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I thoroughly agree with Dr Beyer's view that medicine in this country is generally very good and that many physicians spend a great deal of time working on audit and tissue committees to further improve the quality of care in their hospitals. However, I do have a few relatively minor reservations about one of the examples given in his letter.Most surgeons see patients referred for an opinion regarding surgery rather than "for surgery," and it is part of our responsibility as consultants to dispute the diagnosis if we think surgery is inappropriate. We may be wrong in deciding not to operate, but it would certainly be irresponsible to operate solely to avoid disagreeing with the referring physician or out of an inordinate fear of ever being wrong by not operating. The conscientious exercise of surgical judgment not to operate often requires considerable courage; I am sure that
Mitchell WE. Quality of Medical Care-Reply. JAMA. 1977;237(19):2037. doi:10.1001/jama.1977.03270460022009
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