Errors Of Others Research Articles

The fallacy of comparing surgeons with pilots in the search for safer surgical training

Standards and methods for the assessment of surgical skills are under increased scrutiny as a result of public and professional reactions to clinical failures1. Concerns are that surgeons have a false perception of their abilities, leading to avoidable deaths. To prevent this, better surgical skills assessment has been proposed1. Comparisons between surgery and aviation as two hazardous industries have led to the recommendation of mandatory simulation training before patient encounters2, but the disciplines of aviation and surgery are not strictly comparable. In contrast to aviation simulators, surgical simulators are incomplete to equip a surgeon with sufficient skills to take directly to a real-life operating theatre. The complexity and variation in human anatomy, physiology and disease inevitably means that a fully standardized approach cannot apply to every operation. The skills needed for a non-standardized surgical environment are different from those of a standardized aviation environment. Although surgeons and pilots share a thinking process to determine the correct action by interpreting behavioural clues, the necessary coordination in aviation is explicit, resulting from preset instructions in a highly standardized environment3. Some assumptions about simulated surgical skills training and translation into clinical practice do not stand up to close examination. The autopilot has become a standard component in large aeroplanes. The first fully automated transatlantic flight took place in 1947. Autopilot is the only way to control aeroplanes in many flight phases owing to the effect of temperature on aeroplane parts and surrounding air turbulence4. Simulation is the only way to train commercial pilots in the absence of real flight training opportunities in the air. Robotic simulation is often portrayed as an analogous device for the surgeon, but there is no form of autosurgeon. Robots available for surgical procedures are simple slave mechanical devices that work only with direct human interaction. Another belief is that practice on real patients is dangerous. There is no evidence that supervised surgical training compromises patient safety. Teaching hospitals have better or comparable outcomes to nonteaching hospitals after case-mix correction5. It is 26 times safer to fly than to drive a car6, so perhaps it might be more reasonable to compare surgery with driving. It is still standard to learn driving with an instructor on the road. Drivers, like surgeons, operate in a minimally standardized environment with many variations. Drivers have an agreed thinking process to avoid hazards faced, but no step-by-step instructions. Surgeons have to deal with anatomical and pathological variations, along with unexpected events in the operating theatre, in the same way that drivers have to respond to unexpected events on the road. Driving test assessment tools provide further insight into this similarity. In many countries, the driving test examines both theoretical knowledge and practical skill7. In the UK, the theoretical part consists of multiple choice questions (MCQ) to assess knowledge and hazard perception clips to check learners’ awareness, followed by a period of instructorfacilitated training on the roadwhen it is illegal for the learner to drive alone. Once the learner is fully trained, the practical test is taken. This involves an on-road driving assessment with an examiner armed with a checklist. The clinical skills literature supports the relevance of this type of assessment for the development of surgical skills. Miller8 provided a pyramidal structure to assess clinical skills, with lower levels about knowledge covered by MCQ. Surgical training and assessment are performed in the operating theatre by the trainer using procedure-based assessment forms9. This covers the remaining practical skills assessment levels, with clear parallels to the practical driving test. In surgical training, hazard perception might be achieved with error recovery training10. This stresses subjective detection of errors committed by a third party while using content to justify own errors. Dror10 suggested the use of interactive training clips to detect errors in others, linking error detection with the search for a recovery plan. Making these links should replace self-error justification and denial mechanisms. This new cognitive process could reduce errors and mitigate damage during operations. Errors are infrequent in the standardized automated

A novel approach to minimize error in the medical domain: Cognitive neuroscientific insights into training

Medical errors are an inevitable outcome of the human cognitive system working within the environment and demands of practicing medicine. Training can play a pivotal role in minimizing error, but the prevailing training is not as effective because it directly focuses on error reduction. Based on an understanding of cognitive architecture and how the brain processes information, a new approach is suggested: focusing training on error recovery. This entails specific training in error detection and error mitigation. Such training will not only enable better responses when errors occur, but it is also a more effective way to achieve error reduction. The suggested design for error recovery training is to begin with detecting errors in others. Starting off with highly visible and even exaggerated errors, and advancing to more challenging detections and finally requiring to detect errors within oneself rather than in others. The error mitigation training starts with providing the learners with the correct remedial actions (after they have detected the error). With training, the learners are required to select the appropriate actions within multiple choice alternatives, and eventually are required to generate the appropriate remedial responses themselves. These can be used for instruction as well as for assessment purposes. Time pressure, distractions, competitions and other elements are included so as to make the training more challenging and interactive.

