The Relation of Surgical Volume to Competence: When Is Enough, Enough?

ABSTRACT Given the inherent risk in surgical intervention and the need for the optimal utilization of health care resources, achieving high-quality surgical care is a priority for the American health care system, and competent surgeons are critical to reaching this goal. Despite the multifactorial nature of patient safety and satisfaction, surgeon competence is often oversimplified to an assessment of volume because of the ease of collection and comparison. In any practice model, the analysis of competence is complex, but the components of clinical skill for military surgeons further include multiple areas of expertise, which, although superficially unrelated to surgical currency, augment the overall care delivered by these clinicians. Thus, volume as a solitary indicator of skill excludes the unique circumstances encompassed in military service. In this paper, the factors comprising volume and competence are explained, as well as the additional factors unique to military medicine. Furthermore, process improvements are proposed for assessing and optimizing surgical competence in the Military Health System.

EVOLUTION OF THE USA HEALTHCARE: EFFECTIVENESS, SAFETY, QUALITY AND ACCESS TO HEALTHCARE

The relevance of the study of the evolution of the socially significant sphere of the United States of America, located at the point of bifurcation of socio-economic development, one way or another concerns the entire global community. The main aim of the study is to identify trends in the evolution of American health care in terms of ensuring the effectiveness, safety, quality and accessibility of medical services. Its achievement is based on the traditional methodological basis of statistical and economic analysis of the average annual growth of the main indicators of the development of American health care during the formation of its modern organizational-functional structure in 1951-2020. The results obtained reflect the general direction of the evolution of the USA health care as a haphazard complex mechanism functioning in direct resonance with socio-economic cyclicality. Identified trends in the evolution of healthcare in the context of the extraordinary commercialization of medicine and insurance dependence of patients on market conditions. Analysis of long-term development indicators of the USA health care dynamics reveals rather low results of permanent reforms of national health care due to the adjustment of their parameters and indicators to the existing concept of free market relations in the relevant market of medical goods and services. The limitation of the market mechanism in the use of potential resources of American health care, which is generally provided with both financial and innovative and technological potential, is revealed.

Philosophy within the contemporary practice of American medicine. Various forms of the relationship between both disciplines: Edmund D. Pellegrin's approach

The paper presented here illustrates the issue of philosophy within the contemporary practice of American medicine. Four forms of relationship between both disciplines will be discussed: philosophy and medicine, philosophy within medicine, medical philosophy, and philosophy of medicine. The aim of the paper is to illustrate the specificity of the proposed forms of relationship, i.e. the contrast between the autonomous approach of the both disciplines and the realistic philosophy of medicine promoted by Edmund D. Pellegrin, which closely links the issue of the nature and theory of medicine with the undertaking of philosophical reflection. The issue of the topicality of Edmund D. Pellegrin's philosophy of medicine in the context of the current challenges of American health care will also be discussed.

Considering Needle Phobia among Adult Patients During Mass COVID-19 Vaccinations

As mass vaccination is underway to combat the COVID-19 pandemic and achieve herd immunity, healthcare professionals need to recognize the fear and phobia of needles among their patients. Approximately 11.5 to 66 million U.S. adults may suffer from this condition. This population often avoids seeking medical care including vaccinations. The exact number of people suffering from this phobia is unknown, and the potential years of life lost in the American health care system cannot be estimated accurately. The resistance to vaccinations among this population may delay achieving herd immunity to end this current pandemic. An overview of needle phobia, vaccinations, and current treatments are explored. The use of telemedicine could prove critical for reaching this population as well as those who are hesitant about vaccinations. Providing education to healthcare providers to identify and manage these patients during the pandemic is necessary.