MAY 02, 2022
Question: A colleague often operates on patients that he sees for the first time in the Ambulatory Surgery Center on the day of surgery. He does not perform an ophthalmic examination but reviews the history and exam findings from the referring ophthalmologist, with whom he has worked for many years, before obtaining informed consent. In other cases, however, the referring providers are not physicians, and their scope of practice does not include cataract surgery. Is either of these scenarios a violation of the Academy Code of Ethics?
Answer: Yes, both scenarios violate Code of Ethics Rule 6 (Pretreatment Assessment). Rule 6 states in part, “The ophthalmologist must evaluate and determine the need for treatment for each patient. If the pretreatment evaluation is performed by another health care provider, the ophthalmologist must ensure that the evaluation accurately documents the ophthalmic findings and the indications for treatment.”
Rule 6 does not allow for the assumption of an appropriate prior assessment. Instead, it requires the ophthalmologist who will perform each surgery to make his or her own assessment. If it does not occur, then Rule 6 has been violated.
Many ophthalmologists delegate portions of their preoperative assessment to qualified health care providers, but it is still their responsibility to verify the findings before proceeding with surgery or treatment.
Code of Ethics Rule 2 (Informed Consent) does not require the informed consent process to take place prior to the day of surgery. However, for the comfort of the patient and for liability reasons, it is a good practice. Obtaining a patient’s consent on the day of surgery may be construed as coercion; especially if the patient feels pressure or uncomfortable asking questions or voicing concerns.
To read the Code of Ethics, visit https://www.aao.org/ethics-detail/code-of-ethics.
To submit a question, email ethics@aao.org.