Harmful Medication Errors Involving Unfractionated and Low-Molecular-Weight Heparin in Three Patient Safety Reporting Programs

External reporting of medical errors a adverse events enables learning from the errors of others in the pursuit of systems-level improvements that can prevent future errors. It is logical to presume that medication errors involving the use of anticoagulants, among the most frequently cited product classes involved in harmful medication errors, would be captured in a variety of patient safety reporting programs. Data on reported errors involving the anticoagulant heparin were reviewed, compared, and aggregated from the databases of three large patient safety reporting programs-MEDMARX, the Pennsylvania Patient Safety Authority's Patient Safety Reporting System, and the University Health System Consortium, together representing more than 1,000 reporting organizations for 2005 Approximately 300,000 medication errors and near misses were reported to the programs, and 10,359-a mean of 3.6% (range, 3.1%-5.5%)-involved heparin products. The proportion of heparin-related reports that involved patient harm ranged from 1.4% to 4.9%. The phase of the medication use process cited most frequently in harmful events was the administration phase (56% of errors leading to harm), followed by the prescribing phase (19% of errors leading to harm). This study represents the first attempt by these three large reporting systems to combine data on a single clinical process. The consistent patterns evident in the reports, such as the percentage of all medication errors that involved heparin, suggests that reporting programs, at least for common events such as medication errors, may reach a point of diminishing returns in which aggregating more reports of a certain type yields no additional insight once a large volume of similar events is captured and analyzed.

Inseln der Rationalität: Wie überwindet man fehlerhafte Entscheidungen auf dem Markt, in der Wissenschaft und in der Politik?

Abstract Rationality is the attempt to cope with human fallibility. It presupposes individual freedom and responsibility where responsibility includes suffering from one’s errors. If humans are fallible, then one of the most important characteristics of a social order is whether or not it provides mechanisms for eliminating and correcting errors. It is easiest to institutionalize rationality in an economy. Contestable markets, competition and the threat of bankruptcy suffice. Within academia or science, rationality requires humans to give up the utopian quest for certainty, but nevertheless to continue to rely on logic and experience to make theories ever more consistent as well as compatible with observable facts. It is most difficult to achieve a minimum of rationality in the field of politics. In politics one always suffers from the errors of others rather than from one’s own errors.

Emergency Medical Services Provider Perceptions of the Nature of Adverse Events and Near‐misses in Out‐of‐hospital Care: An Ethnographic View

The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near-misses and adverse events in out-of-hospital care. This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near-misses and adverse events in out-of-hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated. Fifteen in-depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near-misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (< 19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a "blame-and-shame" culture. Adverse events and near-misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis-generating themes are generalizable to the EMS community as a whole.

Discontinuity and Disaster: Gaps and the Negotiation of Culpability in Medication Delivery

This paper shows how discontinuities in the process of drug delivery enable but also underdetermine the isolation of a culprit in adverse medication events. A case example illustrates how we are forced to abandon conceptualizations of blame that assume a dichotomy (either culpable or not), and shift instead to a more nuanced version that estimates the degree to which an actor desired, generated, or could have foreseen the harmful outcome, and the extent to which constraints external to the actor altered the event. The paper concludes that meaningful safety interventions in a system as diverse, socially embedded and complex as health care delivery cannot just build on "good science" (e.g., good methods) to generate "root" causes. Rather, they need to somehow be sensitive to how and which narratives of success and failure are created, as these constrain which countermeasures are likely to be encouraged, funded, and accepted.

Equilibrium with strategy-dependent trembles

Trembling-hand arguments, introduced by Selten, where players make errors in implementing a strategy, are a successful and intuitively plausible approach to eliminating some equilibria. Typically, these errors are independent of the strategy the player aims to implement. In many contexts, however, when a player aims at one strategy, some errors are more likely than if a different strategy is the target. We introduce the notion of strategy-dependent trembles where each strategy intended by a player implies a different probability vector of errors over other strategies. This seemingly minor but plausible change makes a major difference. The focus becomes a player's own errors rather than the errors of others. A weakly dominated strategy is not necessarily eliminated if less costly errors arise when aiming at it than at the dominating strategy. Almost every Nash equilibrium in pure strategies is a strategy-dependent trembling-hand perfect equilibrium.

