GENERALSURGERYNEWS.COM
July/August 2014 • Volume 41 • Number 7
The Independent Monthly Newspaper for the General Surgeon
Opinion
VTE May Be Misleading Quality Measure
Love: Its Real Effect On Patient Care
Hospitals Can Be Penalized Unfairly for Greater Vigilance
B Y B RUCE R AMSHAW , MD ‘Vulnerability is not weakness. Vulnerability is the most accurate measure of courage. Vulnerability is the birthplace of innovation, creativity and change.’ —Brene Brown, PhD, LMSW, The Gifts of Imperfection
M
rs. George (not her real name) was not unlike many patients we see for complex abdominal wall problems. Several years earlier, she had an open abdominal vascular procedure and developed an enlarging incisional hernia. She recounts that when she complained to her primary r care physician and her surgeon, she was told she was getting fat and there was nothing wrong with her abdominal wall. Eventually, she became angry because her physicians simply were not listening to her. After a while, she sought a second opinion, and that surgeon told her she had an incisional hernia. Due to its size,
B Y C HRISTINA F RANGOU Trainees perform simulated case at the Israel Center for Medical Simulation.
environment may contribute strongly to a patient’s surgical decisions. Andrea Covelli, MD, a general surgery resident at the University of
key measure used by the Centers for Medicare & Medicaid Services (CMS) to assess a hospital’s quality performance may not reflect quality at all, according to a new report. Instead, a hospital’s rate of venous thromboembolism (VTE) events directly reflects how frequently the hospital conducts imaging tests to diagnose VTEs. In other words, the more a hospital looks, the more it finds. “Hospitals may be unfairly deemed a poor performer for the outcome VTE measure if they have increased vigilance for VTE by performing more VTE imaging studies,” said study author Mila H. Ju, MD, MS, a clinical scholar with the American College of Surgeons (ACS) and a vascular surgery resident at Northwestern University, Chicago, after presenting the study at the 134th Annual Meeting of the American Surgical Association. VTE is a controversial quality-ofcare measure included in many quality improvement programs and public reporting initiatives. The CMS deemed VTE a “never event” that will not be additionally reimbursed after certain operations. Beginning in 2015, VTE occurrence will be tied to financial
see MASTECTOMY page 11
see VENOUS THROMBOEMBOLISM page 13
Physician Stresses Simulation To Avert Harm to Real Patients Physicians Should Be Selected on Skills Outside of Cognition B Y C HRISTINA F RANGOU SALT LAKE CITYY—As a young combat pilot in the Israeli Air Force, Amitai Ziv practiced on a simulator for every nightmare scenario his trainers could come up with: ejecting from
airplanes, landing planes overcome with flames, managing all sorts of equipment malfunctions. When he started medical school see SIMULATORS page 14
Practice Environment Affects Patient Decisions on Mastectomy Study Shows Contrasts Between United States and Canada
see LOVE page 16
B Y M ONICA J. S MITH
New Product RF Assure Detection System see pages p g 6 and 9
LAS VEGAS—The rapid growth of prophylactic mastectomy has been quite a puzzler in an era that favors increasingly minimal operations. Recent research suggests a surgeon’s practice
INSIDE Opinion
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Reflections on the VA scandal, by Frederick Greene, MD
Web Exclusive
The Visit generalsurgerynews.com (top right of homepage) to read A blog by Victoria Stern a blog that tackles such issues as: Nature vs Nuture: What Makes an Expert Surgeon? Work Hour Restrictions: Are New Surgeons Ready for Practice?
Scope
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