Changing the delivery of surgical care
James P. Waddell, MD
Coeditor
Canadian Journal of Surgery 1997;40(4):244.
© 1997 Canadian Medical Association
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See also
This issue of the Journal contains a number of articles documenting the changing demographics of the delivery of surgical care in this country. All of the editorials deal with either outpatient or short stay surgical procedures facilitated by new surgical techniques such as endoscopy. In addition, the summarized symposium on ambulatory surgery and several other peer reviewed articles deal with changes that are occurring in the delivery of surgical care to patients in Canada.
As rapidly as these changes are occurring here, the pace of change appears to be even faster in the United States. In addition to facilitating the delivery of elective surgical care in a scheduled manner to patients in relatively good health, there is a growing trend among American hospitals and the physicians practising therein to extend the same principles to emergency surgical care.
For blunt and penetrating trauma of the abdomen patients are no longer managed by watchful expectation but are subjected to laparoscopy to document significant or insignificant intra-abdominal disorders, and discharge is expedited accordingly. Patients with fractures (other than fractures of the pelvis or femur) are routinely discharged home from the Emergency Department in some type of splint along with instructions to return in a few days as outpatients for same day surgery to allow short stay fracture care. Patients requiring urgent cervical or lumbar spine disc excision or decompression procedures are now routinely discharged home less than 24 hours postoperatively.
As the new reality of health care funding exerts pressure on us to deliver more care with fewer resources, it would serve everyone's purpose to pause and consider the original object of the exercise: to treat the sick and alleviate their suffering. While supporting initiatives for the enhanced delivery of care that improves the outcome for patients and caregivers alike, physicians have an ongoing responsibility to ensure that "bottom line" medicine does not become the paramount goal of medical practice.
