April 2014 by McMahon Group

GENERALSURGERYNEWS.COM

April 2014 • Volume 41 • Number 4

The Independent Monthly Newspaper for the General Surgeon

Opinion

Understanding Part 2 of 2 Although it is inappropriate, and potentially inaccurate, researchers frequently use linear regression on nonlinear phenomena, calculus on discontinuous functions, or χ2 when data points are interdependent. —Eric Dent PhD, 1994

Controlling All of the Variables? In December 2003, Gordon Smith and Jill Pell published an article in the British Journal of Medicinee entitled, “Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systemic Review of Randomized Controlled Trials” (BMJJ 2003;327:14591461). It was a tongue-in-cheek demonstration of the lack of common sense sometimes exhibited when groups attempt to apply mechanical tools, like prospective, randomized, controlled trials (PRCTs) to health care. It is quite ironic that the study they described, testing the benefits of using a parachute when jumping out of an airplane is actually a much better application for the use of a PRCT than most of the treatments and tests we have subjected to PRCTs in our complex health care system. Let me try to explain. PRCTs are designed to test a hypothesis

Reports Show Recent Uptick In Hospital Violence Shootings Still Very Rare; Increase Possibly Due to Better Reporting; Targets of Violent Acts Usually not Random

Let me start with the accountable care organization (ACO), which is the brainchild of Elliot Fisher, MD, MPH, of Dartmouth Institute for Health Care Policy. Dr. Fisher’s group at Dartmouth had made the initial observation that we have a poor see THUMB WRESTLING page 18

see CHOOSING WISELY page 16

see HOSPITAL VIOLENCE page 8

Thumb Wrestling and d ‘Oklahoma!’

see UNDERSTANDING page 20

GSN is now on

B Y J ON C. W HITE , MD

Accountable Care Organizations

INSIDE In the News

Stitches

Opinion

New Guideline Addresses Appropriate Breast Cancer Margins: No Ink on Tumor

T he History of Laparoscopic Obesity/Metabolic Surgery

B Y C HRISTINA F RANGOU ritical care organizations have announced a list of five practices in the ICU that should be questioned because they are costly, may not always be necessary and could, in fact, be harmful. The project is part of the “Choosing Wisely” initiative of the American Board of Internal Medicine (ABIM) Foundation, which has challenged physicians to look at various medical interventions that are overused and may add needlessly to the country’s health care expenditures. Some critics have panned nned the program as an infringeement on a physician’s right to make decisions about care, but its supporters—and there are many—say this is a case of physicians proactively setting the standard for what is considered high-quality but costeffective health care. “It should be clear to everyone in the audience that rationing is unavoidable,” said Scott Halpern, MD, assistant professor of internal medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, as he presented the

WASHINGTON—In December, an angry former fo patient p walked into a medical al office in Reno, Nev., and fatally shot urologist Charles Garo Gholdoian and injured two oothers before turning the gun on n himself. In a note left at his home, the gunman g made it clear he was targeting t physicians, an act of revvenge for what he deemed were errors made during a vasectomyy years before, according to mediia reports.

his article comes with a disclaimer. You must read to the end to discover how I am going to connect a child’s game and a Broadway musical to accountable health care.

Project Targets Unnecessary Practices in ICU

B Y C HRISTINA F RANGOU

Out of Touch: Feeling Further and Further Removed From My Patients