The controversial first days of Same-Day Surgery newsletter
By Leslie C. Norins, MD, PhD
When we launched Same-Day Surgery newsletter in 1977, just three years after Wallace Reed, MD, and John L. Ford, MD, opened an ambulatory surgery center in Phoenix, outpatient surgery was controversial. Conventional medical teaching at the time was that early discharge put patients at serious risk. Critics charged that ambulatory surgery providers were jeopardizing patient safety in order to make a profit.
Yet many people considered Reed and Ford to be visionaries. A few pioneering hospitals a very few were starting to get into ambulatory surgery.
It seemed very logical to me that this trend would catch on. I went to a convention of freestanding surgery providers, where Reed spoke, and saw a presentation by a surgery professor who was doing pioneering work on early discharge of hernia and gallbladder patients. He showed a movie of the patients up and out of bed by the evening of surgery, taking warm showers, going back to work in a day or two. It was so unusual to do this.
I took a tour of Reed’s original surgery center in Arizona, and I was very impressed. I thought, "This is fantastic." It was very well-organized and seemed to make a lot of sense. I was very idealistically swayed by the merits of the case when I saw what was being accomplished. I didn’t see any charlatanism, dangers, or ripoffs of the public.
We had a dilemma about what to name the newsletter, because the field had no agreed-upon name. Some called it a short-stay unit; others used one-day or ambulatory surgery. Same-day surgery seemed to be the preponderant name at the time. Even those who didn’t use it knew what it was. We printed Same-Day Surgery on green paper like the scrub suits in the operating room.
We were aware of the extreme polarization in the early days between hospitals and freestanding operators. The hospitals at that time saw surgery centers siphoning off revenue and perhaps jeopardizing patient care by turning patients out too soon or not having backup for patients with serious complications. Surgery centers felt hospitals were holding back the progress of medicine and trying to keep a monopoly on surgical medicine.
I decided we would be advancing the cause of ambulatory surgery and try our darndest to be balanced between the two. We served as an emissary between the two camps even while we were giving information.
In some issues, I remember counting column inches to make sure we were even-handed. I wanted to put Reed on the first cover, but I thought the hospitals would hate it. So we split the cover and put a hospital story on top.
Gradually, for competitive reasons, more and more hospitals opened up freestanding units that were hospital-owned and off-campus. There was no longer a practical distinction between the two kinds of centers. The emotions have all died down, and now ambulatory surgery is quite routine.
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