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Thursday, 12 April, 2001, 23:14 GMT 00:14 UK
Guidelines for surgeons over deaths
scrubbing up
Under pressure: preparing for an operation
Surgeons are being urged not to carry out other operations if they have lost a patient earlier the same day.

Professional guidelines are to be drawn up after a survey, published in Friday's British Medical Journal, revealed that many were prepared to do just this.

Many health professionals believe surgeons - and the rest of their operating teams - would not be at their best in this situation.

A small questionnaire survey conducted among orthopaedic surgeons revealed that the majority of those who lost a patient had gone back into theatre later that day to complete their operating lists.

Of the 31 surgeons who replied, 16 had experienced the death of a patient during surgery - and 13 of these had performed more operations on the same day.

Eight of the 16 said they felt that some time away from operating would have been appropriate, although the prevailing attitude was that adjusting to the death of patients was "part of the job".

Fatal accident inquiry

The debate was first raised following a Scottish fatal accident inquiry into two deaths at Falkirk Royal Infirmary on the same day, and involving the same surgeon, Nigel Harris.

Mr Harris was cleared of any blame for the deaths, but a leading surgeon in his field, Professor Sir Alfred Cushieri of Ninewells Hospital in Dundee, told the inquiry that a surgeon in this situation would not be "emotionally or mentally" in the right frame of mind to operate.

The inquiry report backed this view, as did the Royal College of Surgeons in Edinburgh.

Its then president Professor Arnold Maran said: "We can understand the pressure that single surgeons are under, but I think there would be a very strong feeling that, when a surgeon loses a patient, he should not continue operating that day."

However, there are still no professional guidelines on the issue.

Professor John Temple, the current president of the Royal College, said it was his intention to produce some as soon as possible.

Any team which lost a patient unexpectedly during an operation which had been planned in advance, should "stand down" for the rest of the day, he said.

"When you are dealing with a profound blow, such as losing a patient on the operating table, I don't think you should be operating again that same day.

"For a surgeon, a death under any circumstances is always distressing, but when it occurs when you don't reasonably expect it, it's difficult for a surgeon to turn round and cold-heartedly carry on."

He said that emergency cases were a different matter - a surgeon would be prepared in these circumstances to find that there was nothing they could do for the patient.

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See also:

02 Aug 99 | Health
Risk from overworked surgeons
15 Mar 99 | The Bristol heart babies
Tough new rules for surgeons
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