Transparency and the “End Result Idea”

Abstract

Transparency was an issue for the American medical profession a century ago, and transparency is an issue for the American medical profession today. In 1905, Ernest Codman, MD, first described the “end result idea.” 1 Mallon WJ Ernest Amory Codman: the end result of a life in medicine. Saunders, Philadelphia, PA2000 Google Scholar 2 Passaro E Jr Organ CH Jr Ernest A Codman: the improper Bostonian. Bull Am Coll Surg. 1999; 84: 16-22 PubMed Google Scholar 3 Reverby S Stealing the golden eggs: Ernest Amory Codman and the science and management of medicine. Bull Hist Med. 1981; 55: 156-171 PubMed Google Scholar 4 Neuhauser D Ernest Amory Codman MD. Qual Saf Health Care. 2002; 11: 104-105 Crossref PubMed Scopus (86) Google Scholar The end result idea is simply that doctors should follow up with all patients to assess the results of their treatment and that the outcomes actively be made public. The end result idea was considered heretical at the time, but in retrospect Codman was sagacious and prescient. He was an advocate for transparency, which he believed would promote quality improvement, patient choice, and physician learning. Transparency is best viewed as an opportunity, one that we should fully and enthusiastically embrace. It offers a substantive boost as organizations step up to the moral imperative of improving patient care to the best it can be. Misinterpretation of a Pulmonary GI Anastomosis Stapler Line as a Retained Foreign BodyCHESTVol. 133Issue 1PreviewIntraoperatively retained foreign bodies are both medical and medico-legal problems. We report a patient who underwent a lower left lobectomy initially for nonresolving chronic organizing pneumonia. Rethoracotomy was performed due to a suspicious CT finding of a retained surgical sponge that turned out to be a GI anastomosis (GIA) staple line. Postoperatively, the situation was simulated using a surgical sponge adherent to the skin, to demonstrate the difference between the radioopaque marker of the surgical gauze and the GIA staple line. Full-Text PDF Transparency in Health Care: An Issue Throughout US HistoryCHESTVol. 133Issue 1PreviewThe patient bore his acute sufferings with fortitude and perfect resignation to the Divine will, while as the night advanced it became evident that he was sinking, and he seemed fully aware that “his hour was nigh.” He inquired the time, and was answered a few minutes to ten. He spoke no more—the hand of death was on him, and he was conscious that “his hour was come.” With surprising self-possession he prepared to die. Composing his form at length, and folding his arms on his bosom, without a sigh, without a groan, the Father of his Country died. Full-Text PDF