February Fix-Up

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Welcome to the February online edition of Vascular Specialist.

We all had hoped for more but had to settle for another temporary fix to the SGR, this time for 10 months until December 31, 2012. Our SGR story gives the details. When Congress takes it up again the possible cut in our Medicare reimbursement will be 32% instead of 27 and the resolve finally to correct the problem will be harder than ever to muster. There is a strange connection from this dispiriting lack of legislative courage to the memory that it conjured up when I read the story at breakfast.

George Andros, M.D., Medical Editor

By my senior year of medical school I had pretty much decided to go into surgery and got an invitation to observe an operation from an outstanding Chicago heart surgeon who, like many in those days, also did some vascular cases. The day I attended I recall vividly that he performed a “bucket-handle” saphenous vein bypass of an adductor occlusion of the superficial femoral artery. Endovascular intervention has made that procedure, a bypass from just above the adductor tendon to the popliteal artery above the knee, a passé operation. He was a wonderful surgeon; direct and focused, gentle with tissue, and fast as only an efficient surgeon can be. Before he closed, he turned to me and said, “we’ll take a few extra minutes to be certain that we’re dry and the graft is perfect. No sense to wasting that time in the surgeons’ lounge just drinking another cup of coffee.”

But what he said next I think explains why the failure to solve the SGR problem made me recall this experience from decades ago. As he meticulously closed the skin he remarked, “Remember, George, don’t ever rush. You may think that there is never time to do it right, but there is always time to do it over.” Why that remark came so quickly to mind this morning is because I always silently repeat it to myself before I close any case. That surgeon’s advice is as true as ever today for the management of complex OR cases and for challenging legislative matters as well. Soon the SGR will recede from the Congressional consciousness but when it returns let’s all hope that there will still be time to do it over – and that, just maybe, they get it right.

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