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I nvestigative reporters at The Boston Globe—the same unit featured in the film Spotlight—have shined their attention on so-called simultaneous surgery. In a series of articles very much worth reading [1], The Boston Globe described a controversy at Massachusetts General Hospital regarding a practice certainly not limited to that institution: Namely, two patients, in two operating rooms at the same time, for two procedures performed by one surgeon. The Boston Globe series was not an abstract discussion. The reporters began with the poignant story of Tony Meng, a 41-year-old man who awoke from a cervical corpectomy unable to move his arms or legs. The journalists alleged that Mr. Meng’s surgeon ‘‘juggle[d] his care’’ with that of second patient, who also was undergoing a complicated spinal surgery at the same time. The reporters discussed the backroom infighting surrounding the case, including lawsuits, charges and counter-charges, and, ultimately, the dismissal of one surgeon (not involved in the incident in question) for purported violations of privacy rules. This narrative captured the attention it sought. Within months of the article’s appearance, the Massachusetts Medical Board issued new regulations demanding that surgeons document each time they enter and leave the operating room. Shortly thereafter, the American College of Surgeons revised its Statements on Principles [2], stating plainly that a ‘‘primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate.’’ As I write this, the orthopaedic surgery community has not formally responded, but no doubt it will. The Boston Globe story, after all, was an orthopaedic story: Tony Meng had an orthopaedic operation and the physician dismissed from the staff was an orthopaedic surgeon. Indeed, the word ‘‘orthopaedic’’ appeared more than three dozen times in the article. A full analysis of simultaneous surgery is apt to run many pages. There are many ethical principles to be unpacked; there are many competing interests that must be balanced. Still, there are three general principles that must be kept in mind by all those who analyze this issue. Not the Last Word Published online: 27 July 2016 The Association of Bone and Joint Surgeons1 2016

Not the Last Word: Two Patients, Two Operating Rooms, One Surgeon—Does The Math Add Up?