You are aware of a colleague who brags about his meticulous work, but takes on average three times longer to do the same surgery as you do, what would be your reaction?

"This is a possibly explosive situation, because it pits my obligation to report the danger to the patient against what will be seen as an offensive maneuver to make someone look bad for competitive reasons, especially since he or she touts the length of surgery with the excellent outcome, itself a competitive act. Thus, anything I do will have to be based on how his or her patients do in the long run with complications. Because of HIPAA, I cannot investigate that, and as a competitor I shouldn't. But the hospital's appropriate oversight committee, usually the Executive Committee, has the authority to compare and contrast patient outcomes among different doctors. If I've raised the concern, that's all I need do. It would be inappropriate for me to go beyond that."

This is tricky, because surgeons are allowed to have a certain amount of autonomy in how they practice their craft. However, you are obligated to report anything you feel could put a patient or your hospital in jeopardy, medically or medicolegally. There are complications that are more likely the longer a surgery lasts, such as blood loss, infection, delayed healing. or extra pain, so if there is a question of breaching a standard of care--in this case a judgment call--you are obligated to report it to the appropriate authority of the staff, such as Chief-of-Staff, Department Head, or Executive Committee.

"If I were concerned about the length of time a surgeon takes to do a procedure being inappropriate, I would mention it to the Department Head and let him or her take it from there. My responsibility is to speak up if I see something incorrect."