American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

2019 John J. Conley Ethics and Philosophy Lecture

What We Talk about When We Talk about Surgery

Margaret "Gretchen" Schwarze, MD, MPP, FACS

It was a tremendous honor to give the John Conley Ethics and Philosophy lecture at the Clinical Congress in October 2019. As I think back to that time and what we have been through since, I have a feeling of "Wish I didn't know now what I didn't know then." As much as things have changed, much of what we do has stayed the same. People are still sick, and we as surgeons are still here to take care of them.

My talk is based on more than a decade of empirical research, audio recording surgeons talking to patients about major surgery. My primary point is that working with patients to figure out if surgery is right for them is a skill, which requires deliberate practice and thoughtful preparation.

Preoperative communication is the most frequent procedure we do. Still we are using a clunky process of informed consent, which hasn't changed since it was first implemented in the 1960s. The components of informed consent proposed by bioethicists and legal scholars are ideally designed to support patient autonomy, yet our approach hasn't evolved over time to keep up with the needs of our profession and the needs of our patients.

Given we are innovators in surgery, creating solutions to problems as they arise, I am perplexed that we haven't innovated in this critical surgical domain as well. Herein, I make the case that these conversations matter, describe precisely what we currently say to patients, and consider strategies to do better. Illustrious members of the audience enrich the Q&A with a fantastic dialogue.