RAYMOND J. LANZAFAME, MD, MBA
Modern medicine is concerned with empowering the patient, informed consent, applying leapfrog initiatives, IHI's 100,000 Lives bundles, and practicing high-quality, evidence-based medicine, with 21st Century technology, against a backdrop of increasing scrutiny, increasing expenses, and declining reimbursement. Various constituencies tout pathways, clinical algorithms, physician report cards, and pay for performance as the vehicles to achieve improved outcomes and cost-effective, efficient health care.
The American consumer is increasingly more connected to the Internet and is being constantly barraged with a growing number of television and other presentations on health-related themes. Cable television channels air a wide variety of medical shows that demonstrate a diverse array of technology, science, and provide entertainment. High technology and high-risk procedures are presented as being state of the art and foolproof. More and more patients demand that their doctor perform specific procedures or prescribe specific therapies based on information from the Internet and other sources. Patient demands and preferences have a substantial impact on rising costs and increasing use of technology. Consumers demand “the best” and tend to equate high technology with high quality and least risk. These issues fuel the cost of care, particularly in reference to the need to acquire the technology, provide the appropriate care, and resolve complications regardless of whether they resulted from “operator” error or biological response.
My surgical career has seen the rise of arthroscopy, flexible endoscopy, laparoscopic cholecystectomy, minimally invasive surgery, and more recently, robotically assisted surgery. Each of these advances has improved patient care, bringing with it a new cadre of risks, costs, and complications. Each was embraced by the public, who then forced the medical community to seek training and begin to perform the new techniques, or lose substantial patient volumes.
The perception of the cost of these techniques is vastly different for each of the constituencies. The patient believes that no expense should be spared, particularly since most patients have some form of medical insurance or are able to qualify for Medicaid. Payers see increasing expenditures for more procedures. Hospitals see shifts in the cost of materials and changes in case mix and volume.
Learning and the acquisition of new skills are two pursuits that are highly satisfying irrespective of one's station in life. However, clinicians are finding it increasingly difficult to keep current with the staggering pace of advancing medical science and technology. There continues to be a trend toward increasing fragmentation of medical and scientific groups and economic and time constraints that prevent or limit one's ability to attend meetings or participate in a diverse array of organizations. Those of us in surgery and other hands-on specialties need to understand the details of new technologies, and must acquire appropriate training and skill in their use. It is critical for us to understand the proper role and use of these technologies and techniques. We must be willing to critically evaluate their applications and must also thoroughly understand their potential complications and effective methods to resolve them.
It is clear that advances in medicine are occurring across all of its disciplines. Much of the technology that readers of this publication use is also being used and developed by colleagues in other disciplines. Problem-solving techniques and developments in one specialty are often invaluable to those of us in other disciplines. However, knowledge of these advances and applications is often limited to narrow single-specialty societies, particularly if there is no vehicle whereby clinicians, academics, and scientists from different disciplines can come together to vet their ideas in a collaborative atmosphere. The Society of Laparoendoscopic Surgeons represents such an opportunity.
This year's International Congress and Endo Expo will be held at the Westin Copley Place in Boston (September 6-9, 2006). Several learning opportunities and thought provoking sessions are planned. Cutting-edge developments in minimally invasive surgery will be presented. Sessions discussing innovations from the bench to the bedside; informatics and the laparoendoscopic surgeon; competency, metrics, and skills assessment; and numerous other topics will be discussed from the multidisciplinary perspective. Live telesurgery sessions, specialty breakout sessions, and preconference Master's Classes will provide a custom palette for learning, dialogue, and debate.
SLS is truly a unique organization. We have accomplished much and have catalyzed multidisciplinary dialogue that has reaped numerous benefits for patients by advancing minimally invasive surgery and related disciplines. Our vision and mission are forward thinking and provide a basic framework for our direction. Yet, our organization is also a teenager, grappling with an increasingly complex future with a need to question and reevaluate the status quo. We are blessed with a large membership, capable leaders, an excellent central office staff, and a strong financial status. However, like the teenager, we must consider the opportunities and develop the strategies that will position us for the future. We must endeavor to understand minimally invasive surgery and the drivers of its application. Understanding is a critical component to any discussion of the risks, benefits, and opportunities inherent to minimally invasive surgery. It is only then that we can ask appropriate questions that will provide the evidence base for clinical applications and further research. It is only then that we can educate patients and payers about the value-added that minimally invasive technologies provide.
Curiosity and dialogue will expand knowledge and promote learning. The English essayist and critic Walter Pater (1839-1894) noted: “What we have to do is to be forever curiously testing new opinions and courting new impressions.” A collaborative, multidisciplinary dialogue is the key to getting it right for our patients.
Address reprint requests to: Raymond J. Lanzafame, MD, MBA, Vice President for Medical Affairs, Lakeside Memorial Hospital, 156 West Ave, Brockport, NY 14420, USA. Telephone: 585 395 6095, Fax: 585 395 6036.
Raymond J. Lanzafame, MD, MBA, is the Vice President for Medical Affairs at Lakeside Memorial Hospital and the 2006 President of the Society of Laparoendoscopic Surgeons. He holds 27 organizational memberships. Dr Lanzafame is Editor-in-Chief of Photomedicine and Laser Surgery and sits on the editorial boards of General Surgery News; Journal of Laparoendoscopic Surgery; JSLS, Journal of the Society of Laparoendoscopic Surgeons; Lasers in Surgery and Medicine; and Lasers in Medical Science. He is a past president of the Upstate Chapter of the American College of Surgeons and the American Society for Laser Medicine and Surgery (ASLMS). Dr Lanzafame has testified before the FDA on device regulation; participates in national panels on lasers, credentialing, laparoscopy, and managed care; and performs medicolegal and biotech consulting. He is consultant to the General and Plastic Surgery Devices and Medical Devices Advisory Committee panels of FDA-CDRH. His publications include 180 papers and 3 textbooks.
1. Lanzafame RJ. Peregrinations at the millennium: of mergers, cabbages, and kings. J Clin Laser Med Surg. 1999;17(6):237-238
2. Lanzafame RJ. Clinicians, decisions, and technology in the 21st Century. J Clin Laser Med Surg. 2000;18(1):1-2
3. Lanzafame RJ. Of periscopes, telescopes and microscopes: medicine through the looking glass. J Clin Laser Med Surg. 2000;18(5):233-234
4. Lanzafame RJ. Industry-sponsored research: science without a net? J Clin Laser Med Surg. 2000;18(6):275-276
5. Lanzafame RJ. Practices, outcomes and paradigms: factors causing a change in behavior. J Clin Laser Med Surg. 2001;19(3):119-120
6. Lanzafame RJ. Education, performance, quality and the march of technology. J Clin Laser Med Surg. 2002;20(1):1-2
7. Lanzafame RJ. Weighing the evidence: Validating content and improving outcomes. J Clin Laser Med Surg. 2002;20(2):55-56
8. Lanzafame RJ. Ethics, education, common sense and medicine. J Clin Laser Med Surg. 2003;21(1):1-2
9. Lanzafame RJ. Truth, science and advertising in the information age. J Clin Laser Med Surg. 2003;21(2):59-60
10. Lanzafame RJ. Innovation and competence in an era of medical workforces flux. J Clin Laser Med Surg. 2003;21(5):247-248
11. Lanzafame RJ. Safety, scrutiny and conflicts: Assessing the fallout and lessons learned from pharmaceuticals. Photomed Laser Surg. 2005;23(1):1-2.
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