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The Quality of Surgery: Statistical vs Incidental Approaches

Arch Surg. 1993;128(1):109. doi:10.1001/archsurg.1993.01420130121019.
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To the Editor.—The article by McGuire et al1 in the June 1992 issue of the Archives touches a sensitive nerve for all surgeons. Not only are surgeons being taken to task by their own specialty and subspecialty societies for what constitutes "adequate" surgery for standard operations, and not only are they under increased scrutiny by third-party payers for adequacy of performance, but they have also, seemingly, been placed in the position of battling their own hospital staffs regarding the adequacy of their surgical care. Quality assurance, or its modified, current incarnation as continuing quality improvement, has forced hospitals and physicians to play a game, the rules of which are constantly subject to change. The message conveyed by the authors is that it is an adversarial encounter between the regulators and the "good guys." The authors take the position that their conduct of quality assurance is adequate and that


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