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J Thorac Cardiovasc Surg 2003;126:1259-1260
© 2003 The American Association for Thoracic Surgery

Editorials

Our surgical culture of blame: A time for change

^a Cardiothoracic Surgery, Oregon Health and Sciences University, Portland, Ore, USA
^b Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, St Louis, Mo., USA

Received for publication April 10, 2003; accepted for publication April 21, 2003.

^* Address for reprints: Jamie Dickey, PhD, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Mail Code DCRCP, Portland, OR 97239, USA

The first 20% of the full text of this article appears below.

Here men are demoralized in the shortest possible time on the largest possible scale, at the cheapest possible price.

—Soren Kierkegaard, writing about the press in the 19th century

All of us are familiar with the recent events at Duke University Hospital, in which incompatible heart and lungs were transplanted into Jessica Santillán, leading to a second transplant and her eventual death. This was a tragedy not only for this teenage girl and her parents, family, and friends, but also for the dedicated health care professionals involved in her care. We were all touched by the pictures of Jessica before and after her surgery. But just as poignant was the televised statement by her surgeon, who accepted full responsibility for the error that led to her death. All of this was brought to us by the continuous, unrelenting media coverage. The Santillán family's suffering was palpable and understandable. The loss of a child is every parent's worst nightmare. This was accompanied by a predictable frenzy in the news media, as they tried to decipher and assign blame. Although tragic, there is much to be learned about our health care system and our specialty from this incident. It is both a clear example of the shortcomings of our surgical culture and a clarion call for change.

Throughout the history of our specialty, we have accepted the premise that the surgeon is the "captain of the ship" and must accept total responsibility for everything that occurs to a patient under his or her care. Although this is an understandable guiding principle reflecting the awesome responsibility entrusted to us by our patients, it has led to some untoward consequences, which require us to reexamine this important credo to reflect the realities of 21st century medicine. Over the past several decades, . . . [Full Text of this Article]