Statement on Principles Underlying Perioperative Responsibility

The following statement was approved by the College's Board of Regents in February 1996.

1. The surgeon is responsible for confirming the diagnosis for which surgical care is proposed. This responsibility should include the surgeon's personal review of all pertinent aspects of the patient's case. Appropriate consultation should be requested, if necessary.
2. The surgeon is responsible for presenting to the patient the range of options available for the patient's appropriate management, including the surgeon's recommendations and rationale for a specific approach to treatment. Choice of a specific treatment must ultimately be up to the patient; in the event that 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 that of the patient.
3. The surgeon is responsible for obtaining informed consent from the patient, or, if necessary, from the patient's surrogate, after discussion of treatment. The surgeon is responsible for conducting the discussion and for documenting that it took place. The surgeon need not personally obtain the patient's signature on the consent form.
4. The surgeon is responsible for the proper preoperative preparation of the patient. Minimizing the risk of operation, while providing maximal opportunity for a satisfactory outcome, requires a full appreciation by the surgeon of the patient's condition. Achieving optimal preoperative preparation of the patient will frequently require consultation with other physicians; however, the responsibility for attaining this goal rests with the surgeon.
5. The surgeon is responsible for the safe and competent performance of the operation. Part of this responsibility includes planning for the operation with the anesthesiologist in order to ensure anesthesia that is best for the patient.
6. The surgeon is responsible for postoperative care of the patient. This responsibility includes personal participation in and direction of postoperative care, including the management of postoperative complications. The best interest of the patient is thus optimally served because of the surgeon's comprehensive knowledge of the patient's disease and surgical management. Even when some aspects of postoperative care may be best delegated to others, the surgeon must maintain an essential coordinating role. Should complications of operation develop, the surgeon 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 of the operation is predictably small. The surgeon is responsible for determining when the patient should be discharged from the hospital.
7. The surgeon is responsible for disclosing to the patient information related to the conduct of the operation, operative and pathologic findings, the procedure performed, and the expected outcome.
8. When the time comes that the surgeon will no longer be involved in follow-up of the patient, he or she is 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.

Reprinted from Bulletin of the American College of Surgeons
Vol. 81, No. 9, Page 39, September 1996