Myers, Robert S.

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The Linacre QuarterlyVolume 30 | Number 3 Article 2August 1963"Gitting Thar Fustest with the Mostest"Robert S. MyersFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMyers, Robert S. (1963) ""Gitting Thar Fustest with the Mostest"," The Linacre Quarterly: Vol. 30 : No. 3 , Article 2.Available at: http://epublications.marquette.edu/lnq/vol30/iss3/2"GITTING THAR FUSTESTWITH THE MOSTEST"ROBERT S. MYERS, M.D., F.A.C.S. *This article's title, which Con­federate General Nathan Bed­ford Forrest allegedly used asthe reason for his successes onthe Civil War battlefields, isequally applicable to the field ofdata processing in today's mod­ern and progressive hospitals.Now is the time to use businessmachine methods to obtain the m o s t  information the  m o s tquickly about multiple aspectsof patient care. The traditionalmethods of gathering and cor­relating data by hand are notsufficiently accurate, rapid, oreconomical to warrant their use.This does not imply in anyway that computers are going toreplace doctors in the care oftheir patients, for physicianswill still have to examine thepatients, make the diagnoses,write the medical records, andprescribe therapy. What it doesmean is that modern businessmachines are able to record, re­call, and reproduce the data which the medical staff andrecord librarian have gatheredabout the care of patients, mch more quickly, more cheapl_ andmore efficiently than can r ,man beings using hand-tabu :itingmethods. Any doctor wh has ever struggled through a handtabulation of six or seven . ctorsof patient care of even 1 il pa­tients and then has tried J cor­relate the results by se age, length of stay, justificat n for surgery, etc., knows the back­breaking effort which sue , anti­quated methods entail. During the past ten ye ;s, theuse of business machines o pro­vide ready access to th infor­mation in the hospital's linical r e c o r d s  has developc . with breathless rapidity. In , articu­lar, the last two to thrc years, since electronic computu·s havebecome commonly a. ail able,have witnessed revol 1tionarychanges in the gatherin,; of dataabout patient care. •Dr. Myers is Executive AssistantDirector of the American College ofSurgeons; President of the Com­mission on Professional and Hos­pital A�tivities; a member of the Medical Advisory Committee of theCatholic H,1spital Association.John J. Flanagan, S.J., Editor of LINACRE QUARTERLY, is Vice Presi­dent of the Commission on Profes­sional and Hospital Activities.102 I am particularly acquaintedwith one system of handlingmedical record data for the hos­pital's medical staff and admin­istration, since I have been asso­ciated with it in one form or an­other almost since its beginningin the year 1950. This is the Commission on Professional andHospital Activities' ProfessionalActivity Study (PAS) and Med-ical Audit Program (MAP). TheCommission is sponsored by theAmerican College of Physicians,the American College of Sur-LmAcRE QUARTERLY geons, the American HospitalAssociation, and the Southwest­ern Michigan Hospital Associa­tion, and is located in Ann Ar­bor, Michigan. Its staff numbersnearly a hundred of which, near­ly half, are highly trained and skilled specialists. As of today, there are 272 hos­pitals participating in PAS. They represent 37 states, theDistrict of Columbia, Puerto Rico, and 5 Canadian Provinces,and discharge 2,367,400 patientsannually. This is the world'slargest, most diversified, andmost accessible source of case bycase data on hospital patients.Working with abstracts of theindividual patient's records, andusing an electronic computer tohandle the data, PAS and MAPtogether offer to all hospitals in the United States and Canada: The cost to the hospitals forPAS is small indeed for thebenefits obtained. Hospitals paya fee of 30c for every patientdischarged; therefore, if a hos­pital discharges 10,000 patientseach year, it pays the Commi�-1. A professional service ac­counting system for the individ­ual hospital. sion $3,000. This fee, however, 1s offset by a reduction in the work of the medical record depart­ment of the hospital, for from PAS the hospital receives its routine discharge statistics, an_dits disease, operation, and phy_s1-cian indexes, all produced rapid­ly and accurately by the Com­mission's computer. 2. A source of "'yardsticks for· the hospital's own clinical statis­tics.3. A time-saving method forevaluating the quality of patientcare.4. A research arm for the par­ticipating hospital.5. Research studies on the clinical data from many hos­pitals. 6. Work simplification for the llledical record department. 7. A convenient reference onindividual patients which oftenlllakes chart-pulling unneces-lary. Important data upon many as­)lects of patient care are re­turned from the Commission to the doctors and the administra­tion of the individual hospitalslrith the identities of patientsInd doctors concealed. The ob­ject is to put into the hands ofe staff and administrationls which will help in the im­vement of patient care.If the hospital wishes to add the Medical Audit Program to PAS, it pays an addition�! 