Bilingualism and the Latin Language (review)

Reviewed by: Bilingualism and the Latin language by J. N. Adams Joseph F. Eska Bilingualism and the Latin language. By J. N. Adams. Cambridge: Cambridge University Press, 2003. Pp. xxviii, 836. ISBN 0521817714. $140 (Hb). The three principal topics of this fascinating volume are code-switching and its relationship to linguistic interference and borrowing, language contact as a determinant of linguistic change in the languages in contact, and the role played by language choice and language switching in the projection of identity. Other subjects dealt with include L2 acquisition among non-elites, diglossic relationships, language choice for accommodation, solidarity, or power, and onomastic change in response to language contact. All are addressed in an engaging and enlightening manner. The volume is divided into two parts, each with four chapters. The first part is thematic. After Ch. 1 (1–110), which discusses the study of bilingualism and the sources of information on it in the ancient world, Ch. 2 (111–296) examines the extant evidence for the numerous languages in contact with Latin and the specific evidence for each that bears upon bilingualism. The languages discussed include not only the languages of ancient Italy, but also Celtic, Punic, Berber, Aramaic, Hebrew, Germanic, Egyptian, and the language of the Iberian Peninsula, among others. Ch. 3 (297–416) addresses numerous motivations for code-switching with particular attention paid to evidence in the correspondence of Cicero, and Ch. 4 (417–526) investigates the typology of borrowing and interference that subsequently leads to linguistic change. Brief case studies illustrate the effects of phonetic, morphological, and syntactic interference and lexical borrowing that led to the regional diversification of Latin. The second part is composed of four extended case studies. Ch. 5 (527–641) examines the use of Latin in Egypt, especially with regard to the expression of power or accommodation and its diglossic relationship with Greek. Ch. 6 (642–86) explores Latin-Greek bilingualism on the Greek island of Delos, where a trading community of Romans and Italians existed after 167 bc. Adams demonstrates, among other things, that these Italian traders were fully integrated into Greek society and used Latin in inscriptions to associate themselves with Rome, but Greek to express a separateness from other Roman outsiders. Ch. 7 (687–724) studies various aspects of bilingualism as attested in the accounting records of the ceramic factory at La Graufesenque. While some texts are principally in Latin and others in Celtic, the code-switching in some is of such an order that it is difficult to identify the matrix language. Ch. 8 (725–50) is a close analysis of the Latin of a learner contrasted with examples of fluent colloquial Latin. In a volume dealing with so many languages and philological traditions, A has had, of course, to rely heavily on the research of others. I have noted that he has occasionally followed the errors of others, though such instances are never serious. Finally, while there is a great deal for general linguists to learn from this erudite volume, the intended audience is clearly classicists, for translations of Greek and Latin forms and passages are usually not provided. Joseph F. Eska Virginia Polytechnic Institute & State University Copyright © 2004 Linguistic Society of America

The Law of Aerial Bombardment in the 1991 Gulf War

I shall often go wrong through defect of judgment. When right, I shall often be thought wrong by those whose positions will not command a view of the whole ground. I ask your indulgence for my own errors, which will never be intentional, and your support against the errors of others, who may condemn what they would not if seen in all its parts.—Thomas JeffersonOn August 2,1990, Iraqi forces invaded and occupied Kuwait, beginning a seven-monthlong series of events that would come to be known as the Persian Gulf war. Perhaps the most thoroughly examined of these events was the thirty-eight-day air campaign, which began on January 17,1991, and marked the beginning of the offensive by the coalition of states arrayed against Iraq, which ended after the latter’s withdrawal from Kuwait. Much has been written about the air campaign and its objectives, its implications for the future use of military force, and the extent to which it conformed to international law. Although this article will focus on the last of these topics, a contextual understanding of the air campaign is essential to a serious consideration of the military necessity and proportionality issues that lie at the heart of the legal analysis.

The Effectiveness of Collective Retrospection as a Mechanism of Organizational Learning

Retrospective reviews of projects have been proposed as mechanisms for organizational learning, and there is the possibility that in a collective setting some of the cognitive limitations associated with individuals’ retrospections can be mitigated. In a qualitative analysis of retrospective reviews held in three design organizations, evidence emerged both of successes and failures in the extent to which reviews led to convincing explanations of events and remedies for future projects. The review processes showed that individuals could successfully correct errors in others’ beliefs and that in the organizational setting they were sensitive to hindsight bias. They also showed that simulation was an important mechanism by which remedies could be tested, and surrogate experiences added to the concrete experiences of the project under review. However, the information available to the participants often was not diagnostic, the participants’interpretation of events tended to be ahistorical, and their explanations were overly specific.

