American College of Surgeons - Yearbook (Chicago, IL)

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Investigation of Hospital Conditions 5 acquire accurate data with regard to the training of surgeons, not only in the medical schools, but also in the hospitals. It is prob- ably a fair statement to say that eighty per cent of what the sur- geon actually uses in practice he acquires during his interneship and surgical assistantship in a hospital. The conditions under which this training is offered are, therefore, conditions with which the College must be well versed ; and to know what these conditions are means that the College must undertake a thorough investiga- tion of all phases of hospital work. The Director of the College recently, in making a report to the Fellows, said in this connection, — The particular training ground for the surgeon is the hospital. Forced upon us, then, is the obligation to know what this training ground is, and what kind of a standard we should hold up to ourselves as the proper training of a surgeon in a hospital. Further, the problem of the training of a surgeon in a hospital cannot be iso- lated as a separate factor of the hospital ' s program. We cannot say that here the training of the surgeon begins and that there it ends, for the training of the physician is also largely the training of the surgeon. The problem involves us in the whole question as to what is the proper care of sick people. There are specific divisions, however, in every hospital which we may investigate, and, having accurate data, we may point the way of progress. For example, what is the condition of the case-histories of a given hospital? Are they complete? Are findings of surgical operations recorded immediately after the operations? Are the records accessible for study and future guidance? Are end-results followed up with conscientious common sense? Are summaries of these results made public as evidence of the competence of the physicians and surgeons practicing in the hospital? We may ask, further, what the conditions are of the hospital laboratory. Important elements in the training of the surgeon are that he know how to use the laboratory, and that he form a habit of using it. What are the laboratory facilities which a hos- pital of a given number of beds may reasonably be expected to provide? Are the laboratory findings made a part of the case- histories? Does the pathologist report his exact findings as a part of the case-histories? Do the superintendent and the trustees who are responsible for the government and the administration of the hospital take pains to assure themselves that the work of the

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4 American College of Surgeons vides, however, that the total payments assessed against any- Fellow shall not exceed five hundred dollars. Further, dues are not asked of those who have retired from the active practice of surgery, or who have reached the age of sixty-five, or who, in the judgment of the Regents, would find payment of such dues a hardship. At any time a Fellow of the College may become a life member by subscribing five hundred dollars to the permanent Endow- ment Fund of the College. Subscription cards used for this purpose are of the form given below, — In case of death all unpaid balances are canceled. ENDOWMENT FUND hereby subscribe Five Hundred ($soo) Dollars to the Endowment Fund of the American College of Surgeons, the amount to be paid in installments as follows: Date Amount Date Amount Date Amount $ $ $ » $ $ further agree to pay interest on unpaid balances of this pledge at the rate of 5 per cent per annum. Siened Date The Regents propose to bring the Endowment Fund up to one million dollars as rapidly as may be. To this end they earnestly request Fellows of the College who have not already done so, and who can do so without hardship to themselves, to subscribe to the fund rather than to pay annual dues. From time to time unexpended balances in the treasury of the College will be transferred by the Regents to this fund. Subscription cards may be had on application from the General Secretary of the College. INVESTIGATION OF HOSPITAL CONDITIONS The admission of Fellows to the College made necessary at once that the Regents adopt a genuine standard of surgical train- ing. From this fact it followed that the Regents must necessarily

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6 American College of Surgeons laboratory is competent and that reports of findings are fearlessly set down? This last question leads us to the whole problem of hospital administration. We cannot avoid it. What is the relation of the Board of Trustees to the medical staff? Or to the hospital superin- tendent? In passing, let me say that it is the business of the super- intendent to carry out the directions of the Board of Trustees. He should be told what kind of a staff is privileged to practice medicine and surgery in the hospital. He should see to it, then, that only men of the character indicated by the trustees are given this privilege. There is one superintendent in this country whose abihty to meet this difficult problem is an inspiration. His hospital, as it happens, is one of ' open staff. ' This superintendent has not raised any technical question as to the merit of an ' open ' or a ' closed ' staff. To him competence and honesty are fundamental. He has made it his direct business to know what goes on in the operating room, and to know what happens in the particular case before the operation occurs. If a surgeon operates in that hospital without evidence of genuine ability, the superintendent, after the operation is over, quietly puts his hand on the man ' s shoulder and says, ' We do not want you to come back again. Your work is not satisfactory. If you wish to make an issue of this matter, I will meet you. You are privileged to return, however, whenever you will show that you have acquired the training necessary to modern surgery. ' The trustees support this man. What is the result? The hospital is still of the ' open staff ' t3 e, but in practice it is more ' closed ' than most ' closed staff ' types. Competent physicians and surgeons of the community are privileged to make use of the hospital; and at the same time the trustees of the hospital are able to guarantee to the community that the hospital stands for com- petent, honest service. Why shouldn ' t the trustees of all hospitals honestly be able to guarantee to their communities honest, competent service? Such a condition is one of the things which the American College of Surgeons seeks to bring about. It proposes to deal with these problems in no uncertain nor half-hearted fashion. The central part of its effort will be a series of pamphlets written so simply that the man who moves his lips when he reads can under-