Statement of Principles Underlying Surgeon Responsibility Toward the Patient

The following statement was revised by the Board of Governors Best Practices Workgroup and approved by the Board of Regents at its meeting in June 2026. The statement was originally approved by the Board of Regents in February 1996.

1. This statement refers to the surgeon and their responsibility towards the patient and their perioperative course. The ACS recognizes that there are many different practice settings in which an individual surgeon may not personally participate in patient care at each point along the continuum of the patient's perioperative course. This is especially true in settings where surgeons participate in team-based care, in large group practices, and in locum tenens. In all these settings, the responsibilities listed still need to be fulfilled, but they may be performed by multiple surgeons over the course of the patient's care. In such circumstances, care must be delivered in a coordinated, clearly defined manner, with structured communication and explicit handoffs between providers to ensure continuity, accountability, and patient safety throughout the perioperative period.
   
2. The surgeon or group of surgeons plays a vital role in establishing a rapport with the patient to convey a deep understanding of the surgical condition affecting them. This relationship should be grounded in patient-specific communication practices, including attentive listening, sitting at eye level with the patient, and recognizing the patient as a whole person rather than merely a diagnosis. In determining the best treatment options for the patient, the surgeon should also consider language differences, health literacy barriers, disability, regional resource gaps, social determinants of health, and other structural factors that may affect optimal surgical outcomes. The surgeon or a group of surgeons should also explore the patient's understanding of their condition, clearly explain the benefits of surgical intervention, disclose potential risks and adverse outcomes, along with strategies for managing them, and outline the expected course of recovery and rehabilitation. Importantly, the surgeon should remain engaged throughout the patient's surgical journey, offering continuity of care and support.
   
3. The surgeon or group of surgeons should utilize all available subjective and objective data to confirm the diagnosis for which surgical intervention is being considered. This includes a thorough history and physical examination, along with appropriate laboratory testing and radiographic imaging. This responsibility should include the surgeon's personal review of all pertinent aspects of the patient's case. An appropriate consultation should be requested from other medical team members if necessary.
   
4. The surgeon or group of surgeons is responsible for clearly communicating the full range of management options available to the patient, including both operative and non-operative approaches. This discussion should include the surgeon’s recommendation and the rationale behind the proposed treatment plan. All options should be presented in clear, simple language, avoiding medical jargon as much as possible to ensure patient understanding. In cases where medical complexity or the patient’s frailty may affect their ability to undergo surgery safely, these concerns must also be discussed openly. This approach supports a truly patient-centered informed consent process. Moreover, it is the surgeon’s professional responsibility to make their best effort, particularly in communication (e.g., use of professional language services), informed consent, risk assessment, postoperative planning, and transitions of care to ensure adequate conveyance of information related to their surgical care. The choice of a specific treatment must ultimately be up to the patient; if the patient is not legally competent to express a choice, for whatever reason, the decision of the patient's appropriately appointed surrogate must be substituted for the patient.
   
5. The surgeon or group of surgeons is responsible for obtaining informed consent from the patient or, if necessary, from the patient's surrogate, after discussion with them. The surgeon is responsible for leading the discussion and documenting its occurrence. The informed consent discussion should be documented in the medical record. The surgeon need not personally obtain the patient's signature on the consent form; however, the surgeon is responsible for the conversation around the surgical management, potential benefits, adverse outcomes, and alternatives in the surgical disease process.
   
6. The surgeon or group of surgeons is responsible for the optimal preoperative preparation of the patient. Based on each individual patient`s comorbid medical conditions, the surgeon should consider preoperative risk assessment and stratification, and tailor the necessary testing and management needed for the patient in collaboration with other consultant physician teams. The surgeon should serve as the team leader, coordinating consultations with other physician teams to prepare the patient for their surgical procedure.
   
7. The surgeon or group of surgeons is responsible for the safe and competent performance of the operation. This should include knowledge of the surgical instruments needed for the safe conduct of the operation, coordination with the operating room team for adequate and safe patient positioning, coordination with the anesthesia team for the appropriate anesthetic plan, and the need for additional lines or products/medications for the patient.
   
8. The surgeon or group of surgeons is responsible for the postoperative care of the patient. This responsibility includes participation in and direction of postoperative care, including decisions on inpatient versus outpatient disposition, pain medication management, early ambulation, initiation of physical and occupational therapy, and management of postoperative complications. Even when some aspects of postoperative care may be best delegated to others, the surgeon or group of surgeons must be involved in the care. Should postoperative complications develop, the surgeon or group of surgeons is best able to detect them and to provide or coordinate timely and appropriate therapy. This responsibility extends through the period of convalescence until the residual effects of the surgical procedure are minimal and the risk of complications is predictably small. The surgeon is responsible for determining when the patient should be discharged from the hospital.
   
9. The surgeon is responsible for disclosing information related to the conduct of the operation, operative and pathologic findings, the procedure performed, and the expected outcome to the patient.
   
10. When the time comes when the surgeon or group of surgeons will no longer be involved in follow-up of the patient, they are responsible for ensuring appropriate long-term follow-up for continuing problems associated with the patient's surgical care. All information necessary to provide care for those problems should be made available to the patient, the patient's primary care physician, the treatment team, or the consulting surgeon.