Differences between entrepreneurs and managers in large organizations: Biases and heuristics in strategic decision-making

Executive Summary The purpose of this study was to further explore differences between entrepreneurs and managers in large organizations. However, rather than focusing on previously examined individual differences, this study examined differences in the decision-making processes used by entrepreneurs and managers in large organizations. Building on nonrational decision-making models from behavioral decision theory, we asserted that entrepreneurs are more susceptible to the use decision-making biases and heuristics than are managers in large organizations. To understand why entrepreneurs and managers in large organizations may vary in the extent to which they manifest biases and heuristics in their decision- making, it is important to understand the utility of nonrational decision-making. Under conditions of environmental uncertainty and complexity, biases and heuristics can be an effective and efficient guide to decision-making. In such settings, more comprehensive and cautious decision-making is not possible, and biases and heuristics may provide an effective way to approximate the appropriate decisions. The use of heuristics has also been found to be associated with innovativeness. Perhaps a critical difference between these sets of individuals is the extent to which they manifest biases and heuristics in their decision-making. We examined differences between entrepreneurs and managers in large organizations with respect to two biases and heuristics: overconfidence (overestimating the probability of being right) and representativeness (the tendency to overgeneralize from a few characteristics or observations). In this study, entrepreneurs are those who have founded their own firms and are currently involved in the start-up process with the average time since founding of 1.7 years. The analysis for this study involved responses from 124 entrepreneurs. Managers are individuals with middle to upper level responsibilities with substantial oversight in large organizations. To be included in this study, the managers had to oversee at least two functional areas (sample average was 4.55 functional areas). Usable responses were received from 95 managers. The results from the logistic regression analysis show strong support for both hypotheses. Even after controlling for numerous factors, such as several traits and demographic factors, enduring support was found for the way entrepreneurs and managers in large organizations make decisions. Our overconfidence and representativeness variables correctly categorized entrepreneurs and managers more than 70% of the time. Thus, this research indicates that entrepreneurs do behave differently than do managers in large organizations and that these differences are substantial. Practically, we speculate that without the use of biases and heuristics, many entrepreneurial decisions would never be made. With entrepreneurial ventures in particular, the window of opportunity would often be gone by the time all the necessary information became available for more rational decision-making. Additionally, successfully starting a new business usually involves overcoming multiple hurdles. Using biases and heuristics as simplifying mechanisms for dealing with these multiple problems may be crucial. To face such hurdles from a strict econometric approach would not only postpone decisions, but would in all likelihood make them overwhelming. More specifically, overconfidence may be particularly beneficial in implementing a specific decision and persuading others to be enthusiastic about it as well. The use of biases and heuristics may also offer some help in explaining why entrepreneurs sometimes make bad managers. Whereas the use of cognitive biases may be beneficial in some circumstances, it can lead to major errors in others. Although research has yet to establish performance implications, it is possible that the more extensive use of heuristics in strategic decision-making may be a great advantage during the start-up years. However, it may also lead to the demise of a business as a firm matures.

Attitude of the Population toward Joint and Foreign Entrepreneurship in the USSR

The active attraction of foreign capital is a most important condition to extricating the nation from a protracted economic crisis. But while fulfilling this condition, it is extremely important not to repeat today the errors of others. The experience of many Asian and Latin American countries as well as of a number of East European states warns us against becoming overly enthusiastic about foreign credits. Naturally, the latter are also necessary, but primarily for tactical purposes that are in particular connected with securing balance in the internal market as an important prerequisite to deeper qualitative and structural reforms. The resolution of the strategic problems of the economic reform and the transition to the rails of a market economy presuppose first of all the securing of favorable conditions for importing capital in its productive form, the development of foreign and joint enterprise, and the creation of special economic zones in the USSR.

