Today’s Boston Globe “Spotlight” includes a detailed investigation of Dr. David Samadi at Lenox Hill Hospital in Manhattan’s well-to-do Upper East Side. Dr. Samadi made $6.7 million in 2015 as “a specialist in robotic prostate surgery.”
But did he even do the operations?
As the Boston Globe points out,
A review of hospital data obtained by the Boston Globe Spotlight Team found that Samadi overlapped one case with another at some point in about 70 percent of his roughly 2,200 operations between mid-2013 and mid-2016. Hundreds of times, one operation overlapped completely with another. During Nadler’s case, which lasted more than two hours, Samadi had another operating room going for all but about 25 minutes.
The Boston Globe called this “simultaneous surgery,” but that’s not really correct. In the medical community, “simultaneous surgery” means doing two surgeries at once on a patient, which is often the appropriate thing to do, if it’s more dangerous to put the patient under anesthesia more than once, if it will reduce the time to heal after the surgery, or the like. The proper term is “concurrent surgery,” although it’s admittedly not as interesting a term for public consumption. I’d recommend it be called “double-booked surgery.” Everyone knows what that means.
This isn’t a new issue. It’s been increasing over the past decade, particularly as individual surgical practices have been gobbled up by large hospital and healthcare chains. Gone are the days when the individual general surgeon had their own medical practice and “privileges” at the hospital. Now hospitals are a money-making factory assembly line, where the goal is to do as many procedures as possible, and thus bill as much as possible. The end result is as bad as expected: untrained surgical residents are struggling their way through complicated and major surgeries while the “attending” surgeon is shuttling back and forth doing nothing more than take a quick glance to make sure the patient is still alive.
As Health Affairs pointed out last year, studies have consistently shown that patients are not properly informed about these “double-booked” surgeries. Indeed, as the Boston Globe report mentions, doctors and hospital often claim in their advertisement that the attending surgeon will perform the entire procedure. There are thus rampant informed consent problems, and those will likely form the bases for the medical malpractice lawsuits to come.
But I think we need more than just lawsuits. States should require that doctors tell their patients in writing if there is any chance that the attending physician will leave the operating room during the procedure. That’s the only way that we can assure patients even know about this process, and the best way to discourage hospitals from doing it.