By Erin DuPree, MD, FACOG
Dr. Ernest Amory Codman believed in studying information about a patient, the care he or she received, and the result of that care. That hardly sounds revolutionary nowadays, but considering when Dr. Codman began his “end results system” – the early 1900s – it was not only revolutionary but also outrageous.
Dr. Codman was considered a rebel by his peers. He was socially ostracized – even by his friends – and he resigned in disgrace as chairman of the local medical society, all because he firmly believed in the end results system.
Luckily, he never wavered in his beliefs, because it was this work that led Dr. Codman to help found the American College of Surgeons and its hospital standardization program, which was the forerunner of The Joint Commission.
It’s with this in mind that I was honored to attend, on behalf of The Joint Commission, a dedication service for Dr. Codman on July 22, at the Mount Auburn Cemetery in Cambridge, Massachusetts. He had been buried in an unmarked grave all of these years, and the ceremony rectified that, thanks to the efforts led by Dr. Lamar McGinnis.
Dr. Codman was a true revolutionary, not only with his ideas but his actions. He blazed the way for many of us today that are determined to do what is right for the patient. He pushed for the standardization of care processes. He pushed for detailed systems of patient records, including postdischarge follow-up. He pushed for registries to follow patients nationally. He pushed for the public reporting of hospital and physician performance. He pushed for what today is known as outcomes management. He was 100 years ahead of his time.
We all owe a debt of gratitude to Dr. Codman for his passion and commitment to “end results” – his belief that the key to improving quality is through the thoughtful and careful examination of processes followed, treatment provided, and care administered by health care professionals. And, while his efforts were largely dismissed by the medical community at the time, he never wavered, holding firm in his commitment to making health care safe and effective for all. He is a legend because of that firm commitment. His dream was for patients to have the essential information they need to make informed choices about their treatment and where to go for care.
In every sense of the word, Dr. Codman was a revolutionary.
Dr. Codman’s amazing legacy gave me pause in my busy week as a physician at The Joint Commission and as a patient. I have a dream of safe, reliable, effective, individualized care for all. We have so far to go, as I witnessed during a routine outpatient appointment today.
Reflecting on Dr. Codman’s career, and reading a recent piece in The New York Times, I was forced to ponder what it means to be a revolutionary.
That prompted me to ask, "What can I do today?" How can I move through all the barriers and inertia? What are the levers and opportunities at my disposal?
I wonder if Dr. Codman asked himself these questions. He certainly had no shortage of barriers. Yet, he persevered. Here’s hoping more of us are inspired enough to follow in his footsteps toward being revolutionaries.