July/August Ethics Reader Poll Results
Uri P. Hadelsberg, MD, MBA
Hadassah University Medical Center Jerusalem, Israel NASS Ethics Committee
Noam Stadlan, MD Department of Neurosurgery, North Shore Hospital Evanston, IL Chair, NASS Committee on Ethics & Professionalism
Below are the results from the July/August Ethics poll.
If there is an option for treatment that you personally do not perform (for example a specialized injection, MIS technique, OLIF, etc), under what circumstances should you discuss that option with the patient?
Always
Only if there is a significant benefit to that option compared to what I perform
If there is minor or equivocal benefit to that option—the patient should know all reasonable options
As long as what I can do will provide an adequate result, I would not mention the other options
Never
Response from Dr. Hadelsberg
My response to the poll question would be one of the first two options: only if there is a significant benefit or always. Regarding the options, always is a good answer if we had very strong guidelines. However, the data for many of these instances is equivocal and nonrigid at best. In addition, it really depends on the patient themselves. Some patients read about a variety of options, many of which are irrelevant to their treatment, but still may ask about these options. On the other hand, some patients just want a clear-cut answer regarding what type of surgery should be done. The advantage of always sharing what options are available is you are planning the surgery with the patients themselves. Personally, I do stick to my routine types of operations. If there’s a viable option which I don’t offer as of yet, I would suggest that if the patient asks about any other surgical option. Dr. Stadlan—Further Analysis
Thank you Dr. Hadlelsburg for the excellent insight. This question illustrates a potential conflict between surgeon interest (desire to perform a procedure) and patient benefit. I think in general we should err on the side of patient benefit. So, if there isn’t significant benefit to the alternatives, there is no obligation to discuss them. One way to think about it is to place yourself in the position of the patient. What information would you want to know if you were the patient?