It's Judgment Day, Says a Longtime Surgeon

I know I'm as annoying as the screech of a knife on a plate when I rattle on interminably about numbers numbers numbers why don't we have the numbers? But whether the subject is No Child Left Behind or the longevity of household appliances or the rate of hospital infections, nothing can improve unless you know where you are now. That requires data.

So I was cheered by a visit to our offices the other day by Thomas Russell, executive director of the American College of Surgeons. Russell was a surgeon for some 30 years, burying his hands daily in the squishy innards south of the belly button to fix all manner of intestinal problems. His credentials as a competitive, assured cutter are genuine, and he did medicine at a time when those qualities were all that a skillful surgeon needed to win the confidence of others. Why quiz him (always a male, in those days) about his volume or his rate of success? The surgeon was the best judge of his own competence. "I was completely typical," Russell told our small group of journalists.

The philosophy he's currently trying to pound into ACS members is quite different. This is a new era, says Russell. Report cards that accurately reflect the ability of hospitals and of individual surgeons to deliver good care are becoming a given, he says, and physicians had better get used to it. Airing data surgeons once stockpiled in their own notebooks, if they kept them at all, is nothing but positive. Transparency, he calls it. When the proudest, most macho members of the medical community willingly buy into the idea that their work should be measured and judged, I'm a little more optimistic that others will fall in line.