Ghost surgery: the ethical and legal implications of who does the operation.

Case 1: A patient who is rehospitalized for complications after shoulder arthroscopy discovers that his surgeon's partner performed the operation. The orthopaedists contend that they practice as a "team," deciding who does the specific case just prior to the operation(1). Case 2: Arthroscopic partial meniscectomy is performed by a resident. The attending orthopaedist scrubs briefly and then leaves to perform a simultaneous procedure in another room. The patient has a postoperative complication(2). Case 3: Carpal tunnel release is performed by a resident, under the supervision of an attending orthopaedist who has been present for the entire case and who has introduced the resident as his assistant in the informed-consent process. The median nerve is injured by the resident(3).