Leaders of the American College of Surgeons (ACS) and several other medical organizations gathered July 22 to place a memorial headstone at the previously unmarked interment site of Ernest Amory Codman, MD, FACS. The dedication ceremony took place at historic Mount Auburn Cemetery, Cambridge, MA, with speakers paying homage to the unconventional surgeon from Boston, best known for advocating the “end result idea” in medicine. (For details regarding the memorial service, see the “Looking forward” column.)
Dr. Codman’s end result idea centered on the common-sense premise that hospital staffs should record the outcomes for every patient they treat long enough to determine if the treatment was successful, make the results public, and learn from any failures so as to prevent similar problems in the future. Although Dr. Codman’s ideas placed him at odds with the medical establishment of his time, these ideas have become the basis of patient-centered, quality-based surgery promoted in ACS standards and in present-day medical practice.
When Dr. Codman died of melanoma in 1940, his family reportedly lacked the financial means to purchase a headstone for his gravesite, so he was interred in an unmarked site in the burial lot of his wife’s family.*
The newly installed headstone contains his portrait in bas-relief. A bronze tablet is inset into the granite headstone that is mounted in an upright position. Classical sculptor Daniel Altshuler, DIA Sculpture Studios Ltd., Boston, crafted the memorial using the historic Quincy Granite that can be found at many gravesites at Mount Auburn.
Father of outcomes assessment
“The American College of Surgeons and medicine in general owe a huge debt of gratitude to Dr. Codman, who was one of our organization’s early leaders,” said ACS Executive Director David B. Hoyt, MD, FACS. “He contributed immensely to our early hospital standardization activities that eventually led to the establishment of what is now known as The Joint Commission in 1951. He would be proud to see how his advocacy for tracking patients’ outcomes contributed to the development of robust surgical data registries—one of the most valuable tools surgeons use to improve the quality of patient care today.”
Dr. Codman graduated from Harvard Medical School in 1895 after spending a year visiting medical centers in Europe. While in Vienna, he encountered the problem of disease of the subdeltoid bursa and became fascinated with the shoulder joint, culminating in his 1934 book, The Shoulder. His interest in bone cancer also was directly responsible for the development of the ACS Registry of Bone Sarcoma, established in 1920.
Dr. Codman served at Massachusetts General Hospital (MGH) as surgeon to outpatients in 1899, and from 1902 to 1914, was an assistant visiting surgeon at the hospital. He held the post of lecturer at the Harvard Medical School from 1913 to 1915. However, Dr. Codman became discouraged by hospital administrators’ lack of interest in his end result idea, so he resigned from MGH and established his own small hospital. Fittingly, the epitaph on Dr. Codman’s headstone includes a statement that he is reported to have once made: “It may take a hundred years for my ideas to be accepted.”
*Mallon B. Ernest Amory Codman: The End Result of a Life in Medicine. Philadelphia: W.B. Saunders, 1999.