Imagine you’re on a flight to visit your loved ones whom you haven’t seen for years. You’ve just finished the meal service and you’re enjoying a movie, unknown to you the pilot suddenly has a heart attack. What happens to the plane and to you? This is a scenario that airlines around the world need to consider every flight that ever takes off no matter if it’s a ten minute joy ride around the broad water or a long haul flight to Dallas. Airlines need to have a plan…..and similarly it is something that needs to be planned for in the operating theatre. In the air it’s the co-pilot; in theatre it’s the surgical assistant.
Why do surgeons need an assistant?
Very few operations can be done by just the surgeon and a nurse. Most procedures require a surgical assistant. The surgical assistant is present as a second pair of eyes as well as a second pair of hands in an operation. Most importantly they are another qualified doctor in theatre experienced in the surgical procedures in case of an emergency. This helps to ensure the smooth running of a surgical procedure and provides a safety net should an emergency occur.
Assistants are trained to assist in specialty surgical procedures. The majority are qualified doctors, often GPs, and have an interest the fields they most often assist with. They are up to date with current techniques and procedures in order to provide support to the surgeon. Many have performed the procedure hundreds of times with their surgeon and they ensure the best possible outcome for the patient. Assistants participate in the vital quality assurance procedures necessary for optimum patient care. This includes processes such as the “Final Check” where staff double check patient allergies and confirm the correct patient, procedure and site of the operation. Last but not lease having a suitably qualified and experienced assistant speeds everything up. This is especially important when trying to reduce anaesthetic times. In addition it is widely known that a long surgical time has been linked to increased risk of infection, so increased efficiency and speed in an operation wherever possible can reduce the risk of infection.
For more information please see the Royal Australian College of Surgeons position paper on surgical assistants.
How are assistants reimbursed?
In Australia surgical assistants work almost exclusively in the private health system. The role of the assistant in the public system usually falls to the more junior training doctors. As a fully qualified medical practitioner, the surgical assistant determines the cost of assisting at a particular operation and should bill accordingly. Each year The Australian Medical Association releases a list of recommended schedule fees for all procedures and consultations by medical procedures and the assistant should use this to guide their pricing. In some instances the medicare rebates and the patient’s health fund will cover the entire cost of the assistant, for example if a fund has an appropriate “no gap” arrangement with a particular hospital or group of practitioners. In some cases the medicare and health fund rebate will not cover the entire cost of the assistant, as with all medical costs in hospital, and the patient will have to pay an out of pocket expense.
The exact process for billing will differ between hospitals and assistants but most often the patient will receive an invoice similar to the paperwork sent out by the surgeon and the anaesthetist. They can then pay the invoice directly and later claim their health fund and medicare rebates. Alternately they could speak with their assistant and pay the gap only and then authorise their assistant to receive medicare and health fund rebates on their behalf to finalise payment. An unexpected bill after surgery can obviously be frustrating for some patients especially since they may not remember meeting their assistant. This most often occurs when an operation is undertaken at short notice or in an emergency.
I have an operation coming up- how do I find out more?
When preparing for any type of surgery it is important to undertake informed consent for the procedure. This includes financial consent. It is important to speak to your surgeon about the procedure that is to be undertaken and to ask if an assistant will be required. If the answer is yes you are entitled to receive information on who will be assisting and what their costs will be prior to the procedure. Even if you have agreed to a procedure already it is never to late to get more information. Speak to your surgeon again or ask your admitting nurse. While it is often not possible to meet your assistant prior to your hospital admission you can ask to meet them in hospital before your procedure for your own peace of mind. For an idea of surgical assisting costs click assisting.
This is a quick summary of the importance and necessity of having a qualified experienced surgical assistant at your operation. If you would like any further information please fill out the following for details and I look forward to answering your questions.