South Korea Turns to Surveillance as ‘Ghost Surgeries’ Shake Faith in Hospitals | Hacker News Reader

South Korea Turns to Surveillance as ‘Ghost Surgeries’ Shake Faith in Hospitals

nytimes.com

58 pointsbookofjoe31 comments

Retired (1977-2015) neurosurgical anesthesiologist here.

Clipping an intracranial aneurysm is among the most delicate of all operative procedures. One tiny slip and the artery bursts and a patient can die before the neurosurgeon can regain control and locate and stop the bleeding with a clamp. This is because the aneurysm is located deep inside the brain and the magnified surgical microscopic view must be abandoned because the operative field is suddenly filled with pulsatile blood flow everywhere. As the anesthesiologist my job is to immediately lower the patient's blood pressure using a rapidly acting vasodilator to a.) decrease blood loss to a minimum and b.) enable the neurosurgeon to better visualize the flooded operative field. Suction sometimes cannot clear the field enough to find the damaged blood vessel. I have watched this happen on several occasions from a vantage point 1-2 feet away on the other side of the surgical drapes in major teaching hospitals (UCLA and the University of Virginia).

The gold standard of neurosurgical care in these institutions translates as follows: 1. A senior neurosurgery resident ((in year 6 or 7 of their 7-year-long residency) preps and drapes the patient and after anesthesia induction, proceeds to locate and expose the aneurysm. This can take 2-4 hours under a high-powered surgical microscope.

2. The attending is contacted and told the aneurysm is ready for clipping. The attending may be anywhere, in or out of the building, doing anything. Sometimes they're in a nearby OR doing another case. I've waited as long as an hour for the attending to arrive, with the operative field covered with wet dressings and music playing to pass the time. That's some pretty expensive OR time BTW for which the patient will be billed.

3. The attending arrives, clips the aneurysm, and leaves. This can take anywhere from 15 minutes to several hours depending on the complexity of the case.

4. The neurosurgical resident closes the brain/dura/skull/scalp, taking anywhere from 2-4 hours.

My bona fides: https://scholar.google.com/citations?user=5DdrMc8AAAAJ&hl=en

This is fascinating, neurosurgery really is something else. I am surprised it takes that long to close.

Because of the huge downside should postoperative bleeding occur necessitating reexploration, there are numerous 5-10 minute "holds" while closing during which NOTHING happens: the neurosurgery resident simply stands there, looking for even the tiniest ooze or bleed and then cauterizing it.

I kind of feel the same thing happened to me a long time ago when I broke my ankle, the entire time I was attended to by a orthopedic surgeon and it was made out as if he was the surgeon who would operate, however my surgery was done by an intern / student. I was only aware of this because I was semi conscious despite being under full anesthesia. Afterwards the surgeon followed up. I never made any waves and I guess it turned out OK and I'm grateful for the repair but it was kind of bait and switch.

Was the orthopedic surgeon present in the operating room? If so then he basically did perform the surgery, even if the hands-on work was done by other members of the surgical team. If the surgeon wasn't present at all, and didn't make that clear during the pre-op consultation, then that would seem unethical.

nonsense.

there is a world of difference between someone that does the procedure 50-100x/year, vs someone that does it 2x/year.

experienced surgeons operate faster. lower blood loss. no unnecessary trauma. less inflammation. less swelling, faster recovery, fewer side effects.

>experienced surgeons operate faster. lower blood loss. no unnecessary trauma. less inflammation. less swelling, faster recovery, fewer side effects.

Whether these relative differences add up to anything that matters depend a hell of a lot on the surgery in question and how good the "experienced surgeon" is in the first place.

Agree, and at some point you have to let the inexperienced surgeon operate or in 20 years there will be no experienced surgeons. Not to mention the "inexperienced" guy has been doing it for 4 years.

A student or intern (first-year resident) doing your surgery in orthopedics would be pretty shocking. If that’s really the case you should be upset.

In teaching hospitals in the US, orthopedics is a 5 year residency (after 4 years of med school). Technically residents are in training but they are MDs.

Oftentimes (again in teaching hospitals) attending surgeons (the person whose clinic you went to) might “run two rooms” in parallel. Usually because there is a lot of prep time, anesthesia time, etc so they offset patients allowing them to tackle more cases in a day.

