Codman – A Medical Pioneer

Henry Ford was one. So was Eli Whitney, Thomas Edison, and more recently, Steve Jobs. Each developed their own niche through new areas of thought, research and ingenuity and are now synonymous with the title, ‘pioneer.’

‘Medical Outcomes’ Pioneer

Another pioneer was a Boston surgeon by the name of Dr. Ernest Amory Codman. Unfortunately, his work was considered unpopular among his peers, so by the time he died in 1940, he had little fame or fortune. He died penniless without even a headstone on his grave.

Born in 1869, Codman made contributions to anesthesiology, radiology, duodenal ulcer surgery, orthopedic oncology, shoulder surgery, and the study of medical outcomes. But his biggest contribution was founder of what is known today as ‘outcomes management’ in patient care.

Codman became the first American doctor to follow the progress of patients through their recoveries. Using “End Result Cards,” he kept track of every patient he treated, along with demographic data, diagnosis, the treatment rendered, and the eventual outcome of each case. He would follow up with patients at least one year after treatment to determine the outcome of his work.

Unlike his peers, it was his lifelong passion to establish an ‘end results system’ to track patient outcomes. Clinical ‘misadventures’ would be identified and provide additional insight to improve the care of future patients. But this was not enough for Codman. He also believed that all information stemming from this work should be made public so that patients could make educated decisions on which physicians and hospitals to seek care.

This happened over a century ago!

While on surgical staff at Massachusetts General Hospital (MGH), Codman also became a member of the Harvard faculty and instituted the first morbidity and mortality conferences. MGH had little interest in Codman’s pursuit of health outcomes, and he subsequently lost his staff privileges. Not deterred, and exhibiting characteristics of a honey badger, Codman established his own hospital to pursue the performance measurement and improvement objectives he believed would progress medical outcomes management.

From 1911 to 1916, Codman recorded and published 123 errors on 337 patients hospitalized in his care. The cause of errors ranged from lack of knowledge and skill to poor surgical judgment and an absense of care or equipment. He sent copies of his annual hospital reports to major U.S. hospitals challenging them to document their outcomes. But hospitals would not follow his lead. Undeterred, Codman made his reports available to the public allowing patients to be well-informed when seeking care from hospitals.

At a local medical society meeting one evening, Codman blatantly displayed a cartoon (drawn by a friend) showing an ostrich with its head in the sand kicking up sand and golden eggs, explaining that the ostrich represented surgeons and hospital administrators whose only interest was in mining financial rewards – not improved care. From this, he was asked to resign from the society. Shunned by his peers, many of whom no longer referred patients to him, his views were widely ignored by the medical profession.

Through his work, he was a founder of the American College of Surgeons that later became known as the Joint Commission on Accreditation of Healthcare Organizations.
Ahead of his time, Codman once wrote, “We believe it is the duty of every hospital to establish a follow-up system, so that as far as possible the result of every case will be available at all times for investigation by members of the staff, the trustees, or administration, or by other authorized investigators or statisticians.”

Had his peers not ignored his actions and views on improving patient outcomes, one might easily conclude that the rapid advancement of medical outcomes would be light years ahead today.

Since his death, Codman’s impact on the medical profession is viewed quite differently. In 2014, over a century following Codman’s efforts to reform the medical world, a group a physicians raised money to establish a granite and bronze memorial at Codman’s gravesite.

Doing the right thing to benefit the public takes immeasurable courage. Constructing and implementing a contrarian approach may seem disruptive – especially to your peers. These so-called disruptions may eventually reveal themselves as new areas of thought, research and ingenuity. Through his struggles, there’s no doubt that Dr. Ernest Amory Codman was a true medical pioneer.

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