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Mon Mar 5 12:49:59 GMT 2007

Ron,

Yes, the delete key is your friend.

Look, I don't know what the answer to this issue is and I have more
questions than answers. But maybe part of the problem is we're often NOT
talking about liars, cheats and crooks.

Let's look at the best case scenario with all of my personal biases thrown
in. I actually believe that as a group, trauma providers are more motivated,
have more integrity and are better than other groups I have worked with. Of
course I am especially proud of the particular group I had the opportunity
to work with. I was in charge of M&M for a number of years and I can say
that we were EXTREMELY self critical. 

While I think that is a good thing I don't know if it's "sufficient". I
think one of the reasons we could be so hard on ourselves is that whatever
happened or was said stayed within our group. Now say you or I would be
basically suicidal if we were associated with a preventable adverse event
and we would be motivated to make sure that something like that never ever
happened again. Is that "enough"? Well from a systems perspective you can't
ask for a better correction than that. So let me say two things. One, not
everyone would be affected in that way. Two, even in the best, highest
performing group there is variability. I'll bet that over the years that I
had responsibility for M&M there were a couple of docs who were essentially
never associated with a preventable adverse event. Just lucky? I don't think
so. So what about the other good and competent docs who just didn't meet
that lofty standard? Well we never talk about that. And that's the problem.
And this is the BEST scenario involving people who I believe are functioning
at the top percentile of the medical profession. Never mind others who by
comparison are, like I said, stone killers.

I just wonder if it's even realistic to think we can really police our
selves and yet I don't trust anyone else to do it.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Sunday, March 04, 2007 7:02 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Never 27 Law Watch

Rob,

I think that there are bums, thieves, liars and cheats in any and every
field of work you look to - medicine is no different.  I will give you
that much, and perhaps that is where the similarity of Mattox's and
Horan's thought processes begin and end.  Unlike Horan, Mattox believes
that we still can make the difference and "police" our own; we certainly
have enough examples to go on.  On the other hand, by comparison to the
rest of the world, I firmly believe that our percentage of bums,
thieves, liars and cheats is far lower.  It is just that in our field
the stakes are so much higher.

You are right - we need to do better, but I do not agree that the
messages put out by Mattox and Horan are the same - and that has nothing
to do with - antipathy be damned - my complete disdain of Horan and his
"messages" which, by the way now meet with a delete key.

Take care,
Ron

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 3/3/2007 11:14 AM >>>
Ron,

I followed your excellent example. Your deep antipathy toward Tom
aside, I
don't know what you found so objectionable in the four small pages we
are
able to read from the Amazon website. The place where I trained had a
similar ethnic ebbing and flowing. It sounds like a fictional story of
a
principled scientific doctor fighting with some other wicked greedy
docs who
actually run the hospital and don't care about the patients as much.
You're
right that sounds too far fetched.

Why can't we know who this Professor Z is?

I believe Tom and Dr. Mattox are making the same point. The reason laws
like
Never 27 are passed is because we have done such an abominable job
"policing
ourselves". I'm not sure it is logical to believe that powerful groups
will
be able to provide their own oversight. Certainly doctors, lawyers and
cops
would not be poster children for this concept. I worked at place where
economics and internal politics were RELATIVELY less forcefully
influential
than most. I worked with brilliant and dedicated physicians. But we
were and
are forced to work with some absolute stone killers and murderers. I
don't
think once in over a quarter century did a doc lose their privileges
let
alone get fired. Well there was one but that was more an example of how
the
Never 27 laws will be used and abused than anything useful or fair.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Thomas Anthony Horan
Sent: Saturday, March 03, 2007 9:22 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Never 27 Law Watch

Gosh Ron,

 To read any book you will have to be able to maintain attention for
more
than three paragraphs. Maybe you attention deficit was a reaction to
the
source of the recommendation? The surgeon author has over 300 peer
reviewed
articles and is an associate editor of a well know journal. The book
comes
from his experience in NY. Many on the list have  had a lot of
interaction
with the author.

Any way I found it an accurate reflection of what the real problems are
and
how the medical profession protects its incompetent members. If law 27
had
been in force during the events related, the book would not have been
needed.

