Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
The use of non-medically trained surgical assistants in performing
simple procedures, can be traced back to 1967 in USA. The service provided
by these practitioners is invaluable, especially in areas where resources
are limited. Nevertheless, the study performed by Warriner et al (2006),
has not investigated the outcomes in patients where complications did
occur, following such surgical pocedures. The question that arises is
whether surgical practitioners would be able to adequately manage any
procedure-associated complications. Performing a surgical procedure
competently, and ensuring the overall safety of the patient, are two
different issues. The significance of ensuring safety, is augmented by the
elective nature of these procedures. The ethical issue of significant
potential harm, underlining the provision of elective surgical services by
surgical practitioners, needs to be seriously considered before embarking
on such practices.
1. Freedman MA, Jillson D, Coffi n RR, Novick LF. Comparison of
complication rates in first trimester abortions performed by physician
assistants and physicians. Am J Public Health 1986; 76: 550–54.
2.Warriner IK, Meirik O, Hoff man M, et al. Rates of complication in
first-trimester manual vacuum aspiration abortion done by doctors and mid-
level providers in South Africa and Vietnam: a randomised controlled
equivalence trial. Lancet 2006; Nov 29, 2006.