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Second Opinion

Proto readers share their thoughts on standards for surgeons, Hurricane Sandy's aftermath at Bellevue Hospital Center, and the state of empathic care.

SUMMER 2013
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ONE HOSPITAL’S TRAUMA

“Counting the Losses” (Spring 2013) touches on the effects of Hurricane Sandy on the research endeavors of New York University Langone Medical Center in New York City, but that is only part of the story. Sandy also shuttered three of NYU’s teaching institutions—Bellevue Hospital Center, Tisch Hospital and the Manhattan VA—effectively crippling health care in lower Manhattan.

Bellevue, founded on March 31, 1736, is the oldest public hospital in the United States. It is open to all patients, irrespective of their ability to pay. It is also the only Level I trauma center for lower Manhattan. So when Bellevue evacuated for the first time in 276 years on Oct. 31, 2012, it was devastating, not only to its 4,000 employees but, more important, to those who come for its 500,000 outpatient visits and 125,000 emergency room visits per year. Not only were we physicians without our “home,” but so too were our patients who were in need of emergency procedures.

Following an unimaginable 99 days of restoration, Bellevue reopened fully on Feb. 7, 2013. Today, I can honestly say that Bellevue and its 4,000 employees have emerged stronger than before Sandy and with a renewed sense of purpose and family.

S. Rob Todd // Chief, Trauma and Emergency Surgery, Bellevue Hospital Center, New York City

A HIGH BAR FOR SURGEONS

I was gratified to read your insightful piece, “Standards for Surgeons” (Spring 2013), acknowledging the centennial of the American College of Surgeons. You accurately noted that the ACS arose to establish standards for high-quality, safe surgical care in a vacuum of such standards at the turn of the 20th century. Great vision and courage was required of the surgical leaders of a century ago to challenge the status quo and do what was needed for patients with surgical disease.

Your piece resonates today in our complex medical environment as the ACS speaks ever more forcefully for high-quality, safe and cost-efficient surgical care—the only sustainable model for our patients today and for the next 100 years.

A. Brent Eastman // President, American College of Surgeons, Chicago

WHAT DECLINE IN EMPATHY?

“The Need for Compassion” (Spring 2013) emphasizes the common claim that empathy declines during medical school and residency training. However, in our meta-analysis of 11 studies of “empathy decline,” we concluded that the claim is greatly exaggerated. Results of the studies showed on average only about a 0.2-point decline, and means across the individual studies ranged from a 0.1-point increase in self ratings in one study to the largest decline of only half a point in another.

Also, in the four studies that reported response rates by year of training, response rates decreased on average about 26 percentage points from the first to the last year of training. In brief, empathy is a critical part of medical care, but claims about empathy decline with training are based on weak effects subject to response bias.

Jerry A. Colliver // Professor, Southern Illinois University School of Medicine, Springfield

Mindy J. Conlee // Managing Editor, Teaching and Learning in Medicine: An International Journal, Southern Illinois University School of Medicine, Springfield

Steven J. Verhulst // Professor, Southern Illinois University School of Medicine, Springfield

J. Kevin Dorsey // Dean, Southern Illinois University School of Medicine, Springfield

DETECTING SIDE EFFECTS

“On the Trail of Drug Risks” (Spring 2013) featured varied data mining methodologies being developed for detecting drug side effects and adverse events. The article succeeded in highlighting many of the complications involved in collecting, sorting and making sense of these data, but fell short by not addressing how these technologies will be adopted by the health care industry.

Hospital readmissions and prescription nonadherence caused by adverse drug events account for more than $20 billion in direct systemic costs annually. Accordingly, AdverseEvents, Inc. is focused on improving detection methodologies through proprietary data mining and algorithm platforms, and building the analytics and tools needed by various constituencies within the health care industry to lower these costs caused by drug side effects.

Despite the advancements made in drug safety by us and others, until a financial return on investment for adopting these new methodologies is demonstrated, I fear that our collective work will go to waste. We believe that we can push the health care industry to achieve better financial results and patient outcomes by focusing our efforts on the cost centers that can be directly linked to avoidable drug side effects.

It is only by addressing the industry’s need to reduce costs that we can hope to achieve the greater goal of improved patient safety through informatics.

Brian Overstreet // Co-founder and President, Adverse Events, Healdsburg, Calif.

CORRECTION

“Killing Me Brightly” (Spring 2013) stated an incorrect price for Xenex’s UV-C robot. The price is $82,000. Proto regrets the error.

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