Is the premium surgeon still the captain of the ship?

With the mounting pressures of state and federal guidelines and the added burdens of local hospital and ambulatory surgery center bureaucracy, the question remains: Are premium surgeons still in charge in the OR setting?The decisions on whether to use trypan blue to stain the anterior capsule, to use capsular tension rings/hooks in pseudoexfoliation cases or to open the extra viscoelastic tube to avoid endothelial trauma are all examples in play when trying to achieve the best outcome for our patients, but administrative pressures to keep costs down and be compliant with the “standard of care,” which varies to great degrees geographically, push the limits to keep us from going overboard as captain of the ship. Interestingly, there is a legal doctrine named “captain of the ship,” which holds that during an operation in an operating room, “[the] surgeon of record is liable for all actions conducted in the course of the operation.” This legal doctrine was coined in McConnell v. Williams in 1949 in which the Supreme Court of Pennsylvania ruled that “it can be readily understood that in the course of an operation in the operating room of a hospital, and until the surgeon leaves that room at the conclusion of the operation … he is in the same complete charge of those who are present and assisting him as in the captain of a ship over all on board, and that such supreme control is indeed essential in view of the high degree of protection to which an anesthetized, unconscious patient is entitled.”