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In Dialogue

Luedi, Markus M. MD, MBA; Doll, Dietrich MD, PhD

doi: 10.1213/ANE.0000000000001605
Letters to the Editor: Letter to the Editor

Department of Anesthesiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland,

Department of Surgery, St. Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Vechta, Germany

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To the Editor

Aiming to define best patient care, pro–con debates are popular in scientific journals and conferences. In clinical routine, too many aspects are discussed in a pro–con way. Such debates may be seen as risk–benefit discussions between 2 individuals, usually consultants of the same specialty, who look at the same data but come to different conclusions. We seek a modification of pro–con debates that emphasizes a focused collaborative dialogue between 2 individuals with different specialty training. The rapid evolution of the World Wide Web, the globalized economy, and global ecologic challenges are teaching us how interdependent our world has become. We feel the most constructive way forward is benevolent dialogue, which by definition is “a discussion between two or more people or groups…directed toward exploration of a particular subject or resolution of a problem.”a In addition, we feel physicians need to learn from the management sciences to focus on customers’ needs and to aim for an “internal action logic” of collaboration and intense focus on truth as a fundamental leadership quality.1

Exemplary dialogues can reflect a good role modeling among colleagues of the same or different specialties, exchange information from different perspectives, and be more engaging and less dry than a review article. Poor dialogues can be inefficient at presenting information and appear artificially constructed. Examples already exist in medical literature, that is, case discussions in the New England Journal of Medicine and commentaries after papers presented at surgical meetings subsequently published in the surgical literature. As collaborative acute-care physicians devoted to the well-being of humans, we want to go beyond these examples. On the basis of lessons learned from the global realities, we envision patient-centered dialogues on many important issues. Major interdisciplinary concepts such as damage control surgery, discussions of specific care events such as postoperative wound infections, and exchanges about challenging problems such as treating coagulopathy or preoperative discussions of medically challenging patients are some examples. Eventually, we conceive such dialogues finally embracing all aspects of medicine.

To create a dialogue for submission for publication, we recommend the following approach. The parties define beforehand an important patient-centered issue to be addressed. Then, they independently acquire a sound base of knowledge from evidence within their field. Furthermore, they determine the aspects to be discussed and questions to be answered in a structured conversation. Once they meet, the dialogue can be recorded and/or notes can be taken. Finally, they review the material, structure it in a logical order, and link the arguments to the respective literature citations. An introduction, for example, the presentation of a patient, and a conclusion will complement the dialogue.

We call for patient-centered dialogues in medical journals, both within and especially among medical specialties, to advance medicine in its smallest interactions as well as on a scale of global health.

Markus M. Luedi, MD, MBADepartment of AnesthesiologyBern University Hospital Inselspital, University of BernBern,

Dietrich Doll, MD, PhDDepartment of SurgerySt. Marienhospital Vechta, Academic Teaching Hospital of theMedical School HannoverVechta, Germany

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aAvailable at: Accessed June 17, 2016.

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1. Rooke D, Torbert WR. Seven transformations of leadership. Harv Bus Rev. 2005;83:6676, 133.
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