To the general public this sounds super horrible but in practice you were likely operated on by a 4th or 5th year training, ie someone with 12 years of medical training if you include premed undergrad. And the attending was likely in the room and maybe even did the hard bits of the surgery.

It’s a tricky balance because running two rooms ultimately may keep costs down (more productive, etc) and can provide more opportunities to train the next generation of surgeons.

Source: family in orthopedics.

Well I understand that new surgeons don't come out of nowhere, everyone is green at some point so I understand the basis for this but I guess I would have appreciated the heads up prior.

> Ethicists and medical officials, including those at the American College of Surgeons, have cautioned that surveilling surgeons to deter malpractice may undermine trust in doctors, hurt morale, violate patient privacy and discourage physicians from taking risks to save lives.

It seems that cause and effect are switched: cameras are installed because trust is low, not the other way around. If physicians are taking risks that cannot be justified, video-recorded or not, then maybe those risks shouldn't be taken.

In any case, these claims of lowering trust, morale, privacy, and efficacy are pure speculations. We need data to support these claims. Before any data is firm presented, it seems reasonable to at least consider installing cameras to catch these criminals.

A surgeon might choose to let you die in a bland but predictable way if they think they might be sued for their heroic (but perhaps not RCT proven safe) efforts.

I agree that bad surgeons and immoral practices need to be stopped but the line between best intentions and unjustifiable risks isn't black and white when you step outside the textbook cases.

>About 100 cases of ghost surgeries were prosecuted in the five-year period before 2018, according to the health ministry. But between 2008 and 2014, about 100,000 patients were victims of ghost surgeries, the Korean Society of Plastic Surgeons has estimated.

Wow, that's a pretty large number. I can see how this could have society-wide impacts

"Victims" are somewhat charged terms, because those PA nurses [1] are often better at surgery than anyone else, even compared to real surgeons. In some sense they are battle-tested PAs without PA-level compensations and legal protections, making them attractive in many hospitals. PA nurses are not in the position against this practice. The original article didn't interview any nurses or representatives from nursing organizations (say, the Korean Nurses Association), thus completely missed this point.

[1] PA stands for physician assistants but otherwise doesn't bear any relation with actual formally trained PAs.

"Victim" still feels appropriate, on grounds of what should be the pretty basic expectation to be transparent with the patient. I know it's not feasible to exhaustively explain the entire sausage factory, but it's not difficult to avoid deliberately misleading them.

The real shadow doctor issue in Korea looks like this:

Doctor comes into surgery room or at least does the consultation -> anaesthesia -> inexperienced surgeon/non-surgeon comes into room while patient isn't awake and conducts operation

This is fraud, plain and simple. Especially in the plastic surgery sector (which is very established in South Korea), individual surgeons tend to have a reputation for having a certain style they achieve, which is what patients chose the clinic based on.

Victim is a perfectly suitable word.

I mean, they are still victims of those practices, but there is a reason that the Korean Society of Plastic Surgeons uses that particular term.

They seemed to have borrowed that from famous artists that have been doing this since the Dawn of time.

When I read "Ghost surgery", I think "surgery where nothing was done", not "surgery done by someone else".

Similar meaning to "ghost kitchen" or "ghost writer", I suppose.

but what about "ghost drivers"? E.g. Uber or another app showing drivers that don't exist on the map so that you're more likely to use their rideshare service.

In german, ghost driver means somebody driving on the wrong side of the road.

I’ve heard the term “cloud kitchen” more recently

imposter surgery maybe? I thought the same as you.

Surgery done by no one on record. They don’t exist. They’re a ghost.

https://archive.ph/gMQ1v

I don't see a paywall or account wall, why is this necessary?

Because there is one, you merely didn't hit the trigger criteria.

One is fed with such a respect and submission to medicine, doctors, and surgeons that oftentimes follows the straight path to a surgical procedure. They don't care about your well being, look, or health - they tick off a procedure, collect money, or experience required for the next level of specialization. It terrifies me that someday perhaps I will again need a help of these cunts.

it's "worse" in a sense because a lot of these ghost surgeries are in the plastic surgery field where people specifically go to these clinics and pay more for a certain look or outcome. having an experienced resident attend to u vs the attending is a bit diff in general surgery.

terrible analogy, but imagine you pay six figures to some agency to produce your site, introduce you to the team of designers who will be handling it, then they go and source it out to fivver or something lol. could be fine, but that's a complete bate and switch.

This happens in the US too - its rife in any place with surigical tourism.

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