American College of Surgeons Clinical Congress
CONVENTION ISSUE:
40th Anniversary 1972-2012
GENERALSURGERYNEWS.COM
September 2012 • Volume 39 • Number 9
The Independent Monthly Newspaper for the General Surgeon
Opinion
Res Ipsa Loquitur B Y J ON C. W HITE , MD
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es ipsa loquiturr or “the thing speaks for itself ” is the core principle applied in many medical malpractice cases where culpability for a tort has to be established. It is the job of the plaintiff ’s legal team to make a clear-cut case, which is not always easy. As all physicians know, medicine is part art and part science, and clinicians rely on their experience and judgment as well as a body of established facts to determine what course of action is appropriate for an individual patient. When there is a bad outcome resulting from such a clinical decision, the nuances of the case may be difficult for the lay public to grasp. The facts must be presented so that there is a convincing inference of negligence, which can be understood by a jury. Thus, the argument must “speak for itself.”
Texas Physician Population Surges Since Tort Reform Legislation in 2003 A 44% Increase; Report Does Not Prove Causality; Number of General Surgeons Decrease B Y C HRISTINA F RANGOU SAN DIEGO—Texas’ 2003 tort reform legislation was associated with an upsurge in actively practicing physicians in the state, with physician population growth outstripping regular population growth and increasing the per capita number of physicians in
20 of 22 trauma service areas, a new study shows. “Tort reform is associated with a very significant increase in the number of Texas physicians relative to the Texas population,” said lead author see TEXAS PHYSICIANS page 20
Tort Happens As physicians, we also know that mistakes do occur. We have all made mistakes, know others who have made mistakes and have seen the resulting bad outcomes. None of us is or should be expected to be perfect. When a minor lapse in judgment is linked to an unfortunate set of comorbidities or circumstances, the outcome can be bad. These types of errors are not and should not be considered malpractice. At other times,
Device-Tissue Interaction: Evaluating New Devices for Your Surgical Practice
Program Cuts SSI Rates in Colorectal Surgery Patients B Y K ATE O’R OURKE
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comprehensive unit-based safety program (CUSP) has cut the surgical site infection rate of colorectal surgery patients at Johns Hopkins Hospital by 33%. Hopkins researchers say that if similar programs are adapted nationwide and applied to all surgical procedures, 170,000 surgical site infections (SSIs) could be avoided at a savings of $102 million to $170 million annually. The key to success, say researchers, is that the program engaged frontline providers. “The message is not that our bundle is the solution, but that engaging the frontline is the solution,” said Elizabeth Wick, MD, a colorectal surgeon at Hopkins who led the study. “Instead of having a top down quality improvement, where a bundle is imposed on [clinicians] by the administration, you should instead educate the frontline and have them come up with a list of defects, address them and work together with the leadership to address the problem.” The study appeared in the August issue of the Journal of the American College of Surgeons. The use of CUSP by hospitals has been growing in recent years, with the see SURGICAL SITE INFECTION page 20
see TORT REFORM 53
CLINICAL COMMENTARY
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In this piece, Ephemera #8, 48"x48" oil on canvas, Chad Hoover heightens the contrast between light and dark, displaying a luminous operative field and creating a great sense of theatricality. See page 17 for further description.
see page 25
REPORT Technological Advancements in Tissue-Sealing Devices See insert at page 28
INSIDE Opinion Emergency Room Call Is Ruining My Credit Rating . ................... 6
Obesity Care CMS Green Lights Sleeve; Sexual Misconduct by Pro- Weight Discrimination Law; fessionals: A New Model Experts Debate Sleeve of Understanding .......... 12 Gastrectomy for Teens .... 22