Baue, Arthur E.; Geha, Alexander S.; O'Kane, Hugh
January 1974
Angiology;Jan1974, Vol. 25 Issue 1, p43
Academic Journal
The question �Why develop a cardiac surgical unit?� has been answered in the past by the response �because we want to�. This is no longer an acceptable or sufficient reason. The answer to the question �Where should there be a cardiac surgical unit?� has been �wherever anyone would like to develop one�. This is no longer an appropriate or acceptable reason. The answer to the question �When should a cardiac surgical unit be developed?� has usually been totally dependent upon the individuals involved and where and when they wished to do it. This again is no longer completely acceptable. The answer to the question, �With what?� has in the past been with whatever resources can be developed within the institution or community, and now this question must be answered by consideration of the best utilization of facilities, resources and capabilities. Finally, �How to develop such a unit?� has been reviewed with recommendations given as to how to plan and develop a cardiac surgical unit in a safe and efficient way to provide optimal and high quality care for patients. Obviously, the old and new answers to the questions which have been raised suggest the very real possibility that completely free enterprise in this area of health care and the public welfare may not be in complete agreement. Free enterprise versus the public welfare is perhaps too dramatic a portrayal of the present situation. However, there are very real questions in this regard which are being raised by government, by society and by the consumer of health care. If there are conflicts between free enterprise in the delivery of health care and the public welfare, will they be resolved in a voluntary fashion or by various controls? There are concerns about mass production in health care and what this might do to quality control. Mass production has been a highly admired aspect of the industrial revolution and has been developed to its ultimate extent in this country. However, just as mass production of automobiles at relatively low cost has produced problems of quality control and deaths on the highways, so mass production in cardiac surgery may not ]3rovide for maintenance of the highest quality control. Finally, the resources available for health care will have to be utilized to provide the best health possible. Quality and quantity will be in conflict and this has important relationships to cardiac surgery in particular. How resources will be distributed and how the decisions will be made as to where they can best contribute to the health of the nation are not known. We certainly do not have the answers to these questions, but they will be answered and we as physicians and surgeons may not all like the answers. If, however, those of us who are interested in the evaluation and treatment of patients with cardiovascular disease will adhere to the principle of having cardiac surgical units where there is a demonstrable need for patient care and a corollary need for education, then the public welfare will be served. There will be accountability to the public and certain aspects of free enterprise will survive.


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