Ethical Question with a Drunken Surgeon

[Lokhtar]

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A medical student has no obligation to provide any service to a patient who requests it. A phyician who does not feel capable of safely performing a procedure is not obligated to perform that procedure, even if a patient is demanding the procedure.

I'm not questioning the legality of the physician refusing any procedure he feels he cannot do safely.....

Anyway, I agree the situation is a little bull.

Frankly, this whole "island" thing is bull. The more interesting question is: you are a pre-med shadow. (so based on your position NOW) You've been invited by an anesthesiologist to observe a surgery. The surgeon scrubbing seems drunk (slurring words, odor on breath, unsteady on feet). What do you do?

I never ask ethics questions at interview. I have other fish to fry.

Is the right answer, "Push him aside, grab the scalpel, tell the anesthesiologist to put the thingamajig in the patient and do the surgery yourself?"

 

[Slack3r]

This question is ******ed. And why are we assuming that a surgeon would be too drunk to operate, but not drunk enough to talk an M3, who's possibly never even held a scalpel, through surgery?

 

[mauberley]

what do ya do with a drunken surgeon, what do you with a drunken surgeon, what do you do with a drunken surgeon early in the moorrrrrniinnngggg!

shave his belly with a rusty razor, shave his belly with a rusty razor, shave his belly with a rusty razor early in the moorrrrrniinnngggg!

👍 I definitely was humming that to myself too

I am so glad I'm not the only one who was thinking that.

 

[Chip N Sawbones]

Well, the first recorded instance of a cesarean section in which both the mother and baby survived was performed in 1500 by a Swiss pig butcher who used his job skills to operate on his wife, so in this case amateur surgery is technically possible, if frightening. Of course, this leads to a new ethical question-- Does the medical student operate, or the bacon slicer?

 

[Mbeas]

Well, the first recorded instance of a cesarean section in which both the mother and baby survived was performed in 1500 by a Swiss pig butcher who used his job skills to operate on his wife, so in this case amateur surgery is technically possible, if frightening. Of course, this leads to a new ethical question-- Does the medical student operate, or the bacon slicer?

solid argument

 

[DrMagic]

So say your on an island with your attending surgeon, and ur the 3rd year med student.someone needs emergency apendectomy and will die if you dont perform it. there is no one around to help you. the surgeon's breath reaks of alcohol. what do you do?

I think the surgeon should do it. Since the quantity of alcohol was not mentioned, I have talked to a surgeon once that in an ethics question, a correct answer would be to allow a surgeon to do a procedure after a single beer. If nobody, and I mean nobody is there, I'm sure a "drunken" surgeon and a third year medical student can figure something out.

 

[newdoc2013]

the greater omentum would strangle the sick appendix for a couple days - enough for the surgeon to sober up and perform the operation

 

[45408]

the greater omentum would strangle the sick appendix for a couple days - enough for the surgeon to sober up and perform the operation

Maybe. The patient also might get generalized peritonitis and go into septic shock.

 

[postbacpremed87]

Hahaha

I'd say it's time for both you and the surgeon to put down the bottle.

 

[newdoc2013]

Maybe. The patient also might get generalized peritonitis and go into septic shock.

truth.

 

[Holderlin]

Well, the first recorded instance of a cesarean section in which both the mother and baby survived was performed in 1500 by a Swiss pig butcher who used his job skills to operate on his wife, so in this case amateur surgery is technically possible, if frightening. Of course, this leads to a new ethical question-- Does the medical student operate, or the bacon slicer?

I always say surgeons are skilled butchers. Most people don't agree.

 

[LizzyM]

My mom, a surgical ward nurse, always said uroloists were plumbers.

I suppose by that logic, orthopedic surgeons are carpenters.

With transcranial stimulation catching on, soon neurosurgeons will be glorified electricians. 😉

 

[slatermd]

And ENTs are nose pickers.

not srs.

 

[DrMagic]

My mom, a surgical ward nurse, always said uroloists were plumbers.

I suppose by that logic, orthopedic surgeons are carpenters.

With transcranial stimulation catching on, soon neurosurgeons will be glorified electricians. 😉

Yes well said, so I wonder if ortho surgeons like Makitas better or DeWalts? My mom's hip surgeon was a Black and Decker type of guy.

 

[SouthParkMD]

i got this in an interview...and am still beating myself up over if i answered correctly

I don't get it, what exactly is this supposed to tell the interviewer about you? Such a pointless question.

 

[45408]

Let sleeping threads lie.

 

[rahmadi]

i would find a well trained monkey to do the procedure.

 

[ESzczesniak]

A medical student has no obligation to provide any service to a patient who requests it. A phyician who does not feel capable of safely performing a procedure is not obligated to perform that procedure, even if a patient is demanding the procedure...

That's not always precisely correct. There are a number of procedures that if you are not willing to personally provide (assuming you're boarded/trained appropriately), then you must provide referal to an appropriate provider to complete. The classic of these examples or abortions of medical necessity. While an obstetrician is not required to personally perform this procedure, they are required to be able to provide this procedure when indicated...even if performed by another provider. The specifics of this vary by state law and in some states, this obligation to either perform, or refer to another provider who will, is compeltely non-existent. In others, it is very clear and rigid.