Tom

> ----------
> From:
trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org] on
behalf of Ronald Gross[SMTP:Rgross at harthosp.org] 
> Reply To: 	Trauma &amp; Critical Care mailing list
> Sent: 	sábado, 3 de março de 2007 00:04
> To: 	Trauma &amp; Critical Care mailing list
> Subject: 	RE: Never 27 Law Watch
> 
> Hey Tom,
> 
> I Googled this mysterious Professor Z that you seem to admire so
much
> and couldn't find a damn thing about him.  So I looked at his book
on
> the only place I could find it on line - Amazon.com.  I read page 1
and
> I have to ask the question....Is the rest of the book the same
> fictitious garbage as page one is?  
> Wait!  I get it - we have now moved into the rea
lm of evidence based
> fiction.  Great.  Just great.
> 
> Ron
> 
> 
> >>> "Thomas Anthony Horan" <thoran at sarah.br> 3/2/2007 12:45 PM >>>
> Dear Ryan,
> 
> you are absolutely correct and Ron provides no evidence to support
his
> contrary minded view.
> Recently a well known Surgeon  from new York has published an
account
> of how poorly the current accountability situation plays out in a
> hospital. "Behind the Green Door" professor Z worth the read.
> 
> Tom
> 
> > ----------
> > From:
>
	trauma-list-bounces at trauma.org[SMTP:trauma-list-bounces at trauma.org]

> on behalf of Ronald Gross[SMTP:Rgross at harthosp.org] 
> > Reply To: 	Trauma &amp; Critical Care mailing list
> > Sent: 	sexta-feira, 2 de março de 2007 10:07
> > To: 	Trauma &amp; Critical Care mailing list
> > Subject: 	Re: Never 27 Law Watch
> > 
> > Ryan,
> > 
> > It is quite clear that you have never been involved with an
> investigation of a reportable "adverse event".  And I am sorry to
say
> that it is just as clear that you fail to give the average
"consumer"
> (formerly known as a patient) the credit that he/she is due when you
> assume that these folks are accepting their PMD's golf partner as
their
> physician.
> > 
> > I hope you return to this list with your revised comments 2 or 3
> years after you have entered the real world as a practicing
physician. 
> Even better, as a solo practitioner who hangs out a shingle in a
town
> where there are 16 other surgeons, you don't have time to play golf,
and
> your practice grows solely on your ability to practice medicine or
> surgery and care for your patients the way they want to be cared for
-
> as if each and every one of them were the most important person in
your
> world getting the best results possible.
> > 
> > Good luck,
> > Ron
> > 
> > >>> Ryan Shanahan <rs339 at georgetown.edu> 3/1/2007 6:10 PM >>>
> > With considerable respect to Drs. Mattox and Gross I would
question
> whether anyone on this list or the hospitals they work for create
enough
> report-able events to make this law an administrative hassle.  If it
is
> the case than the reporting requirements should be the least worry. 
> (granted the last report-able event "any adverse event ... that
causes
> death or serious disability" is uncomfortably vague)
> > 
> > For all the problems that the consumerization of medicine has and
> will continue to create it should allow people to compare and choose
a
> doctor based on some objective criteria.  At least something more
> objective than a list in a phone book or their primary care
providers
> golf partner.  Yet there has been considerable reluctance to provide>

> practice quality data like this to the public.  Usually adverse
events
> like the ones mentioned in this law are buried in an internal QC
review
> with admonitions to do better in the future and very little tangible
> change.  Every so often when an error occurs a patient sues but that
is
> the exception rather than the rule. (Keepnews D, Mitchell P. (2003,
> September 30). Health systems' accountability for patient safety.
Online
> Journal of Issues in Nursing 8(3):2).  More often patients sue when
no
> error has been committed.
> > 
> > Legislation like this is the least efficient way to make the
required
> changes in openness and accountability for mistakes but if the
> profession is unwilling to make the changes internally then external
> prodding is the only way left.
> > 
> > Ryan Shanahan M'09
> > 
> > 
> > 
> > ----- Original Message -----
> > From: KMATTOX at aol.com 
> > Date: Thursday, March 1, 2007 11:35 am
> > Subject: Re: Never 27 Law Watch
> > 
> > > Ron:   I think that the majority of the persons on this list  
> > > (including 
> > > international members) are in total agreement wi
> th  you.   There 
> > > are a few on this 
> > > list that are supportive of the  Regulatory Industrial Complex
and
> 
> > > the clip 
> > > board carrying job assurance  programs. 
> > > 
> > > k
> > > <BR><BR><BR>***************
***********************<BR> AOL now 
> > > offers free 
> > > email to everyone.  Find out more about what's free from AOL at 
> > > http://www.aol.com.
> > > --
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