Letters to the Editor   |    
Frederick A. MatsenIII, MD; Edward V. Fehringer, MD
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These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Dr. Matsen holds the Harryman/DePuy chair). In addition, a commercial entity (the Harryman/DePuy chair) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which one of the authors is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Feb 01;88(2):448-b-450
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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 attention."1 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.
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