The only way this changes is removing the choice from the surgeon doing the cutting. Sounds a bit dramatic but if they think action is genuinely inappropriate,

The only way this changes is removing the choice from the surgeon doing the cutting. Sounds a bit dramatic but if they think action is genuinely inappropriate, they should make the case to their colleagues, or a Multi Disciplinary Team, and let them have the final say. Together they should be able to enforce the Royal College and NICE guidelines for operating and the CQC —the main monitoring body— should be able to work out (both from data and on-the-ground inspectors) whether hospitals are doing as they should. I realise that's pretty UK specific but the ACS should be able to achieve something similar.