Boston surgeon who advocated the “End Result Idea” in patient care is remembered by leaders in American medicine for his visionary work in promoting medical outcomes
NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE RELEASE
CAMBRIDGE, MA (July 22, 2014 – 2:30 pm ET): To recognize the valiant contributions of Ernest Amory Codman, MD, FACS (1869–1940), to American surgery and to patient care as a whole, a memorial headstone has been placed at his previously unmarked gravesite in the historic Mount Auburn Cemetery in Cambridge, Mass. Leaders from the American College of Surgeons (ACS) and other medical organizations gathered at a dedication event this afternoon at Mount Auburn to view the Codman Memorial stone and to pay homage to the renegade surgeon from Boston, well known for advocating the “End Result Idea” in medicine.
The “Idea” simply was the common-sense premise that hospital staffs would follow every patient they treated long enough to determine whether or not the treatment was successful, then learn from any failures, with a goal of preventing similar failures in the future. 1
Dr. Codman was a maverick whose ideas were not entirely appreciated by his peers during his lifetime, but whose ideas have become the basis of patient-centered, quality-based surgery promoted in ACS standards and in current-day medical practice. Throughout his storied career, his viewpoint, and his passion for promoting it, typically placed him at bitter odds with the medical establishment to the point that it became difficult for him to earn a living. When he died of melanoma in 1940, his family reportedly did not have the financial means to purchase a headstone for his gravesite so he was interred in an unmarked site in his wife’s family lot at Mount Auburn Cemetery.2
"The American College of Surgeons, and medicine in general, owe a huge debt of gratitude to Dr. Codman, who was one of our organization's early leaders," said ACS Executive Director David B. Hoyt, MD, FACS. "He contributed immensely to our early hospital standardization activities that eventually led to the establishment of the Joint Commission in 1951. And decades later, I think he would be proud to see how his advocacy for tracking patients’ outcomes contributed to the development of robust surgical data registries—one of the most valuable tools surgeons use to improve the quality of patient care today."
The Codman Memorial is a headstone that contains his portrait in bas-relief. A bronze tablet is inset into the granite headstone that is mounted in an upright position. The headstone was created using historic Quincy Granite that can be found at many gravesites at Mount Auburn. The Memorial was crafted by classical sculptor Daniel Altshuler, DIA Sculpture Studios Ltd., Gloucester, MA.
Dr. Codman’s epitaph on the headstone reads:
Born 1869 ~ Died 1940
Father of Outcomes Assessment and Quality Measurement in Health Care
It May Take a Hundred Years for My Ideas to be Accepted
During this afternoon’s memorial event, ACS leaders expressed their deep gratitude to all donors for their assistance in securing the memorial headstone for Dr. Codman, an icon in American surgery, whose ideas have contributed to the framework for surgical quality improvement in the United States.
See the list of donors.
Editor’s note: A photo of the Codman Memorial headstone is available on request from the American College of Surgeons Office of Public Information, e-mail: firstname.lastname@example.org
- Roberts JS, Coale JG, Redman RR. A history of the Joint Commission on Accreditation of Hospitals. JAMA. 1987;258(7):936–940.
- Mallon, B. Ernest Amory Codman: The End Result of a Life in Medicine. Philadelphia: W. B. Saunders; 1999.
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About Ernest Amory Codman, MD, FACS
Born to a highly respected Boston family and educated in its private schools, Dr. Codman graduated from Harvard Medical School in 1895 after spending a year visiting outstanding medical centers in Europe. While in Vienna, he encountered the problem of disease of the subdeltoid bursa and became fascinated with the shoulder joint. Throughout all his many pursuits and accomplishments, this subject remained of deep interest to him, culminating in his 1934 book The Shoulder.
His interest in bone sarcomas also was directly responsible for the development of the Registry of Bone Sarcoma of the American College of Surgeons, established in 1920. But both of these interests served him to promote the main passion of his life, the “End Result Idea,” a simple premise that patients should be followed to determine the success of their treatments so the hospital staff could learn from any failures, with a goal of preventing similar failures in the future.
Dr. Codman served at Massachusetts General Hospital (MGH) as Surgeon to outpatients in 1899, and from 1902 to 1914 was an assistant visiting surgeon at the hospital. He held the post of Lecturer at the Harvard Medical School from 1913 to 1915. He collaborated with Harvey Cushing, MD, FACS, in some of his early activities such as clinical application of diagnostic x-rays and studying results of treatments using anesthesia, but Dr. Codman became discouraged by the hospital administrators’ lack of interest in his End Result Idea. The administration continued its seniority system of promotion, which Dr. Codman believed was absolutely incompatible with the End Result Idea. Codman firmly believed that outcomes—the end results—of a surgeon’s practice should determine his promotion, so he resigned from MGH, establishing his own small hospital.
Later, during World War I, Dr. Codman served with his hospital staff in the military taking his end results cards to test efficiency of medical procedures.
A member of many other surgical associations such as the American Surgical Association, the Society of Clinical Surgery, and Massachusetts medical societies, Dr. Codman is credited in some sources as being crucial to the founding of the American College of Surgeons. He formed a friendship with Edward Martin, MD, FACS, whom he convinced of the value of the End Result Idea, and by 1910, when Dr. Martin was president of the Clinical Congress of North America, he appointed his colleague Dr. Codman to a new Committee on Hospital Standardization. The work of this Committee was a major reason for the birth of the American College of Surgeons in 1913 and has continued as a major cornerstone of ACS activities today.
Source: Highlights from the Archives of the American College of Surgeons, Ernest A. Codman, MD, FACS (1869–1940)
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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
American College of Surgeons