Letters to the Editor

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to dschneidman@facs.org, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.

Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.

Military surgeon reflects on service

It is with great pleasure that my wife and I thank the Bulletin for publishing the remarks of Alexander Stojadinovic, MD, FACS, in the December 2013 issue (Bull Am Coll Surg. 2013;98[12]15-18). His thoughts and perspectives on the “citizen surgeon” resonated clearly with this surgeon, who at 34 years of age and as a University of California-San Francisco (UCSF) chief resident was drafted in 1967; and with his U.S. Army Nurse Corps First Lieutenant scrub nurse of the same era and future wife, Jeannie Mitchell (Baldwin). Both of us, like all individuals who have experienced combat, returned “different”—more mature and caring, but also more watchful and wary.

We had the good fortune to work in the theater with some of the giants Dr. Stojadinovic mentioned, such as Col. Basil Pruitt, MD, FACS, and Col. Norman Rich, MD, FACS. Others include the great Michael DeBakey, MD, FACS, and UCSF’s own World War II thoracic surgeon, Rose-Bowl-winning wide receiver, and fabulous teacher, H. Brodie Stephens, MD, FACS. The article reminded me of remarks that Ron Stoney, MD, FACS, made at the memorial for Jack Wylie, MD, FACS: “We stand on the shoulders of giants.” This phrase was relatively new to me at the time, but since then, having seen some of the “kids” I mentored as residents become those giants, it has become more than a phrase—it has become a reality. Just a few who stood—unknowingly to both of us—on my shoulders to become more than I include former American College of Surgeons (ACS) Executive Director Thomas R. Russell, MD, FACS; Donald D. Trunkey, MD, FACS; ACS Past-President A. Brent Eastman, MD, FACS; ACS President Carlos Pellegrini, MD, FACS; and others.

The mentoring system works, and the citizen soldier, as I once was, has surgical contributions to offer upon return to civilian life. I performed approximately 1,800 operations between 1968 and 1969 in Vietnam, which was the highlight of my professional life. Dr. Stojadinovic clearly paints the picture of citizen surgeon courage. He quotes George Crile, MD, FACS, a founder of the ACS, who said, “More progress has been made in surgery from lessons learned during armed conflict than has been achieved by an entire generation.”

Dr. Stojadinovic also quotes Canadian physician Major John M. McCrae’s poem after the Second Battle of Ypres, World War I, “In Flanders Fields”: “If ye break faith with us who die/ We shall not sleep, though poppies grow/ In Flanders Fields.” Those of us who have served understand this sentiment completely. We “shall never forget.”
Jeannie and I will travel to Normandy on June 6, 2014, for the 70th anniversary of D-Day, Operation Overlord, and we will walk on Omaha Beach and Flanders Field remembering those giants upon whose shoulders we stood, when as a young surgeon and nurse in combat, now 45 years long, we used the teachings of J. Englebert Dunphy, MD, FACS; Dr. Stephens; Victor Richards, MD, FACS; Carlton Mathewson, MD, FACS; Dr. DeBakey; and all the rest to fix young Americans, Aussies, Vietnamese, and, yes, Viet Cong soldiers using the best surgical techniques we could offer, learned from the many great Fellows of our College.

Thank you, Dr. Stojadinovic, for bringing tears to our eyes as we remembered what we have been given and those brave men and women whom we have served as citizen surgeons.

John N. Baldwin, MD, FACS
Twain Harte/Monterey, CA

The essence of professionalism

The articles by Paul H. Jordan, Jr., MD, FACS (Bull Am Coll Surg. 2013:98[1]:58-60), and Roger A. Meyer, MD, DDS, FACS (Bull Am Coll Surg. 2013:98[11]:39-41), on professionalism and the medical profession were excellent. Yet, the true essence of “professionalism” cannot be overstated—especially as solo practice nears extinction. A physician may be the most talented, well-educated, specially trained, and well-reputed individual and still not be a true professional.

The Hippocratic Oath states:

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.… I will not cut for stone…. [but] will leave this operation to be performed by practitioners….*

Though the oath makes no mention of the “professional” or “professionalism” by word, the essence of these modern terms must have been clearly understood and intended by Hippocrates.

A professional uses special knowledge, skill, and a sense of duty to act primarily in the best interest of an individual who requires or has contracted for service. Professionalism is the mindset that brings about this special type of practice. For a professional, what one is becomes integral to what one does—and vice-versa.

A professional is not by necessity highly educated or trained; however, all professionals not only believe in their value as individuals, but also in the value of their endeavors to help others. Professionals also acknowledge their limitations; and, as such, provide further value to those they serve.

As the U.S. and the American College of Surgeons (ACS) advance further into the world of corporate medical practice, industrialization, and universal health care, surgeons (and other physicians) should promote and retain a focus on the value of professionalism to our lives and to the well-being of our patients.

Lawrence A. Danto, MD, FACS
Truckee, CA

*Sheldon GF. Presidential address: Professionalism, managed care, and the human rights movement. Bull Am Coll Surg. 1998;63(12):13-33. Available at: http://www.facs.org/archives/pdfs/sheldon1998.pdf. Accessed February 3, 2014.

ACS should study sleep deprivation

In the December 2013 Bulletin (Bull Am Coll Surg. 2013;98[12]:36-41), Edwin W. Shearburn III, MD, FACS, discusses sleep deprivation, the surgeon, and patient care. He suggests guidelines for use in potentially unsafe work practices, despite the fact that none of the work practices are proven to be unsafe. As a surgeon, should I hand off a patient with a surgical abdomen (resulting in perhaps a wait of two hours) to satisfy the hospital guidelines at the risk of violating optimal patient care guidelines? Lawyers will have a field day with such a scenario; I suggest caution.

I agree with the author that all medical personnel should be exposed to education regarding sleep deprivation. More study is needed in this area, and who better to study surgeons than the ACS? At the very least, it is important that surgeons agree on important endpoints regarding the potential effects of sleep deprivation. The general public demands action on this topic, even if further study reveals there is a minimal problem. If the ACS doesn’t initiate a study, the government will.

William H. Baker, MD, FACS
Maywood, IL

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