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American Academy of Ophthalmology
Advantages, Disadvantages and Recommendations for Visiting Surgeons

By Claude Cowan, MD

Dr. Cowan is a member of the Academy's Task Force on Haiti Recovery.

The overwhelming and well-intentioned support for the people of Haiti has shown light on several issues surrounding relief efforts in a disaster situation, including the prevalence and influence of visiting surgeons. The support has also shown examples of effective and successful efforts by physicians. In this article, I will outline some of the advantages and potential disadvantages associated with visiting surgeons, including recommendations for providing the most effective and helpful care.

Advantages of visiting surgeons
Visiting surgeons offer three major advantages to a community, including direct care, exposure to new technology/skills and local medical advocacy.

Visiting surgeons often offer treatment to populations traditionally underserved. In addition, visiting surgeons can share their skills and technology with local care providers. The advances in technology, medications and techniques brought by visiting surgeons may allow local providers to offer a higher quality level of care.

Regarding advocacy, visiting physicians can lead advocacy efforts through their association with non-governmental health organizations and political connections that may provide access to local government officials. Physicians with public health expertise may be able to present a comprehensive case for increased eye care resources in a fashion that can be understood and appreciated by government officials.

Disadvantages and concerns
While visiting surgeons can offer many benefits to a community in need, there are potential barriers to lasting effective efforts and potential issues surrounding the delivery of care.

Occasionally, visiting surgeons will employ inconsistent case selection, choosing cases that will allow for the development of their own surgical skills rather than those who may most need surgery. This approach to patient care can prevent visiting surgeons from establishing collegial relationships with local health care providers, leading to poorly coordinated follow-up beyond the immediate post-op period.

Frequently unrecognized is the lowering of status of local physicians brought about by visiting physicians who often have access to technology and skills not available to local care providers. The indigenous practitioners are thus relegated to second-class status and citizens may delay seeking much-needed care and abandon locally available therapies because they would prefer to wait for the foreign physician to return. In contrast, if the visiting surgeon experiences poor outcomes due to the use of new and untested techniques and treatments, local residents may develop a mistrust of modern medical care and revert back to relying on traditional and sometimes dangerous practices.

Recommendations for the visiting surgeon and sponsoring organization
Clearly there are two sides to the issue of visiting surgeons. Visits by foreign physicians can bring about much-needed improvements in care and increased access, but regulation is needed.

Suggestions:

  1. Visiting surgeons should be sponsored by a local physician or medical society.
  2. The physician’s itinerary should be agreed upon by the sponsoring physician or group.
  3. Surgeons should provide a copy of their delineation of privileges from their regular hospital.
  4. Visiting surgeons should be temporarily licensed and privileged by a locally acceptable health care or humanitarian aid organization, local medical society or health department.
  5. Visiting residents should be closely monitored and supervisory roles should be clearly defined.
  6. Physicians should work with local providers to prioritize local needs.
  7. All visiting surgeons should commit to participate in at least one educational activity, if they will be in the country for five or more days.

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