By now, most of you have read or heard about Dr. Atul Gawande’s New Yorker piece last year on the topic of a “surgical coach.” After taking a tennis lesson which improved his game, he decided to see if acquiring a surgical coach would improve his “surgical game.” He wanted to continue to reduce his—[self-described] already lower than the national average but level for a few years—complication rate. He enlisted a retired surgeon, who was a mentor during his residency training, as a “coach,” and his complication rate is falling again.

Here are my issues with Gawande’s surgical coach.

Where would the average surgeon find a suitable coach? There aren’t many retired surgeons who would have the necessary skills, the time or the motivation to do it. Gawande practices in a major teaching hospital in Boston. Very few surgeons would have access to people like the coach he chose.

His coach is apparently only involved with what goes on in the OR. Many complications arise due to patient co-morbidities, decision to operate, timing of the operation, postoperative care, supervision of residents and many other factors. Should the coach make floor rounds or see patients in the surgeon’s office too?

The liability question is real. You can bet that if a patient has a serious complication or dies in the OR, everyone in the room, including the coach, will be sued. And the coach, a retired surgeon, is not likely to have malpractice insurance. 

The patient has a right to know who is in the operating room. How does one explain the presence of a coach to the patient? At the end of his article, Gawande shares a vignette depicting his rather awkward attempt to introduce his coach to a patient on the operating room table:

“He’s a colleague,” I said. “I asked him along to observe and see if he saw things I could improve.” The patient gave me a look that was somewhere between puzzlement and alarm. “He’s like a coach,” I finally said. She did not seem reassured. 

That is not surprising since only the most enlightened patient would see the value of a coach in that situation. I think a more typical reaction would be to think, “Maybe the coach should operate on me instead of the trainee.”

From an ivory tower in Boston, the idea of a surgical coach is a lovely one. Too bad it has little to do with the average surgeon in the United States.

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 315,000 page views, and he has over 3900 followers on Twitter.