American College of Surgeons - Yearbook (Chicago, IL)

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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-

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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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Further Advance of Surgery 7 stand. These pamphlets will deal one after another with the things which make hospitals the right sort of institutions for the care of sick people. Sometimes it may be necessary to call meetings of the local commercial clubs, or of other bodies of laymen, in order to waken up the community as to the actual conditions in their hospitals. If this course is necessary, it will be followed. The day has gone by when any sort of indifferent or incompetent prac- tice can be shielded in a hospital. The day has gone by when hospital trustees may rest in an irresponsible attitude toward the trust imposed in them. Again, what is the relation of the hospital to the county or local medical society? Are the facilities of the hospital freely at the service of the society? Is the spirit which domin ates the work of the hospital an inspiration? Is it progressive and unselfish? These are merely some of the questions which the College of Sur- geons proposes to answer in the fashion already indicated. It is probable that we shall begin with a study of the training of the internes. This problem is most closely related to our needs in the administration of the College. Further, if we go right to the bottom of the problem we shall find that it is really a question of what is the proper care of the patient. A full outline of this prob- lem has already been sent to you. FURTHER ADVANCE OF SURGERY The investigation of hospitals offers one of the chief avenues of contact between the College on the one hand and the medical pro- fession and the general public on the other. Through these studies, further, the College seeks to inspire real headway toward better surgery. But the Regents are not content to rest their efforts in this single field. The following paragraphs from the re- port of the General Secretary to the Fellows, October 27, 1916, are self-explanatory in this matter, — At all times in the administration of their trust the Regents have these questions to answer: (i) What is a genuine standard of good surgery? (2) How may we recognize those who practice good surgery and invite them to ally themselves with the College? (3) By what processes shall we make headway toward better standards of surgery? It is easy for an exclusive society of eighty or one hundred