Patient safety issues

AS A retired general surgeon of 33 years starting in 1966 at a Harvard-affiliated teaching hospital in Cambridge, I would like to respond to Dr. Stephen Bergman's "Valor and fear in surgeons" (Op-ed, Oct. 13). There are at least two significant issues related to patient safety that are not mentioned.

While the 1984 Libby Zion case in New York was primarily the result of resident physician fatigue, it was also notably caused by inadequate supervision of the resident staff by the attending staff, part of a culture in academic medicine at the time that allowed residents full responsibility for patient care without direct supervision. At the institution where I practiced, residents were never allowed to operate without the attending surgeon present.

Second, part of the culture of surgery necessitates developing the discipline to push oneself hard. When a surgeon is called into the hospital to operate in the middle of the night, he or she cannot go home to bed, abandoning the surgical cases scheduled for that morning, and no current system exists to enable this. It is the responsibility of the surgeon to provide the best of care to every patient regardless of the time of day. If surgical residents cannot push themselves when they're young, they certainly cannot learn to do it at age 50 or 60.

Dr. CARL J. CANZANELLI
Naples, Maine