Letters to the Editor

Editor’s note: The following letter was submitted regarding a recent article published in the Bulletin. A response from the authors of the article follows.

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.

Surgeons do their best to prevent errors

I was dismayed to see the title on the cover of the March issue of the Bulletin.* “Preventing surgeon errors” is the worst admonishment you could issue to the busy surgeon working day in and day out trying to survive the onslaught of demands that define surgery today. The plaintiff attorneys will love you for the title, though.

As you are well aware, surgeons are humans and making mistakes will always be a part of being a surgeon and being a human. There is a bell-shaped curve for everything in life, and no matter how hard we try, some surgeons will always be at the top and some at the bottom. The title is reminiscent of the foolishness of “never events” and how the American College of Surgeons (ACS) never stood up to the use of this ludicrous phrase to say there is no such thing in medicine.

Although the authors present some excellent ideas to help decrease errors in surgery, these ideas will never prevent errors for the reasons stated above. Some attorneys and patients are taught that the practice of medicine should be perfect and that any time a complication occurs it is due to negligence and error.

We surgeons who operate day in and day out face this hostility and these expectations every day. Most of the article puts all the blame and responsibility on surgeons, stating what they should do, and none of the burden on the noncompliant or hostile patient, on the operating room that does not have the staff or the materials to properly care for the patient, and on the insurance companies that control everything. The entire article is about negative results and negative thoughts, when the vast majority of surgery leads to positive results.

We need a College that is ready to lead and not follow. We need a College that is ready to think outside of the box and use what we do as surgeons as a leverage to truly represent working surgeons and their patients. I don’t believe this can be accomplished by playing nice and being politically correct, as it seems so much of the College’s efforts revolve around today. The ACS led the fight to get rid of the sustainable growth rate’s yearly threats to reimbursement only for it to be replaced with the Quality Payment Program under the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act and other ridiculous ideas. We need vigorous and strong resistance to what is being done to us, and it is sad to see the College not leading but following.

Guy Voeller, MD, FACS
Memphis, TN

Reponse from the authors

We are pleased to respond to Dr. Voeller’s heartfelt letter regarding our Bulletin article, “Evolving insights for preventing surgeons’ errors.” Dr. Voeller is a noteworthy force in herniology, advocacy, and health care policy whose voice carries considerable weight.

To leave no misunderstanding, the opinions and interpretation of data expressed in the article are those of the authors. Surgeon staff at the College reviewed the article and recommended acceptance. Beyond that, the College took no stance as to the article’s content.

As Dr. Voeller notes, most errors have a systematic component, to err is human, surgeon errors are inevitable, and errors are not synonymous with negligence or culpability. We are confident that the article implies nothing to the contrary. The authors share Dr. Voeller’s distaste for the word “error.” Nonetheless, it is what it is. In the past, we have referred to “technical misadventures” and “behavioral violations.” To update what we have learned since then, we chose error for this article.

Furthermore, any perceived shortcomings of our article should not be a platform for denigrating the ACS programs that support surgeons and their patients. The ACS has introduced educational programs to target the newfound causes of errors and liability, including courses in communication. New emphasis has been assigned to the ACS clinical databases, including the National Trauma Data Bank®, the National Cancer Database, and the ACS National Surgical Quality Improvement Program and the role they can play in increasing quality, decreasing liability, and providing data to measure outcomes and identify benchmark practices that lead to evidence-based care.

The College’s pursuit of liability reform is ongoing. Tort reform has been largely successful at the state level, and the College has offered alternatives to the tort system. Examples include alternative dispute resolution, health courts, enterprise liability, safe harbors, and communication and resolution programs, which have shown to lead to safer care, costs savings, and more equitable settlements.

As a result, the ACS is now seen as a patient-sensitive advocate in the health policy arena. We have achieved this position without pandering and without the stigma of political correctness.

The authors appreciate Dr. Voeller’s cogent input and the opportunity to participate in the discussion. We are optimistic that things are better for surgeons and their patients now than in the past, and that, in spite of the challenges, the future is bright. Even so, Dr. Voeller is correct: Surgeons must step up.

David H. Ballard, MD
St. Louis, MO

Navdeep S. Samra, MD
Shreveport, LA

F. Dean Griffen, MD, FACS
Shreveport, LA

*Ballard DH, Samra NS, Griffen FD. Evolving insights for preventing surgeon errors: Balancing professionalism and cognition with knowledge and skill. Bull Am Coll Surg. 2017;102(3):10-18.


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