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“Medicine is Changing and So Should We:” Commentary on the New Proposed Guidelines of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

| February 21, 2013

Dear friends, colleagues, and readers of Bariatric Times:

By now you may be familiar with the controversy that was recently unleashed following the release of the new suggested guidelines and standards for the American Society for Metabolic and Bariatric Surgery (ASMBS)/American College of Surgeons (ACS) accreditation program called the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) that were sent out for public comment. While many, if not most of us, may have been puzzled, upset, or offended by the suggested guidelines, others expressed that they were pleased and felt that these new standards are a breath of fresh air.

How can we get this right? What designates what is right? Can we, should we, and will we be able to please everyone? Why should we change the status quo? Quo Vadis? Are we going in the right direction?

Regardless of what the right answers may be, we should first and foremost keep our patients’ interests and wellbeing at the center of this discussion. What should designate what is right is what is best for the patient. Nevertheless, we must collectively as a whole concurrently look after the interests of our member surgeons, nutritionists, nurses, psychologists, and other multidisciplinary professionals since they are the ones taking care of those affected by this deadly disease. Any alternative to doing so will leave our patients behind. We need to make our voices heard by voting “yay” or “nay,” and make comments when letters and surveys are sent to us via e-mail.

Let us support Dr. Jaime Ponce, ASMBS President, whom we voted to lead us through this difficult time so that we can make this change happen without major disruption and finger pointing. At the end of this road we will probably not be able to please every single association member (I admittedly was upset myself with some of the new standards), but nevertheless I am certain that we are heading in the right direction.

Regardless of whether or not you individually agree or disagree with certification, accreditation, designation, volumes (and I strongly believe that volume matters), and so many other variables, medicine itself is changing and so we must adapt. In the near future (if not already in the present) we will be judged and compensated based mainly on our outcomes. It is imperative that we adjust our standards, guidelines, and databases so that we can reliably report our results to the public. Are we going to adjust to that reality, or are we going to follow the Swedish Database for the next 100 years comparing open Roux-en-Y gastric bypass (RYGB) to vertical banded gastroplasty (VBG) as the gold standard? If we do not guide ourselves to critical change as a group now, others will do it for us.

I recall my time practicing surgery in South America and Europe. I witnessed legendary surgeons who carried their designation “Fellow of the American College of Surgeons,” or FACS behind their MD title, with honor and pride. Nowadays, so do I. In fact, I believe—as many other members do—that we will be their poster child. I am certain that by joining forces with the ACS, we (ASMBS) gained even more credibility and will become stronger. We should continue to foster the culture to become FASMBS.

I am optimistic. As we know, crisis and change are also opportunities, and their presence and implementation necessitate growing pains. While at times the discourse becomes fiery and passionate, I am sure that we will emerge from this crisis as a stronger society. Let’s get this job done, stay united, and stay tuned.

In 2012, the Obesity Action Coalition (OAC) held more than 50 Walks for Obesity nationwide raising the level of awareness of the obesity disease. Please read this month’s ASMBS Foundation News and Update for the 2012 Walk for Obesity wrap up. We thank those who organized and participated in walks and we also thank our partners in the industry, without whose support these great events may not occur.

In this issue of Bariatric Times, Dr. Leslie Heinberg provides an excellent summary on the role of psychological testing in the preoperative period.

We also present part one of a two-part series dedicated to the role of online support for bariatric patients titled “Support after Bariatric Surgery: The Offline–Online Connection.” Author Katherine Jukic presents an interesting overview on how we can support our patients postoperatively by providing support programs online to complement those offered in person.

In this month’s “Medical Methods in Obesity Treatment,” under the direction of Craig Primak and Wendy Scinta, Dr. Robert Ziltzer provides an overview on the role of appetite suppressants in postsurgical patients. Should we use appetite suppressants for those who fail to lose or regain weight? How safe are these medications? I always wanted to conduct a randomized, controlled trial comparing laparoscopic adjustable gastric banding (LAGB) with and without appetite suppressants. I am sure the appetite suppressants would affect patient outcomes in this situation.

In this month’s “Checklists in Bariatric Surgery,” we tackle a fairly common and difficult problem to resolve—chronic diarrhea and malnutrition after malabsorptive procedures.

Do not forget to mark your calendar for the first annual Obesity Week taking place November 11 to 16, 2013, in Atlanta, Georgia. There will be many things to celebrate, including the 10-year anniversary of Bariatric Times. Kudos to Publisher Robert Dougherty and his team for their hard work on Bariatric Times through the years. The journal has truly been our voice and has given us a stage in bariatric surgery worldwide.

I hope you will enjoy this issue.

Sincerely,
Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

Category: Editorial Message

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