Have we lost our way?

Abstract

There are many serious problems that beset society in general and medicine in particular. Some are related to the social and economic revolution that currently involves the world and will necessarily affect the practice of surgery. There is considerable evidence to indicate that one of the main battlefronts in this revolution is the practice of surgery. A review of five aspects of our current professional life has emphasized the complexity and significance of the problems with which we are confronted. It would seem that we are responsible for some of these problems and the associated confusion. In many instances, and perhaps most, it would appear that our problems and the related attempts at their solution have developed with the planning and help of other political, social, and legal groups, and often to their advantage but to the disadvantage of our patients and us. In our effort to find solutions to these problems, a vicious cycle has been established which, in turn, has produced deleterious effects and the impairment of surgical practice. As changes have been introduced in rapid succession, confusion and frustration have occurred. To eliminate confusion, committees have been appointed to solve the problems. In most instances the solutions developed by committees produced more problems which, in turn, required the appointment of still more committees which also created problems along with the development of their solutions. Consequently, the pace of academic and hospital functions has progressively increased to the point that a professional time and energy drain has been created. As the professional energy drain has increased, there has been a decrease in patient care and a breakdown of the system provided to supply this care, due in large measure to the erosion of the surgeon's time by administrative, committee, and various other nonprofessional activities. With the breakdown of hospital surgical practice, a loss of direction and a loss of control have developed. The answer would not seem to lie in the appointment of more committees and increased committee action since these would undoubtedly further increase the number of problems and force us further along many misdirected pathways. Rather, our efforts might be directed towards clearly defining the problems, carefully working out solutions, and using available information to educate and effectively influence the lay public, Congress, the legal profession, and the press, always keeping in mind the primary purpose of surgical care as being that which is best for the patient. A mass of factual information has been developed under SOSSUS under the direction of Zuidema and the authority of the American College of Surgeons and the American Surgical Association. The intelligent use of this data base should be helpful in formulating such a program. Access of this information to the lay public, Congress, and the press should be provided as soon as possible by a well informed medical-surgical liaison group representing surgeons and their patients. There would also seem to be a growing and urgent need for summary manuals or other teaching aids prepared by authoritative persons or groups for the education of surgeons and surgical specialists with periodic updating. Spending our energies and time in such programs should help to eliminate confusion; re-establish positive programs of patient care, teaching, and research; improve patient care; and reduce the current waste of time and energy of surgeons on nonsurgical responsibilities and effort.