MAY 22, 2024
Question: A colleague has four practices in neighboring cities. He operates in one practice on one day, then travels to another the next day, and so on. I learned that his patients’ assessments for cataract surgery are delegated to his referring professionals, who appear to be licensed to provide these services.
Following the assessments, the patients are mailed informed consent materials from the ophthalmologist’s office. On the day of surgery, patients give their consent forms to the front desk staff, and then sit together with other patients awaiting surgery. Each patient is then taken, in turn, into the OR suite for cataract surgery. When I casually asked the ophthalmologist about this practice, he said he spot-checks the referring professionals’ work and that examining each patient prior to surgery is “simply not practical.” This seems problematic to me. Is this ethical?
Answer: The first provision of Code of Ethics Rule 7, Delegation of Services, is that ophthalmologists remain responsible for the eye care services provided by personnel under their supervision. Whatever the degree of delegation, the ophthalmologist is responsible for the quality of services provided by the eye care professionals to whom he has delegated the preoperative assessment of his patients.
It is ethical for an ophthalmologist to delegate the acquisition of the data required for the preoperative history and physical. However, the surgical planning and synthesis of information prior to surgery must be done by the operating ophthalmologist. The sur geon must discuss the findings and recommendations with the patient in advance of surgery rather than meeting the patient moments before surgery begins. Additionally, the ophthalmologist appears to be in violation of Code of Ethics Rule 2, Informed Consent by dispensing with the informed consent process and substituting paper forms in the mail. The patient’s only apparent opportunity to ask questions of the ophthalmologist is in the waiting area with other patients scheduled for surgery that day.
Code of Ethics Rule 7, Delegation of Services, clearly approves delegation to those who are legally qualified to provide the delegated services. How ever, Rule 6, Pretreatment assessment, does not allow for spot-checking, but requires oversight on the part of the operating ophthalmologist. Ophthalmologists are responsible for verifying the findings of the examining eye care professional before proceeding with surgery or treatment for all patients.
Learn more at aao.org/clinical-education/redmond-ethics-center.
To submit a question, contact the Ethics Committee at ethics@aao.org.