American College of Surgeons - Yearbook (Chicago, IL)

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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

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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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8 American College of Surgeons surgical specialists to define a standard of excellence and arbitrarily to select eighty or one hundred men on the continent who will qualify for membership. Such societies are usually social as well as scientific; and they are of vast benefit to the progress of medicine, for they aid in distributing new and higher ideals of attainment. Their object is to advance some particular specialty of surgery to its highest excellence There are already in existence one or two such societies for each branch of surgery that is recognized by the American College of Surgeons. The American College of Surgeons, in contrast to these socie- ties, is a democratic and inclusive organization. It is not only interested in the advancement of some branch of surgery, but of every branch of surgery. Its special task is to insist that surgery wherever practiced on this continent shall be under the surveil- lance of an organization which is strong enough in its moral repu- tation, and strong enough in its influence upon society, to render impossible the practice of surgery on the part of men who are not educationally, scientifically, and morally equipped to do the work. Its task is to provide the pubHc with honest, competent service. . . . The first step forward was, obviously, to determine upon a standard of moral and scientific excellence for admission to Fellow- ship. Years of experience are essential to anything hke a final analysis in this matter. But we know that any right standard must command the respect of the profession at large and the con- fidence of laymen. Of necessity, we must look into the moral and intellectual soundness of each candidate. This means that we must estimate the value of the candidate ' s educational opportun- ities, as determined especially by the medical school from which he graduated. We must estimate the practical hospital training that he received, the assistantship which he served in the art and science of surgery, the value involved in the hcense which he has acquired to legalize his practice, and his actual performance as an independ- ent practitioner of surgery. Of great importance also is a knowl- edge of the methods of the hospital and of laboratory environment wherein his work is done. . . . Conscientious work as an official or a committeeman of the College soon convinces one that there is no concerted action on the part of the medical societies, medical schools, hospitals, or legisla- tures in the direction of making safe and experienced surgeons out