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Ann Thorac Surg 2005;79:1092
© 2005 The Society of Thoracic Surgeons

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Correspondence

The Third Option

All India Institute of Medical Sciences, CT Centre, AIIMS, New Delhi 110029, India

(E-mail: asampath_kumar{at}hotmail.com).

To the Editor:

Drs Kouchoukos, Cohn, and Sade are to be congratulated for bringing out the issue of ethics so succinctly [1].

In addition to the pro and con arguments, there is scope for a third concept—com, or compromise. Perhaps it is a more attractive option for the case in point. Looking again at Mrs Barefoot's problem and Dr Click's dilemma, I can see another possibility. What if Dr Click were to call Dr Wisdom (the expert with more experience in the Ross procedure at the Crosstown Memorial Hospital) and request his help in performing a Ross procedure at University Hospital (the hospital where Dr Click practices). This would provide Mrs Barefoot the best option, safeguard her interest, and give her the opportunity to be operated on by 2 surgeons with a vastly greater combined experience. Dr Click would have offered the most ethical solution to Mrs Barefoot. In addition, Dr Wisdom would be contributing to professional ethics by improving Dr Click's ability to perform a Ross procedure with greater confidence now and in the future. Perhaps they could even share the professional fees. If Dr Wisdom were to refuse to help, he would be guilty of putting his personal interests before those of the patient and the profession.

Working in an academic institution, my colleagues and I use this option regularly. For example, as a surgeon with experience in mitral valve repair, I am happy to assist a colleague perform this operation. As a result, the patient receives the most appropriate procedure, my colleague learns to do the operation with greater confidence, and I earn the satisfaction of having shared my knowledge and experience. Professional colleagues in such situations should put aside individual considerations and barriers to delivery of quality health care to their patients. I am a bit disappointed that Drs Kouchoukos, Cohn, and Sade did not consider this more ethical and professionally elevating option.

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1. Kouchoukos NT, Cohn LH, Sade RM. Are surgeons ethically obligated to refer patients to other surgeons who achieve better results? Ann Thorac Surg 2004;77:757-760.[Free Full Text]

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