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 email@example.com, 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.
Matrix conferences needed
I read with interest the Resident and Associate Society essays on surgical complications in the January Bulletin. The challenge for surgeons at all levels is to analyze the complication in such a manner that sustained lessons emerge from that analysis.
The traditional surgical morbidity and mortality conference addresses this challenge. Unfortunately, the traditional conference has several failings. The greatest failing is that, despite the preparation, presentation, and discussion of complications, there is no reliable method of collating and distributing all of the error- and complication-reducing points raised in a moderated discussion. The great lessons of surgery die at the exit door.
Changes to this conference are needed and are needed now. The moderator of the morbidity and mortality conference should have the responsibility of selecting cases, preparing the resident staff for the presentation of those cases, moderating the often spirited discussions, and then summarizing those discussions. E-mail distribution should follow, along with quarterly testing for the resident and attending staff. If such changes are implemented, an ongoing, constantly renewed patient safety curriculum would emerge, rather than an isolated weekly meeting.
Organized surgery has opened up to dramatic cultural change but still clings to an outmoded teaching methodology. The ultimate goal of discussing complications is to prevent them. Surgical residents need a teaching methodology that ensures that this goal is being met.
As a first step toward updating the morbidity and mortality conference, its name should be changed. Call it the Matrix Conference—The Department of Surgery’s Patient Safety Curriculum. The Matrix concept is designed to ensure that the surgical community is making progress in improving patient safety by preventing the same mistakes from happening over and over again.
Full disclosure: I have discussed this concept at all levels of American surgery, written essays and books about it to the point that I am now crusading for a change. The job of transforming the traditional conference to a valuable teaching tool falls to the authors of these perceptive essays. They are the future of surgery.
It has recently been reported that 24 percent of graduating surgical residents fail to recognize the early signs of a surgical complication.* This indicates a pressing and immediate need to change the conference that analyzes complications.
The time has come for surgical teaching to move on from unstructured tribal lore passed down orally in an entertaining but ineffective venue, to a more reliable curriculum that uses all available technology.
This change will assure the public that every resident knows what every surgeon needs to know to minimize mistakes and prevent complications.
These essays show that ACS-affiliated residents care enough to analyze the impact of a complication. Converting the traditional morbidity and mortality conference to a Matrix conference offers these residents and all surgeons a method of lifelong learning from surgical complications.
*Mattar SG, Alseidi AA, Jones DB, et al. General surgery residency inadequately prepares trainees for fellowship. Ann Surg. 2013;258(3):440-449.
Leo A. Gordon, MD, FACS
Los Angeles, CA
Google Glass implications
I read with interest Tony Peregrin’s “Surgeons see future applications for Google Glass” in the July Bulletin. Briefly, the article is an anthology of surgical promoters’ favorable experience with Google Glass in the operating room. The article also points readers to an important legal issue associated with Google Glass: The need for compliance with the Health Insurance Portability and Accountability Act.
Unfortunately, the article does not address a much larger legal issue. It is very likely that the courts will hold that the intraoperative video recordings created by Google Glass are medical records. As a medical record, Google Glass video recordings will have to comply with a number of statutes, including those governing the maintenance of a medical record. Thus, surgeons who use Google Glass in the operating room should be prepared to store the video for at least six years. See 45 CFR 164.316(b)(2). Moreover, while the Google Glass video is in storage, it is potentially discoverable, should there be subsequent litigation.
While I am not a Luddite or a technophobe, I do think the American College of Surgeons should warn the early adopters of Google Glass of the potential legal liability associated with the creation of a medical record.
Thomas R. McLean, MD, JD, FACS, ESQ
I am writing regarding the article “Preparing for implementation of the Physician Payments Sunshine Act,” which was published in the March Bulletin. I fully agree with the Affordable Care Act’s intent in developing these provisions: To increase transparency in the financial relationships between physician and special interest groups (drug and medical device manufacturers). This transparency allows patients to make more informed decisions regarding their care.
I would hope that the American College of Surgeons would be the leader in suggesting that Congress and state legislators impose their own “Sunshine Act” upon themselves. I’m sure members of Congress and state legislators are bestowed with large financial contributions and other valuable items for themselves and their families by special interest groups.
I would be deeply offended if members of Congress and state legislators believe they are above increased transparency and we, as one of the noblest professions, are not. I hope that the College would ask that our representatives’ feet should be held to the same fire that they ask of us.
Scott C. Thornton, MD, FACS, FASCRS
The Bulletin occasionally posts disciplinary actions taken against Fellows of the American College of Surgeons. While publication of this information may be necessary to demonstrate that the College is, indeed, policing its members and upholding the highest standards in our profession, the postings also sometimes graphically announce the offense that prompted action. I would ask the College to reconsider this practice. It is enough to list the names and locations of these surgeons. Adding the offense adds insult to injury and, in my mind, is completely unnecessary and, as far as the general readership, is nobody’s business. In addition, I would wonder if this practice borders on slander, as some of the offenses may still be under dispute. Please reconsider this policy. Let these tortured souls maintain some level of dignity and respect as they try to rebuild their lives.
Thomas S. Helling, MD, FACS