Common Cycling Injuries

The increasing participation in the athletic forms of bicycling warrants expanded physician attention to the traumatic and overuse injuries experienced by cyclists. The modern bicycle consists of a frame with various components, including handlebars, brakes, wheels, pedals, and gears, in various configurations for the various modes of cycling. For high performance cycling the proper fit of the bicycle is critical. The most efficient method to provide an accurate fit is the Fitkit, but proper frame selection and adjustment can be made by following simple guidelines for frame size, seat height, fore and aft saddle position, saddle angle, reach and handlebar height. The human body functions most effectively in a narrow range of pedal resistance to effort. Riding at too much pedal resistance is a major cause of overuse problems in cyclists. Overuse injuries are lower using lower gear ratios at a higher cadence. Cycling injuries account for 500,000 visits per year to emergency rooms in the US. Over half the accidents involve motor vehicles, and road surface and mechanical problems with the bicycle are also common causes of accidents. Head injuries are common in cyclists and account for most of the fatal accidents. Despite good evidence of their effectiveness, victims with head injuries have rarely worn helmets. Contusions, sprains and fractures may occur throughout the body, most commonly to the hand, wrist, lower arm, shoulder, ankle and lower leg. The handlebar and seat have been implicated in a wide variety of abdominal and genital injuries. Abrasions, lacerations and bruises of the skin are the most common traumatic injuries. Trauma may be prevented or reduced by proper protective safety equipment and keeping the bike in top mechanical condition. Anticipation of the errors of others and practising and adopting specific riding strategies also help to prevent traumatic injuries. Management of overuse injuries in cycling generally involves mechanical adjustment as well as medical management. Neck and back pain are extremely common in cyclists, occurring in up to 60% of riders. Ulnar neuropathy, characterised by tingling, numbness and weakness in the hands is common in serious cyclists after several days of riding. Managing saddle-related injuries or irritations may also involve adjusting seat height, angle and fore and aft position in addition to changing the saddle. Padding in the saddle and shorts play an important part in saddle problems. Saddle-related problems include chafing, perineal folliculitis and furuncles, subcutaneous perineal nodules, pudendal neuropathy, male impotence, traumatic urethritis and a variety of vulva trauma.(ABSTRACT TRUNCATED AT 400 WORDS)

Improving aviation accident research through the use of video

The investigation and analysis of aviation accidents is a critical aspect of aviation safety and a major tool for aviation system improvement. The National Transportation Safety Board is charged with the responsibility of determining the probable cause of aviation accidents, identifying contributing factors, and making recommendations for changes to equipment or procedures as a result of their investigations. The intent is to identify what went wrong and prevent its recurrence -- to learn from the errors of others and, thus, save lives and property.

Complications in the Treatment of Acute Spinal Injury

Complications may occur during any phase of the treatment process for acute spinal injuries. An awareness of the most common problems is the most powerful tool that the physician has to prevent him or her from repeating at least some of the errors of others.

Bonds of Enterprise: John Murray Forbes and Western Development in America's Railway Age

Bonds of Enterprise: John Murray Forbes and Western Development in America's Railway Age. By John Lauritz Larson. (Iowa City: University of Iowa Press, 2001. Pp. xxiii, 257. Paper, $17.95.) Bonds of Enterprise was first published seventeen years ago. book offered a comprehensive business history biography of John Murray Forbes and a carefully constructed interdisciplinary look at the so-called railroad question. In his introduction to this new and expanded edition, John Lauritz Larson reflects: I had hoped when the book came out that it would model in a small way the kind of integrated history that might reconcile claims about the impact of railroads, the plight of farmers, the intentions of political reformers, and the efficacy of government regulation-all issues about which historians, economists, geographers, and rural sociologists had argued bitterly for many decades (xi). Those acquainted with the previous edition are familiar with Larson's dual approach, which offers a commanding look at Forbes and his financial capitalist orchestrations interwoven with the sweeping historical theme of western railroad development. Now, in one of the ways good reading becomes classic reading, the University of Iowa Press reissue of Bonds of Enterprise extends an opportunity to a wider audience to discover the richness of this work and contemplate Larson's plea for the integrated historical method. book endures as a well-documented account of the professional life of John Murray Forbes. Through his acumen and dealings, we gain a better understanding of railroad expansion and its consequences. As Forbes quickly realized in his initial venture with the Michigan Central Railroad, by correcting the errors of others, fortunes could be made. Acquisitions and fine-tuning business practices from financing to operations ultimately played as large a role in the railroad question as new construction itself. Scholars of the early republic will find the first half of Bonds of Enterprise especially interesting, as later chapters focus on the railroad era beyond the mid-nineteenth century. Chapter one, The Liberal Merchant, tells how the young Forbes, having lost his father and brother, moved to China at the age of seventeen to work in a commission house. reader senses the personal hardship of such a choice with the slow transportation and communication possibilities of the early 1830s. Forbes subsequently dedicated his professional life to motivating railroad development, which accelerated the flow of information and goods to and from distant regions. That journey began in the late 1830s and early 1840s as Forbes shifted from brokering deals among traders to brokering deals among investors. Chapter two, An Assault on Space and Time, is the forbearer to the same theme in Carol Sheriff's Artificial River: Erie Canal and the Paradox of Progress, 1817-1862 (1996). …

