I have spent 50 years focused on the craft of surgery. In this blurb I wish to share memoirs, observations, experiences, opinion, thoughts, science, art and paradigms arising from my experience. No specific reference will be made to particular persons or places. Nothing discussed should be taken as advice for any individual actual situation.

Each patient with his/her individual needs, comorbidities, multiple contributing factors, pathology and psychosocial needs will have a unique, individual problem and experience. The patient and his/her immediate family will need to take an active part in evaluating their individual situation and participating in the selection of options explained and recommended by their chosen or recommended surgeon.

I hope to provide patients with a basis on which to better understand surgical problems and then participate in their own decision making with their physician and/or surgeon. Some of this information will also be helpful to nonsurgical specialists and might supplement some open minded practicing Surgeons.

I suggest that this content be kept in the context that your are reading abstract information and you have not been trained as a surgeon.

I was trained as a General Surgeon and actually had the opportunity to practice the skills learned in training while in the Army at a Superb noncombat hospital center in Europe in the early 1970’s servicing the servicemen and families of many countries.

Rural General Surgeons still have this opportunity. Many General Surgeons never practice the skills that they spent five years learning. The majority of fully trained General Surgeons now go on to a few years of subspecialty Fellowships that arose from the advances that the previous generation instilled and where a new need for further experience evolved.

After I returned to New York in 1973, the organization of hospitals into subspecialty focuses gradually trimmed my practice to focusing on Abdominal Surgery. However, my understanding of the other specialties like Vascular, Head and Neck, Orthopedics, Urology, Thoracic Surgery, Gynecology and aspects of Internal Medicine have been integrated into my concept of total care of the surgical patient and assist me in consulting with specialists and working with them as a team.

During these five decades, I have experienced the logistic challenges from changes in the Medical-Industrial Socio-Economic System with advances in Technology, changes in medical Education, first influenced, then controlled by Corporate Management, Health Insurance Companies and Government Regulations and cost-cutting. The Federal and State initiatives coordinated with Insurance companies, PharmA, Hospitals, Chambers of Commerce which overwhelm traditional Physician representation trying to create a system hybridizing health systems in other countries (Recommended Reading: America's Bitter Pill. By Steven Brill. Random House. 2015.) The majority of Physicians are already integrated with or are employed by hospitals and are subject to Insurance company controls.

Not-for-Profit Hospitals are making huge profits. Hospitals systems are forming insurance companies and insurance companies takeover hospitals. Data from national data banks or insurance company data subdivisions like UHC’s Optum will be used to develop protocols based on statistical mining. All systems use codes to describe encounters, services, procedures and diagnoses and collect data and statistics. No one has shown that quality is improved with this system. Possibly costs and safety will improve. Your surgical experience will become part of those statistics. Your experience is represented by codes.

”Best practices” will be devised based on the statistical analysis of these data and the metanalysis of peer review papers which collect the data reached by coding from many unrelated studies already subject to statistical manipulation and add another layer of statistical analysis. Systems tend to encourage inductive decision-making based on these devised “best practices,” which, in my opinion, are useful guidelines but do not satisfy the requirement for focused and detailed decision making for the individual patient with his/her own special anatomy, comorbidity and extent of disease.

So I hope to give you some knowledge which you can augment on the Web (Google, Yahoo, Library of Congress’s Pub Med, etc.) and become an intellectual and diplomatic participant in decision making for your care.

    A. Douglas Heymann,
    MD, FACS.
    Over 50 years of experience.

    Dr. Heymann

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