Should Current Laws Be Revised to Address Occupational Hazards Caused by Hand-Tool Size Mismatch Among Surgeons?

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American Medical Association




When surgical tools are poorly fitted for the hands that use them, surgeons experience pain, injuries, and disabilities, a problem that affects anyone with smaller hands and women in particular.1 In one study,2 38% of surgeons reported that their hand size affected their ability to learn a procedure. Female surgical residents reported needing both hands for using certain instruments that require only one for most men, although many surgical procedures require multiple tools simultaneously.1 The hand-tool size mismatch leads to an increase in upper limb musculoskeletal disorders in female surgeons.3 Accordingly, female surgeons may leave their practice early, and this may contribute to shortages of surgeons, especially in gynecology, in which female surgeons constitute a larger portion of the workforce.

This is a form of structural discrimination. Surgical tool manufacturers must build tools—and hospitals must buy tools—with a variety of hand sizes in mind.3 In some cases, manufacturers could use the principles of universal design: making tools that work just as well for larger and smaller hands. Alternatively, tools need to be designed in multiple sizes, just as 5 different sizes of surgical gloves are available. Given the lack of progress to date, this article explores potential legal remedies to address this challenge. However, only a few legal solutions exist, and additional legislation is likely required. It is not uncommon for the law to lag behind technology and societal change.

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