The tissue committee is usually thought to be charged with the duty of preventing unnecessary surgery. While this is an important part of the committee's role, an equally important part is detecting improperly performed surgery and cases where necessary surgery was delayed or not performed. To fulfill this role, the tissue committee should be merged with the committee that reviews deaths and complications. The dealt and complications review is usually conducted informally as a teaching exercise, but it has great significance in the monitoring of medical staff performance.
Because the death and complications review is informal, while the tissue committee review is formal, the surgeons on a medical staff usually receive much closer scrutiny than the nonsurgeons. Every surgical procedure may be reviewed by the tissue committee, while a death on a medical service unit may escape formal review. The effect of this is to hold the surgical staff to a different standard of review than the other members of the medical staff. This problem is most severe when nonsurgeons interact with surgeon consultants. The general practitioner who is the attending physician may unreasonably delay in calling in the surgeon, but it is the surgeon's conduct that will be reviewed.
The first step in broadening the scope of an existing tissue committee is to review the preoperative and postoperative care rendered to patients with questionable surgical results. The attending physician is responsible for the overall care rendered the patient, irrespective of the presence of consultant surgeons. The conduct of the attending physician must be reviewed whenever the conduct of the surgical consultant is reviewed. Ultimately, the tissue committee should evolve into a general review committee charged with the duty to investigate all death and unexpected complications.
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