Intended for healthcare professionals

Feature Medicine and the Media

Demystifying surgery live on TV

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4910 (Published 22 November 2018) Cite this as: BMJ 2018;363:k4910
  1. Greta McLachlan, editorial registrar
  1. The BMJ
  1. gmclachlan{at}bmj.com

Ethical concerns can be managed, writes Greta McLachlan, and it’s good for the public to see exactly what goes on in NHS operating theatres

On the three evenings of 13-15 November, Channel 5 broadcast live operations from Barts Health NHS Trust in London. Kemal had an aortic valve replacement, Howard a total knee replacement, and Tim a right hemicolectomy.

Live surgical broadcasts are nothing new, but they continue to raise concerns about patient safety and ethics. We’ve been treated to tweeted operations,1 as well as live dissemination by Snapchat,2 radio,3 and virtual reality4—and Channel 4 showed a live colonoscopy in an advertisement for Cancer Research UK.5

Best interests

Ben Challacombe, a consultant urological surgeon at Guy’s and St Thomas’s Hospital in London, sits on the committee of the European Association of Urology, which has published guidelines for live broadcasts.6 “At conferences these operations play to packed houses,” he told The BMJ, talking about live surgery as a teaching aid for clinicians—“but it is an ethical dilemma whether it is in the best interests of the individual.”

In a survey of 106 European urologists who had performed live broadcasts 7% reported “significant anxiety” during the broadcast, and 16% thought that their performance had been “slightly worse,”7 although research indicates that complication rates were consistent.891011 Still, at least two patients have died in association with live broadcasts,1213 and most Japanese and US surgical societies have banned the practice.12 The Royal College of Surgeons of England does not advocate live surgical broadcasting.14

The consultant orthopaedic surgeon Steven Millington, who operated live on Channel 5, told The BMJ that he had worked closely with the production team to ensure that infection control and patient safety were paramount: the camera crew “were told where they could and couldn’t be.”

Ninder Billing, executive producer at the production company the Garden, personally wrote “reams of protocol documents,” she said. “We spent almost more time doing these documents than any other aspect—safeguarding the patients, the families, the audience, the surgical teams, and making sure we weren’t manipulating a patient pathway or waiting list.”

To minimise distractions while operating, a different consultant surgeon answered questions posed by the presenter, Nicky Campbell. Contingency plans included a recorded operation to cut to if complications arose, and another consultant surgeon was ready to contact the patient’s family. The surgeons who took part all told The BMJ that they would have stopped the broadcast if they had any concerns, because their patients came first.

Reassuring the public

Billing wanted to show the public some of the procedures, step by step, that go on in hospitals near them, and the consultant laparoscopic colorectal surgeon Shafi Ahmed, who performed the hemicolectomy, thought that this could help to demystify surgery for people.

The Garden also produces 24 Hours in A&E, which reassured Ahmed. “They had managed to create really good programmes but still maintain patient dignity,” he told The BMJ. “They were thinking about the patient first and foremost.” He added that such programmes could help to reduce patients’ anxiety of having surgery: “We are too paternalistic about what the public may or may not wish to see; we should ask them the question.”

And it seems that the public wants to see live surgery. The programmes had a reported one million viewers each night and largely positive responses on Twitter. One tweet said that the programmes “reassured us and took away the fear of the unknown.”

Broadcast at 10 pm, with a delay of 20 minutes, these were not normal elective hours. But Kulvinder Lall, the consultant cardiothoracic surgeon who did the live valve replacement, explained that, because of the post-watershed screening time, staff had started their shifts “later, to ensure everyone was fresh.”

Teamwork

These shows emphasised teamwork, rather than a “top surgeon saving lives,” and were a great advert for the NHS, said Millington. They showed interviews with Pamela the scrub nurse, Sophie the perfusionist, and George the senior house officer, as well as the patients and their families. The programmes may also have been an education for clinical team members who look after patients outside the theatre, said Lall.

And, in these days of low morale, it showed what a privilege it is to work in the NHS. Chhaya Sharma, consultant anaesthetist, said on the show, “I am very fortunate in that I love what I do. I’ve had a lot of hard days—we all have—but I’ve never had a day where I’ve not wanted to be there or [wanted] to do something else.”

Operation Live was broadcast on Channel 5 on 13-15 November and is available at www.channel5.com/show/operation-live/

Footnotes

  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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