Surgery should not be entertainment

VIEWPOINT By Mr David Ward
Royal College of Surgeons council member

Image caption,
Videos can be pre-recorded for educational training or information

Advances in medicine and technology have seen the practice of 'live surgery' - the real-time transmission of surgical procedures to an audience - become increasingly popular.

But in this week's Scrubbing Up, Mr David Ward, of the Royal College of Surgeons, argues that this could be putting patients at risk and that live surgery should only be used for educational purposes.

Medical television shows are extremely popular with British audiences, we are all intrigued to hear the 'real' story from operating theatres, wards and clinics across the country.

Small wonder, as many of us will one day undergo an operation and when it happens it will be a major event in our lives, so we need to know what it involves.

What are the boundaries?

Recent advances in medical and media technology though have enabled us to push the boundaries and broadcast surgical operations in real-time across the world.

And in the field of surgical education this has been an immense step forward.

In the past a pioneering surgeon in Australia developing a new procedure would have to fly around the world to demonstrate his new technique; now that surgeon can arrange a live feed and transmit his knowledge more quickly.

Unsurprisingly, this has created much debate in the surgical community about where the boundaries of 'live surgery' should lie.

While many acknowledge that the general benefits of observing an operation should be available to everyone, such as demystifying a procedure or inspiring future doctors, many feel that to ensure the highest standards of patient safety public broadcast of surgery should be pre-recorded and not a 'live' TV event.

A recent debate on the topic at the Royal College of Surgeons concluded that 'live surgery' was unethical for a television broadcast and could not be recommended.

This is because the patient bears the brunt of the risk during live surgery while others stand to gain the most benefit. With the foundations of the best surgical practice rooted in patient safety, privacy and consent it is difficult to see what patients gain from having their surgery publicly observed

Safety worries

There are also safety concerns - such as the distraction of hosting a live event. A surgeon and the team could split their concentration between the patient and the public audience and unwittingly adapt the operation or delay elements of it for the benefit of the 'lay' observer.

There could also be risks as surgeons may be asked to operate in an environment which they are not familiar - for example using different instruments to provide the lay audience with a better view or having to work to a broadcast schedule which results in their patient may be anaesthetised longer than normal.

Surgeons may also not feel they have the power or control to terminate a procedure being publicly broadcast.

And what about protecting privacy? Patients may disclose unanticipated personal information live on air leading to a distasteful or sensational portrayal of surgery.

As well, do patients believe that agreeing to have their operation broadcast will result in their surgery being done better or earlier? Are they, along with the surgeon, putting themselves forward for the operation for self-promotion?

We are not saying don't show operations to the public; just don't show them live - pre-record.

The public can still gain an understanding of surgery and feel informed, reassured and inspired, but without as many risks.

Broadcasts used to train surgeons are fundamentally different. Most operations undertaken in NHS hospitals do so with junior surgeons being trained and gaining experience.

By extending that opportunity out of the operating theatre through training broadcasts the small risks for the patient are balanced against the needs to ensure that the next generation of patients will be treated by fully trained professionals.

No such direct patient benefit exists for the general public in live surgical broadcasts.

The medical profession agrees that operating theatres should not be closed places, but we have to balance explaining our work to the wider world in a way that has the least potential impact on the patient being treated that day.

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