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    Should high-volume surgeons have surgical privileges?

    The relationship between surgical volumes, outcomes: More is more


    In school they told me “Practice makes perfect.” And then they told me "Nobody's perfect," so then I stopped practicing.          —Steven Wright

    As a youngster growing up in New Jersey, I had parents who would say things like: “If you work hard, you can accomplish anything you put your mind to.” Foolishly, I believed them.

    So, like any normal boy, I set my mind to becoming a star player in the NBA. My models were Julius “Dr. J” Erving (forward for the New Jersey Nets) and Larry Bird (forward for the Boston Celtics).

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    Taking to heart the parental wisdom that hard work was important, I practiced for hours every day—especially during the summers when I was not in school or working my summer job flipping hamburgers on the boardwalk. In practice time, I spent hour after hour taking shot after shot from the right or left side of the court, with the idea that eventually my field goal percentage would approach 100%.

    The practice paid off in that my game definitely improved, but there were certain painfully apparent differences between my on-court performance and that of my role models.

    Like Erving and Bird, I usually played the position of forward. But, as the saying goes, I made up for my relative lack of size and leaping ability by being slow. Eventually, it became clear that a career on the hardwood courts of the NBA was not in the cards, so I gravitated toward the second-most glamorous career (ophthalmologist).

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    But the lesson of how repetition leads to improved performance was not lost on yours truly. While practice may not always make perfect (at least in this life), it definitely does “make better” not only in sports, but also in the operating room. In cardiac, orthopedic, and gastrointestinal surgery, higher-surgical volumes for physicians and hospitals are associated with better outcomes, including lower mortality rates.

    Next: Adverse envent, volume link

    Photo credit: ©MichaelVauilin/Shutterstock.com

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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    • Anonymous
      I once heard a surgeon on a recorded CME program state that his average preop vision was 20/25. That's one way to become a high volume surgeon. But I think those type of surgeons should be looked at carefully by the Medical society's ethics committee.
    • Anonymous
      Operating on clear lenses also lowers complication rates...which is what most of these high volume people are doing. No matter what the patient's complaint, their diagnosis is cataract and their solution is phaco...usually recommending a premium lens of course. So essentially you are suggesting that only those with low morals should be allowed to operate. Brilliant.
    • Anonymous


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