10c for every discharge, makmg a total fee of 40c. For this, the hos­pital receives a further tabulat­ed review of all of the cases handled by each departl"!l�nt ofthe medical staff in addition to the material returned by PAS. Case review forms are also sup­plied for optional use. One word of caution is proper at this particular point. Individ­ual hospitals should squ�shpromptly any enthusiasm to m­stall their own business ma­chines to conduct evaluations on their own. Machines are very expensive equipment, but more important and costly than the "hardware" is the system of data processing in which it is to be 103 employed. Even the largest hos­pital cannot justify the cost of developing the system, keeping it modern, and renting and op­erating the equipment. While the Commission's computer rent­al exceeds $11,000 per month, an almost equal amount is expend­ed on just the process of keeping the system up to date--deter­mining what to abstract from each clinical record and design­ing the form, working out the most useful report data and for­mat, and writing the necessary computer programs (in 1963 the PAS and MAP programs exceed 250,000 separate machine lan­guage instructions). It is this meticulous attention to detail which makes PAS and MAP simple and effective--and the investment required for the sys­tem is as great for a one-hospital system as for the entire family of PAS hospitals. In addition, PAS and MAP supervise and control the quality of the data, both incoming and outgoing, solve the individual hospital's needs for data with special tabu­lations and studies, and offer instruction to medical staff, ad­ministration and medical records personnel in the use of the new tool. 104 Neither the medical staff nor 1the administration should iew PAS or MAP as entirely pai less solutions to the problems o the evaluation of patient care. hey aren't. The records have t be carefully abstracted (and the abstracts can be no better han 1the records they condense) The information from the abst icts, after it has been compilec and displayed by the computer, nust be conscientiously studied )ack in the hospital. The medic a· 3taff must answer to itself the ues­tions "What quality of can does our record reveal?" and se. cted individual charts will sti re­quire committee review. J llt if the staff and administ ition wish to receive adequate and useful information abou the quantity and quality of F tient care, and they can througl PAS and MAP, then hospitals i 10uld be anxious to particip.: e in these programs. The way to do the jor is to "git thar fustest with the most­est" and this means usin mo· dern business machines. There just isn't any excuse n w to waste the time and effxt of busy doctors and medical �·ecord librarians in futile and O' ,solete methods of evaluation. LmACRE QUARTERLY THE DOCTOR PRESCRIBED A CURSILLO JOSEPH C. LESHOCK, M.D. Since the primary purpose of Catholic Physicians' Guilds is to improve the spirituality of its in­dividual members, it behooves the officers and directors of these groups to appraise any movement which will promote this primary end. The Cursillo Movement magnifies and vivi­fies the basic eternal teachings of the Church and induces a pro­found increase in the life of grace in the soul. Therefore, it is manda tbry that we evaluate this for possible use within the framework of our individual Guilds. Further impetus is giv­en by the fact that a doctor was primarily responsible for its in­ception1 d e v e l o p m e n t  a n d  growth. Specifically, the word Cursmo is Spanish and means a short course of lectures. The CursiUo Christianidad, therefore, means a short course of lectures on Christianity. This, then, is the substance of a Cursillo, a series of lectures on Christianity dur­ing which there is a profound, constant, and overwhelming at­tention to the life of grace in the individual soul. In a limited sense, we Americans may com­pare the Cursillo to a retreat. However, in a retreat the work of the priest is two-fold-to teach the doctrine of the Church and to convince the retreatants that the Catholic way of life is the happiest and best way of life for them. In a Cursillo, the Priest's conferences cover the doctrine, while lay helpers do the convincing for the retreat-ants. Fully two-thirds of the lec­tures are given by lay "profes­sors." Instead of retreat silence prevailing, the "free time" at a Cursillo is filled with stimulat­ing conversation, discus�ion and analysis among the participants, together with happy spirited song. The history of the Cursillo dates back to 1944 on Majorca, a Mediterranean island off the coast of Spain. Dr. Edward Bon­nin, a practicing psychi�trist on the island, was deeply disturbed by the religious apathy among the people of that area. Throu�h his efforts, a group of some thir­ty laymen and priests were or­ganized to seek a better "'!'ay tobring about a more Christ-cen­tered life among the islanders. In working with the Bishop of Majorca, the Most Reverend Juan Hervas, it was decided that a Cursillo would best achieve their purposes since this would combine both the elements of a retreat with actual lectures in Christianity. For the next five years Dr. Bonnin and his group labored intensely to develop their project into a complete and well-planned program. By 1949 it was established, the lay-professors were well trained and integrated into the proced­ure with the priests, and this first apostolic group was ready to follow the admonition of Christ in going forth and re�lly teaching. The first Cursillo Christianidad was held at the San Honorato Monastery �nd was attended by twenty-nine 105 

Gitting Thar Fustest with the Mostest

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Gitting Thar Fustest with the Mostest

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