CTSNET READER COMMENTS

?Policing and penmanship do not substitute for competence and common sense, neither of
which can be legislated into existence.?

Dr. Gaudiani,

Your eloquent analogy of our
current plague of process improvements will strike a chord in every healthcare provider
that reads it. We are all being pushed further and further from the bedside and true
quality care by the gaming requirements to document the obfuscating surrogate outcomes
measures you so accurately describe. The biblical parallel of your observations is that
we are straining at gnats while swallowing camels whole. The gnats are getting so thick
now that we don?t even recognize the camels anymore. 

The examples of this are myriad
and readily identifiable in cardiothoracic surgery.  Many legitimate recommendations
that should be studied and possibly adopted become instant requirements for
reimbursement and passing JCHAO scores. As a PA, I have always regarded my supervising
cardiothoracic surgeon as the sorcerer, but I sense lately that an imposter has stepped
in as the sorcerer. The new sorcerer does not even recognize some of the issues that we
should be addressing ? the ?art? aspects of your trade are the camel lost in the swarm
of gnats, and have parallel applications at every level of patient care.

Paul Stelzer
captured much of this conundrum in a single sentence in the above quote.
Unfortunately, in many situations I witness that policing and penmanship actually
suppress competence and common sense.

Thank you for your essay and the opportunity to
comment. I hope the true sorcerers enact your recommendations and that order is
restored to the workshop someday soon.

Respectfully,
LaWaun Hance, PA-C
lhance@comcast.net

Vincent Augustus Gaudiani, M.D.
2900 Whipple Avenue
Suite 210 
Redwood City, CA  94062
United States 
  Dear Doctor Gaudiani 

   My name is Domingo Braile. I am a Cardiac
Surgeon in Brazil and the Editor in Chief of the Brazilian Journal of Cardiovascular
Surgery  http://www.bjcvs.org  I read your "In My Opinion" The Sorcerer and The
Sorcerer?s Apprentice. It is a piece of art and knowledge to be distributed to every
Cardiac Surgeon in the word. In reason of that I am asking to you the permission to
publish your "fantastic" ideas in our journal given all the credits to you and to
CTSNet from which I am also an Editor.
   Congratulations for your very clear mind.
Sincerely 

 Domingo Braile