do?

However, I seek favor from our seniors, we require their encouragement and support so that we can talk regarding the affairs of skills for the sake of patients' well-being. Regards- Rabiul.

Md Rabiul Alam Sir, you are quite correct. The relationship between the surgical team members (mutual respect) is a cornerstone of patient safety and outcomes. I, too, respect our seniors, for we stand on their shoulders as our juniors will stand on ours. No healthcare provider should remain silent at the cost of patient safety. Thank you my friend for bringing your perspective to this discussion.

Warmest regard,

Christopher

Interesting discussion. But a very careful caution is required to keep patients' trust on us (healthcare providers). I would suggest you to leave/pile up rationales on why your colleagues need to carefully consider a co-work with the problematic surgeon so that you can get mutually agreed decision making.

Yes sir I also encountered with such poor surgeons .It is a great stress to the Anaesthesiologyst.We used to modify our techniques such as getting more wide bore cannulae, arterial line, central line depending on the surgeon's caliber,anticipating inadvertent complications...

Dear Colleagues

Dear Dr Karim

I think we can’t reply to this question without considering situation of operating room , hospital , patient general condition , where we are working , patient information about himself, surgeon character and etc .

we don’t work in an abstract place . I am working in an Educational hospital, I was watching so many surgery residents from bugging and many of them are expert surgeon now. If we have access to a more experienced surgeon or patient has not an emergency disease we can postpone operation with respectful manner . Although, we are working in a remote area with very ill patient and one surgeon in access we have no choice , sometimes what happens which is completely different from our prediction. We must consider there are many Operating Room Nurses who are so competent and the can leading surgeon to a better plan . I saw many surgeons who are in a great stress about what must do . They are human beings like us .

with Respect

Taravati Hossein