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Part of every surgeon's job description is to be confident. Confidence is necessary both to sell patients on the concept of surgery and to actually perform it. And in truth, competence and confidence often seem to go hand in hand.
But everyone who's been around surgery knows that there is a thin line between confidence and overconfidence-between being aggressive and being delusional. And we all know that some surgeons cross that line and stay there until, as Petrarch put it, fortune brings them to earth.
A surgeon I used to know justified his aggressive marketing campaign by explaining that if he hid his light under a bushel, he would be depriving thousands of patients of his supreme surgical skills. Few people were surprised when he recently lost a multimillion dollar malpractice suit.
Overconfident surgeons are dangerous. But overconfident surgeons with their own in-office surgery suites are menaces to society. That's why I applaud the American Society of Plastic and Reconstructive Surgeons' decision last month to essentially mandate accreditation of office surgery facilities owned by its members by July, 2002. I think other surgeons doing surgery that requires level II or above anesthesia should also seek accreditation.
It is true that this step may cost some of these surgeons tens of thousands of dollars to upgrade their facilities. It will also cause them to have to fight through a lot of red tape that many will find onerous and unnecessary. Many surgeons also can probably credibly argue that they are doing a fine job already, and that accreditation in their case is simply superfluous.
All true, but office surgeons still need to seek accreditation.
One reason comes clear when you observe the moratorium on office surgery that took place after several patients died during or after office procedures in Florida. In fact, the deaths might have occurred regardless of the setting, but this fact was lost in most of the articles (including one in USA Today) about the event. Office surgery cannot sustain many public relations fiascoes like that one.
More important, though, is the fact that all surgeons can benefit from outside evaluation and oversight. The world's greatest orthopod or urologist or gastroenterologist may still have woefully inadequate training in the areas of anesthesia or infection control or life support. The accreditation process helps make sure everything is in order.
A few years ago, a Texas ENT surgeon did an office tympanoplasty on a nine-year-old. The patient died under the knife. An investigation revealed that the Halothane vaporizer on the ancient anesthesia machine was leaky. If mandatory accreditation of office surgery suites prevents just one death, as it could have prevented that one, it will have all been worthwhile.
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