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Second Opinion

Proto readers weigh in on how physicians and patients can work together to make decisions, ways to improve medical error reporting, and the need for standards when evaluating breath tests used to diagnose disease.

FALL 2013
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SURGICAL DECISIONS

“On the Same Page” (Summer 2013) addresses a central issue for the ethical practice of surgery: informed consent. As a surgeon, I am critically aware of how informed consent has changed over the last several decades. It is no longer appropriate to assume that the doctor knows best. As your piece correctly points out, the new paradigm for surgeons and patients is “shared decision making,” which requires surgeons to pay attention to a patient’s values while providing information to pave the way for an informed decision. However, respecting the autonomy of the patient does not mean informing the patient of a menu of options without any recommendation. The recommendation of the surgeon should be based on the goals of the individual patient, but the failure to make any recommendation is to shirk one’s responsibility as a surgeon. Patients should expect their surgeons to be more than waiters describing the menu. Patients expect more and should get it.

Peter Angelos // Professor of Surgery, University of Chicago

ROOM FOR IMPROVEMENT

I read with great interest “Medical Errors From the Patient’s View” (Summer 2013). I share the view that patients can and should be partners in improving the quality and safety of health care. The concept of patient reporting of adverse events has the potential to overcome some of the limitations in the current provider-reporting initiatives, and to identify potential safety issues and opportunities for improvement that may not always be apparent to providers. Patient self-reporting of their experience of care, including the widespread adoption of the Agency for Healthcare Research and Quality’s (AHRQ) Consumer Assessment of Healthcare Providers and Systems Surveys, has transformed the way we evaluate and redesign care. However, while patients can be a valuable source of information regarding their experience of care, patient reporting of outcomes would have to be cross-checked with the medical record before being reported as accurate. For instance, a patient with redness around her surgical wound may be inclined to report an infection, when in fact a red wound does not always signal infection. In summary, I applaud AHRQ for engaging patients more directly in our efforts to improve the quality, safety and patient-centricity of health care.

Kevin J. Bozic // Professor and Vice Chair, Department of Orthopaedic Surgery, University of California, San Francisco

BATED BREATH

“In One Breath” (Summer 2013) provides an excellent update on breath tests. It effectively illustrates the tension between the excitement of clinical researchers and hesitation on the part of practicing physicians. The beauty of these breath tests is that they are pushing powerful metabolomics toward the doctor’s office. The introduction of “omics” in medicine raises understandable resistance among doctors because it relies entirely on statistics and bioinformatics. Therefore, let us all follow the international STARD guidelines for testing diagnostic accuracy and avoiding false-positive discovery when using molecular signatures.

The European Respiratory Society has launched a task force on exhaled breath analysis to validate and harmonize the sampling, analysis and clinical testing of breath tests. I urge Proto readers to join.

Peter J. Sterk // Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam

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