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Changing our culture: adopting the military aviation safety system
  1. Charles William Kerber
  1. Department of Radiology and Neurosurgery, UCSD Medical Center, San Diego, California, USA
  1. Correspondence to Dr Charles William Kerber, Department of Radiology and Neurosurgery, UCSD Medical Center, 4094 Fourth Avenue, Suite 200, San Diego, CA 92103-0834, USA; kaos{at}

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A call to arms

Change is in the air. Problems are brewing throughout the profession of medicine, but especially in our surgical practices. Reimbursements are down. People with no experience practicing medicine are, more and more, deciding what standards of practice will be. ‘Metrics’—developed particularly by the federal government—are being created to judge us: to evaluate our competence, our adverse event rate and even to decide upon whether an adverse event constitutes criminal behavior. Bureaucrats will justify their judgments because complication indices —for example, infection rates, operating on the wrong site, medication errors and, particular for our specialty, errors of judgment—have remained painfully constant over the years.1–8

Why should not we—the physician/surgeons of our specialty—again be the leaders? I mean leaders in changing our culture. The continuing and preventable errors rate, which has not significantly changed over the last decades, demands a change, a change that must come from us before it is imposed upon us by an uncaring administration or federal bureaucracy. Ask yourself: how often has the federal government, once accruing power, ever relinquished it?

As background for this leadership—our leadership—premise, I invite you to go back to the early papers of the 1960s and early 1970s, papers written before there were any national societies or even a recognized specialty dedicated to our work. You will likely realize that we were the ones who developed what eventually came to be called ‘minimally invasive surgery’. We also performed the first image-guided surgery. Was our work not the origin of robotic surgery? Look at the early papers by Amundsen et al,9 Boulos et al,10 Doppman et al,11 Newton et al,12 Hillal et al13 and Djinjian et al.14

Now we are living through another time of great change. This time, though, the federal …

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