Bulletin March 2012

MARCH 2012 Volume 97, Number 3 INSPIRING QUALITY: Highest Standards, Better Outcomes FEATURES Diane S. Schneidman Editor-in-Chief Cultural competence: Why surgeons should care 13 Lynn Kahn Amal Khoury, MD; April Mendoza, MD; Director, Division of and Anthony Charles, MD, MPH, FACS Integrated Communications A crisis in the ED: Liability protection needed STAT 19 Tony Peregrin Senior Editor Patrick V. Bailey, MD, FACS Jeannie Glickson Survey shows social media usage increasing among ACS Fellows 23 Katie McCauley Contributing Editors Setting the record straight: The real history of Poland’s syndrome 27 Tina Woelke CPT Justin P. Fox, MD, MC, USAF, and Alan E. Seyfer, MD, FACS Graphic Designer Charles D. Mabry, MD, FACS Leigh A. Neumayer, DEPARTMENTS MD, FACS Marshall Z. Schwartz, MD, FACS Looking forward 4 Mark C. Weissler, Editorial by David B. Hoyt, MD, FACS, ACS Executive Director MD, FACS What surgeons should know about... 7 Editorial Advisors The Medicare Shared Savings Program Tina Woelke Henry R. Desmarais, MD, MPA Front cover design HPRI data tracks 30 Trends in the otolaryngology workforce in the U.S. Future meetings Simon Neuwahl; Erin Fraher, MPP, PhD; Harold Pillsbury III, MD, FACS; Mark C. Weissler, MD, FACS; Thomas Ricketts, MPH, PhD; and Katie Gaul Clinical Congress 2012 Chicago, IL, September 30– October 4 2013 Washington, DC, October 6–10 2014 San Francisco, CA, October 26–30 Letters to the Editor should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to [email protected], or via mail to Diane S. Schneidman, Editor-in- Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or clarity. Permis- sion to publish letters is assumed un- On the cover: Culture, education, and belief systems influence all aspects of the surgical less the author indicates otherwise. experience, and therefore it is important for surgeons to be adept in the principles of cultural competence (see article, page 13). NEWS Bulletin of the American College of Surgeons (ISSN 0002-8045) is published monthly Advocacy for surgeons at the AMA House of Delegates 35 by the American College of Sur- John H. Armstrong, MD, FACS, and Jon H. Sutton geons, 633 N. Saint Clair St., Chicago, IL 60611. It is distrib- ACS President Dr. Numann attends uted without charge to Fellows, Clinical Congress of Philippine College of Surgeons 37 Associate Fellows, Resident and Medical Student Members, Af- filiate Members, and to medical NQF endorses two ACS NSQIP® quality measures 39 libraries and allied health personnel. Periodicals postage paid at Introducing the ACS Clinical Research Program of the Alliance 40 Chicago, IL, and additional mail- Heidi Nelson, MD, FACS ing offices. POSTMASTER: Send address changes to Bulletin of the Take the ethical challenge on e-FACS.org 41 American College of Surgeons, 3251 Riverport Lane, Maryland March 31 is deadline to claim CME credit for 2011 Clinical Congress 43 Heights, MO 63043. Canadian Publications Mail Agreement No. Trauma meetings calendar 43 40035010. Canada returns to: Station A, PO Box 54, Windsor, College’s historical collection of rare books achieves new visibility 45 ON N9A 6J5. The American College of A look at The ointJ Commission: Surgeons’ headquarters is lo- Resources for preventing hospital readmissions 46 cated at 633 N. Saint Clair St., Chicago, IL 60611-3211; tel. Disciplinary action taken 47 312-202-5000; toll-free: 800- 621-4111; e-mail:postmaster@ 2013 Traveling Fellowship to Japan available 48 facs.org; website: www.facs. org. Washington, DC, office is 2013 Traveling Fellowship to Germany announced 49 located at 20 F Street N.W. Suite 1000, Washington, DC. 20001- NTDB® data points: 6701; tel. 202-337-2701; web- Seventy-five years of banking 50 site: www.tmiva.net/20fstreetcc/ Richard J. Fantus, MD, FACS, Richard J. Fantus, and Robert J. Fantus home. Unless specifically stated otherwise, the opinions expressed and statements made in this publication reflect the authors’ personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2012 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted in any form by any means without prior writ- ten permission of the publisher. Library of Congress number 45-49454. Printed in the USA. Publications Agreement No. 1564382. The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Looking forward early 2.3 million military men and women have been deployed to Iraq or Afghanistan in the last 10 years. Because of the advances in military medicine Nand protective gear, as well as the type of weaponry often used in these conflicts, the total number of ’’ casualties has been relatively