To The Editor:The editorial "Are Validated Questionnaires Valid?"
(2005;87:1671-2), by my
respected colleague Bert Zarins, was a provocative piece. While what he says
rings true, there are other aspects to the "validity" issue that
should be added to our thoughtful consideration. I will enlist the help of
another Massachusetts General surgeon who is often, but incompletely,
quoted:"Already in 1900 I had become interested in what I have called the
End Result Idea, which was merely the common-sense notion that every hospital
should follow every patient it treats, long enough to determine whether or not
the treatment has been successful, and then to inquire `if not, why not?'...
We had found that this routine tracing of every case, interesting or
uninteresting, had brought to our notice many things in which our knowledge,
our technique, our organization, our own skill or wisdom, and perhaps even our
care and our consciences, needed
When he presented this idea in 1913 in the great hall of the Philadelphia
Academy of Medicine, Codman pointed out that answering these questions is of
primary interest to the patient, the public, and those in the medical field.
He then asked, "Who represents or acts for these interests?" and
answered, "Strangely enough the answer is: No
one."1 In his
infamous cartoon of the "Back Bay Golden Goose Ostrich," he showed
the bird producing golden eggs of profit while hiding her head in the sand so
she could not see how much (or how little) the care was benefiting the
patient1. For his
insolence, he was fired from the hospital.