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Revista Brasileira de Ortopedia

Print version ISSN 0102-3616

Rev. bras. ortop. vol.47 no.2 São Paulo Mar./Apr. 2012

http://dx.doi.org/10.1590/S0102-36162012000200001 

EDITORIAL

 

Of orthopedists and pilots

 

 

Some professions carry great responsibility, and this responsibility is what weighs most heavily in practicing these professions.

In most instances, the professional is not the one who furnishes the elements needed for the quality of the service provided to be ideal, but it falls to this professional to judge whether what has been made available is enough for him to accept responsibility for carrying out the task.

Airplane pilots are among these professionals, given that on every flight, the lives of many people depend on him: people who, in using the service that he commands, are not seeking to risk their lives but just to be transported.

The aircraft model is chosen through a political-economic decision by the company, which the pilot does not participate in. Moreover, the airworthiness of the plane is maintained by a team of mechanics who he does not know but who he needs to trust, since a maintenance failure could be disastrous.

The fuel is loaded at each airport and this also has to be totally trustworthy, for obvious reasons. The same applies to the airports generally, and to the air traffic controllers, both in the airport control tower and along the flight path.

The pilot just has to judge all these services and accept them or veto them. The power of veto is fundamental for exercising his activity.

The entire immense infrastructure that is set up for aircraft to take off and transport passengers is conditional on approval by one individual: the person responsible for the plane, i.e. the pilot.

Our activity greatly resembles that of a pilot. Perhaps the difference lies in the number of people and the fact that in principle, our own lives are not involved in the surgical operation.

Although the quality of the hospital, its state of asepsis and the nursing care are not directly under our influence, they are our responsibility. Any failure at one point in this chain will be attributed to the physician. No one will ever forgive us for an infection if the cause of a failure in the sterilization system is attributed to us.

The care in the surgical theater, the nursing involved and the basic set of instruments made available are not chosen according to our guidance, but they are our responsibility, since any failure resulting from any of these items will be attributed to the surgeon in charge.

With regard to the choice of surgical material and what is to be implanted, comments are superfluous.

I do not know whether pilots have to choose between three options of fuel to know which one will be released for use; or whether they can only fly a given aircraft after authorization from someone who does not about planes; or whether some airports can be used by certain passengers and not by others. Is it possible that in using certain equipment, an employee of the company that supplies the equipment is present in the command cockpit giving guidance and suggesting other types?

I do not believe that this type of interference exists in pilots' professional practice, but I am sure that if it existed, pilots would not accept any of these options. They would demand the best conditions for preserving their passengers' lives and their own.

We, in accepting hospitals under inadequate conditions and accepting material selection based on any criterion other than our own, place our patients and our professional lives at risk.

In both professions, the responsibility is personal and non-transferable. There is no institutional ethics: just personal ethics.

Pilots undergo constant training on simulators and rigorous medical examinations to be able to exercise their responsibility.

For us to accept our responsibility, we have a long history of academic training, an arduous and difficult period of medical residence, a rigorous selection examination and constant continuing education. We refine our responsibility through every congress that we attend, every article that we read, every case that we discuss and every opinion that we hear.

We cannot, under any circumstance, make concessions. No one has the power to contest, or is capable of contesting our judgment, since the person with the responsibility has the authority to choose and select everything for which he is answerable. This is a legal precept.

Just as we expect that pilots will exercise their responsibility with the greatest rigor, let us exercise ours.

 

And have a good trip

Gilberto Luis Camanho