Surgery News - March 2008 - (Page 6) 6 OPINION FROM THE COLLEGE SURGERY NEWS • M A R C H 2 0 0 8 Let Competence, Safety, and Quality Be Our Legacy s the 88th president of the American ulatory authorities, increased risk of malCollege of Surgeons, I encourage practice lawsuits, and poorer outcomes our members to strive for compe- ( JAMA 2007;298:1057-9). Anyone who has tence, safety, and quality—the attributes been a patient knows that bedside manner necessary to provide surgical care to 21st- counts. Patients don’t care how much you century patients and to create a legacy as know until they know how much you care. Unfortunately, modern technology posa FACS: a Fellow of the ACS, and Forever es traps that may seduce a surgeon away A Caring Surgeon. from direct communication A framework for achieving with the patient. Throughout these attributes exists largely in society, the art of conversation the six core competencies we is being replaced by printed are expected to attain and words rapidly scrolling across a maintain throughout our cacomputer screen or BlackBerreers: patient care; medical ry. Bombarded with myriad knowledge; practice-based facts each day, we are losing learning and improvement; inour ability to effectively comterpersonal and communicamunicate with other humans, tion skills; professionalism; and and technology sometimes systems-based practice. The BY GERALD B. HEALY, makes us forget the human first three competencies are M.D., FACS qualities that differentiate us those possessed by any capable physician. However, I firmly believe that from the surgical robot. Further challenging our ability to assure the major obstacle to the successful practice of safe, quality, and effective surgery the public that we provide safe, quality is failure to be proficient in the last three. care are breaches in professional conduct. A recent study confirms that poor com- We work in a climate of uncertainty laced munication skills lead to patient dissatis- with the loss of collegiality, driven by a faction, higher rates of complaints to reg- never-ending bottom-line mentality, and A surrounded by falling reimbursement for our services. In addition, outsiders are constantly invading the physician-patient relationship, willingly replacing the physician at a moment’s notice. This environment naturally increases our frustration level and has led to a marked increase in disruptive behavior within our profession. In a survey of more than 1,500 members of the American College of Physician Executives, a significant percentage reported unprofessional conduct, including physical abuse, verbal insults, and refusal to perform tasks and duties (Physician Exec. 2004;30[5]:16-7). These actions have the potential to intimidate patients and increase staff turnover and lawsuits, which, in turn, escalate practice expenses. We must demonstrate our willingness to confront the bad actors. Be proactive and establish a code of conduct that is acceptable within your organization. Help disruptive individuals understand why their actions are inappropriate and untenable. Finally, follow up to ensure that the culture is effectively changing. Many of us trained in the 20th century under icons who led monolithically and sometimes by fear. This model no longer works. Twenty-first century surgery will revolve around systems-based care rendered by effective teams. To function successfully in such practices, surgeons must promote teamwork and communication. Poor care is inevitable when a complicated patient receives care from multiple individuals who have not been trained to communicate effectively as a team. The Institute of Medicine’s report, To Err Is Human: Building a Safer Health Care System, showed that avoidable errors occur every day in health care, largely because care is so often delivered in a fragmented way. To ensure safe, high-quality care, we can no longer be only surgeons. Instead, we must be leaders of coordinated, high-performance teams. Through leadership, a person influences others to accomplish an objective and directs an organization so it becomes more cohesive and coherent. Leadership requires passion, a strong sense of purpose, and vision. Today’s surgeons must make leadership a part of their legacy. Remember, Martin Luther King Jr. said, “I have a dream,” and not “I have a very good plan.” Successful leaders are defined by what I call the seven Cs: courage, confidence, creativity, communication, caring, charisma, and character. Furthermore, effective leaders take the time to understand the community they guide, studying its history and mores. Wherever you choose to exercise leadership, challenge the process, inspire a vision, enable others, be a role model, and encourage the heart of the organization to be better. Become a leader in advocating for our patients. Every one of us has been given an enormous opportunity to leave a legacy in a profession dedicated to serving our fellow beings. Savor, nourish, and cherish it. Our legacy follows us forever. Hopefully, it will be said that this was your legacy: Forever A Caring Surgeon. ■ DR. HEALY is president of the American College of Surgeons, the Healy Chair in Pediatric Otolaryngology and professor of otology and laryngology at Harvard Medical School, and otolaryngologist in chief at Children’s Hospital, Boston. LETTERS Act Now, Pay Later The College Cost Reduction Act (H.R. 2699), signed into law by President Bush in September 2007, abolished the 20/220 rule, through which many residents qualify for economic hardship deferment for the first 3 years of residency. Instead, the law created a mechanism whereby as of Jan. 1, 2009, borrowers may opt for a repayment program that would require paying in excess of $4,000 annually. Alternatively, residents may choose forbearance and have interest immediately begin capitalizing. Dr. Michael Maves, executive vice president and CEO of the American Medical Association (AMA), has expressed his strong opposition to this provision, and thanks to intense lobbying efforts, the 20/220 pathway has been extended through fall 2008. But with the average student loan debt continuing to rise (now $130,571) and an average monthly gross income of $3,180, any repayment program would place a burden on many residents, and H.R. 2669 would be less beneficial than the current standard. A long-term legislative solution is needed to ensure the continuation of economic hardship deferment. Sen. Richard Burr (R-N.C.) introduced S. 2303, a bill through which the 20/220 pathway would be reinstated and continue to benefit residents whose educational loans are currently deferred. A similar bill, H.R. 4344, was introduced in the House. Information about the 20/220 pathway is available at www.amaassn.org/go/ loandeferment. Residents are urged to contact the AMA (rfs@ama-assn.org) and their congressmen. Jacob Moalem, M.D. San Francisco Editor’s note: We thank Dr. Moalem, vice chair of the American College of Surgeons’ Resident/Associate Society, for bringing this issue to our readers’ attention. According to Matthew Schick, legislative analyst for the Association of the American Medical Colleges, no end date has been set for the economic hardship deferment. He said that the Department of Education may continue this program indefinitely. The AAMC has posted a letter from the Department of Education indicating that lenders should still be offering the 20/220 pathway of the economic hardship deferment (see www.aamc.org/advocacy). http://www.ce-university.org/surgery http://www.ce-university.org/surgery http://www.aamc.org/advocacy
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