So technically, it is true that you never have to perform a procedure that you do not wish to peform. However, in some cases, you are still responsible to be sure that procedure can be performed when indicated.

This is more an issue with not ethically wishing to provide the procedure rather than not feeling capable of performing the procedure. Then we just get in to issues of core competencies...

 

[deleted185747]

The same rules apply if you come across a MVA and the patient needs a chest tube.

Don't do it unless you are experienced and can do it safely. Shoot, it you are not experienced how can you even decide on the acuity of the situation?

And above all- do no harm.

 

[mitchlucker]

You know guys, what about the patient doing his own surgery? We need to think outside the box in situations like this.

 

[AZFutureDoc]

I don't even know how to prepare for ethical questions in interviews. I'm more nervous about getting asked an ethical question than I was about the mcat!!!

 

[deleted393595]

So say your on an island with your attending surgeon, and ur the 3rd year med student.someone needs emergency apendectomy and will die if you dont perform it. there is no one around to help you. the surgeon's breath reaks of alcohol. what do you do?

Maybe he disinfects his mouth by rinsing it with alcohol?

 

[afreaknamedpete]

Maybe he disinfects his mouth by rinsing it with alcohol?

This is an island in the middle of no where that may or may not have the necessary surgical equipment... that way he can do the surgery with his teeth! Brilliant!

 

[AZFutureDoc]

I have heard from a couple friends who scrubbed in on surgeries during their first year of med school at an ivy league school, that the surgeon let them make some very simple incisions during surgery. I also know that this happens with third and fourth years during their rotations. For the sake of argument, if this is a simple surgery, why would it be illegal for the drunk surgeon to help the MS 3?

If the surgeon simply cannot operate, and the patient will surely die without surgery, would it be wrong to operate as an MS 3? It's either a 0% chance of life, or a non-zero % of life. If the MS 3 operating means the patient has a better chance of living, doesn't that count? Wouldn't an ethics board, or whoever would review what happened be able to see the impossibility of the situation? Wouldn't their compassionate side see that this was the best thing for the patient?

 

[ponyo]

You know guys, what about the patient doing his own surgery? We need to think outside the box in situations like this.

Not sure why this thread was revived, but can't believe nobody brought this up: http://www.bmj.com/content/339/bmj.b4965.full

I suspect that doing an appy on yourself, even as a certified surgeon, is probably much riskier than having a drunken surgeon operate. This guy is insane.

There's also Jerri Nielsen who was a doctor but not a surgeon, also in Antarctica, who biopsied her own breast and then gave herself chemo.

 

[Morsetlis]

So say your on an island with your attending surgeon, and ur the 3rd year med student.someone needs emergency apendectomy and will die if you dont perform it. there is no one around to help you. the surgeon's breath reaks of alcohol. what do you do?

Evacuation flight to Miami or Barbados. It's in our insurance plan!

 

[MrBananaGrabber]

Not sure why this thread was revived, but can't believe nobody brought this up: http://www.bmj.com/content/339/bmj.b4965.full

I suspect that doing an appy on yourself, even as a certified surgeon, is probably much riskier than having a drunken surgeon operate. This guy is insane.

There's also Jerri Nielsen who was a doctor but not a surgeon, also in Antarctica, who biopsied her own breast and then gave herself chemo.

Wow that story is incredible, I can't believe he survived!

 

[KaplanKrackers]

Yes that is a much better question. I would bring it to the anesthesiologist's attention. The next logical question is the anesthesiologist tells you to mind your own business so what do you do now? I would answer that I would probably keep my mouth shut. Your duty to act as a premed shadow is basically nil, and if a whole OR full of nurses, scrub techs, residents, and anesthesiologists is ignoring the situation than there is probably another explanation. Either way you've done your duty by telling the anesthesiologist, and it's on his back now.

I would assume that of course the anesthesiologist would deny it if you brought it up to him. I'd go up to another doctor, or one of the nurses and say "I realize I am probably just imagining things, but I think I may have smelled alcohol on the anesthesiologist's breath", then let them handle it from there. If that doctor/nurse tells you you're crazy and doesn't look into it...well I'm done answering hypothetical questions.

 

[artsciencelove]

I think we are all ignoring the really important question:

What's the nutritional value of a septic human appendix, grilled medium rare over an open flame?

 

[Epen]

I think we are all ignoring the really important question:

What's the nutritional value of a septic human appendix, grilled medium rare over an open flame?

I once ran across a mention of some awesome researcher that calculated the nutritional value of human flesh. Too lazy to search for it again...I think it was in a Mary Roach book.

In other words, that information is probably out there somewhere

 

[Morsetlis]

Well, the first recorded instance of a cesarean section in which both the mother and baby survived was performed in 1500 by a Swiss pig butcher who used his job skills to operate on his wife, so in this case amateur surgery is technically possible, if frightening. Of course, this leads to a new ethical question-- Does the medical student operate, or the bacon slicer?

The original surgeons were barbers.

Hippocrates forbade physicians from performing abortions.