low. However, approximately 50,000 veterans are returning home with serious bodily injuries, and one in six suffers from traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD). As the war drawdown continues and the pool of Through the Joining veterans grows, access to effective care for active and former military personnel will become increas- Forces initiative, the ingly crucial. Yet, with the exception of military and Veterans Affairs (VA) physicians, few clinicians College is partnering with are trained to meet the challenges associated with providing care for this population. The American the AAMC, the AACOM, College of Surgeons (ACS) is partnering with other health care organizations and the government and other participating to rectify this problem through its participation in a program known as “Joining Forces.” organizations to collectively Identifying veterans’ needs improve the quality of A common misconception is that most veterans receive their medical and surgical care through the care that vets receive. VA. Consequently, some surgeons and physicians who practice outside of the VA system believe they rarely, if ever, will be expected to deal with veterans’ unique health care issues. However, the fact of the ’’ matter is that more than 50 percent of veterans who have returned to civilian life have the same type of insurance coverage as other American workers. They have employer-based coverage and therefore seek care from physicians and other health care providers that participate in their insurance plans. So, all health care professionals need to be familiar with the unique physical and psychiatric problems that TAK ING ACTION TO SERVE afflict a significant number of veterans. AMERICA’S MILITARY FAMILIES As noted previously, many of the veterans have ex- perienced multiple bodily injuries, a condition that JOININGFORCES.GOV the VA calls “polytrauma.” TBI is frequently seen in polytrauma patients, along with other disabling conditions, such as amputation, auditory and visual impairments, spinal cord injury, and so on. Due to the severity and complexity of their injuries, these injured and those who were not—also are battling patients may require an extraordinary level of coor- PTSD and other mental illnesses. The VA has re- dinated and integrated clinical and support services, ported 167,000 cases of PTSD, 195,000 cases of including care that only a surgeon can provide. depressive conditions and affective psychoses, and 4 Many veterans—both those who were physically 103,000 cases of anxiety disorders. These conditions VOLUME 97, NUMBER 3, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS put people at risk for suicide. Tragically, the suicide This information can be accessed at http://www. rate in the U.S. Army and Marine Corps has, for ptsd.va.gov/professional/index.asp and http://www. the first time on record, reached that of the civilian polytrauma.va.gov/understanding-tbi/. population, and the VA’s Veterans Crisis Line (800- 273-8255) has received approximately 500,000 calls Joining Forces from returning veterans who are considering taking I recently had the privilege of learning about the their own lives. Joining Forces initiative, which First Lady Michelle It behooves surgeons to get the training necessary Obama and Second Lady Jill Biden, EdD, are to identify and help these patients locate the help spearheading. Joining Forces is a broad program they need. As trusted providers of patient care, all designed to bring the government and the private surgeons and other clinicians need to be able to sector together to ensure that veterans have access detect when a veteran is reaching a mental breaking to jobs, higher education, and health care. (More point. The VA offers many resources to help health information regarding the Joining Forces program is care professionals understand TBI and PTSD, learn available at http://www.whitehouse.gov/joiningforces.) how screen for these conditions, and decide when In an effort targeted at addressing the health care to refer patients to mental health professionals. component, in January, the White House, the De- partment of Defense (DoD), and the VA convened a roundtable program for leaders of an impressive Roundtable participant organizations number of health care organizations (see list at left). American College of Surgeons This discussion centered on how the medical and American Academy of Family Physicians surgical communities can work together and with American Academy of Neurology the government to better meet the neurological American Academy of Nurse

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