Difficult Decisions in Thoracic Surgery

Why do thoracic surgeons need training in decision making? Many of us who have weathered harrowing residencies in surgery feel that, after such experiences, decision making is a natural extension of our selves. While this is no doubt true, correct decision making is something that many of us have yet to master. The impetus to develop a text on evidence-based decision making in thoracic surgery was stimulated by a conference for cardiothoracic surgical trainees developed in 2004 and sponsored by the American College of Chest Physicians. During that conference it became clear that we as thoracic surgeons are operating from a very limited fund of true evidence-based information. What was also clear was the fact that many of the decisions we make in our everyday practices are not only uninformed by evidence-based medicine, but often are contradictory to existing guidelines or evidence-based recommendations.

The objectives of this book are to explain the process of decision making, both on the part of the physician and on the part of the patient, and to discuss specific clinical problems in thoracic surgery and provide recommendations regarding their management using evidence-based methodology. Producing a text that will purportedly guide experienced, practicing surgeons in the decision-making process that they are accustomed to observe on a daily basis is a daunting task. To accomplish this it was necessary to assemble a veritable army of authors who are widely considered to be experts in their fields. They were given the unusual (to many of them) task of critically evaluating evidence on a well-defined topic and provide two opinions regarding appropriate management of their topic: one based solely on the existing evidence, and another based on their prevailing practice, clinical experience, and teaching. Most authors found this to be an excellent learning experience. It is hoped that the readers of this book will be similarly enlightened by its contents.

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