Faults and fallacies in microbiology.

Summary:I need hardly say how much I appreciate the honour of being asked to give the fourth lecture in memory of Marjory Stephenson and how little I feel able to do justice to the task. Though many of you here knew her better than I did, I may perhaps be allowed to claim a small share in the success which she achieved. In the early twenties, when she was brooding over problems of growth and nutrition, she realized the necessity of using a quantitative technique. For this reason she came to Manchester where Topley had recently inaugurated the Diploma in Bacteriology course, and it was there that I had the privilege of teaching her how to count bacteria. The choice of a subject for this lecture proved very difficult. As I have done no bench work for 14 years, it had to be a general one. I have always been interested in technique, and I therefore thought it might be worth studying the part played by faulty technique in reaching erroneous conclusions. I found an almost embarrassing richness of material before me, and I have perforce limited myself to a few illustrative examples. Many of you will regard studying the errors of others as a presumptuous and invidious undertaking. I admit this. My purpose, however, is not, as that of some of the literary critics has been, to denigrate the outstanding men of the past, but to try and learn how lesser men can avoid falling into their errors. Even the greatest of scientists may go wrong, and all of us should realize the abyss at our side and say with John Bradford ‘But for the grace of God there go I’ So far from attempting to act as a judge, I propose to be no more than an honest seeker after truth and of the ways of reaching it. I approach my subject, as every scientific investigator should, wearing ‘the napless vesture of humility’.

THE ACCIDENT-PRONE AUTOMOBILE DRIVER

In this study the existence of accidentprone drivers has been demonstrated in the records of accidents from a bus company extending over a period of 6 years. The frequency of appearance of the same individual in the high accident group in multiple years has been noted. It has been shown that because of their high accident rate their importance in contributing accidents far exceeds their numbers. In other words, a few drivers account for a disproportionate number of accidents year after year. A group of high and low accident drivers in a taxi firm have been interviewed and the differences in the personality and background of the 2 groups have been noted. It has been demonstrated that the high accident taxi driver most frequently comes from a home marked by parental divorce and instability. During childhood his life is marked by evidence of instability and disrespect for organized authority. As a result he has often encountered difficulty with the school authority and frequently has been before the Juvenile...

Planning the Rhinoplasty

IT HAS been rather unfortunate that rhinoplasty was originated in obscurity and its progress hindered by the disapproval, even antipathy, of the great mass of the medical profession. Each rhinoplastic surgeon not only made his own errors but repeated the errors of others. That was the situation when I first started doing this work at the old Howard Hospital in 1926. Conditions have changed since then. At that time the mere shortening and narrowing of the nose or the filling of a saddle nose was satisfactory both to the patient and to the operator. Since then the public has become plastic conscious—in fact, excessively so. Today the public expects results that as yet are too often impossible to attain. A patient may have a tremendous nose. The skin is extraordinarily thick, with secretions oozing out of the pores on the slightest pressure. She requests a small, thin nose. We tell

PLANNING THE RHINOPLASTY

IT HAS been rather unfortunate that rhinoplasty was originated in obscurity and its progress hindered by the disapproval, even antipathy, of the great mass of the medical profession. Each rhinoplastic surgeon not only made his own errors but repeated the errors of others. That was the situation when I first started doing this work at the old Howard Hospital in 1926. Conditions have changed since then. At that time the mere shortening and narrowing of the nose or the filling of a saddle nose was satisfactory both to the patient and to the operator. Since then the public has become plastic conscious—in fact, excessively so. Today the public expects results that as yet are too often impossible to attain. A patient may have a tremendous nose. The skin is extraordinarily thick, with secretions oozing out of the pores on the slightest pressure. She requests a small, thin nose. We tell