FROM THE EDITORS DESK

Robert Perrillo

Welcome to the Spring issue of the Ochsner Journal. You may notice that the Journal has undergone some changes in design, which hopefully you agree improves its readability.

The Spring issue of The Ochsner Journal reaffirms our mission not only to serve as a source of medical information but also to present topics that are important from a societal perspective. An apt example of this can be found in the discussion by Dr. Michael Wilson, Chairman of Graduate Medical Education at Ochsner Clinic Foundation, of the new resident duty hours mandated by the Accreditation Council for Graduate Medical Education (ACGME). We live in a society where sweeping changes in medical education can occur suddenly, often in response to public pressure linked to a specific event defined in the media. Dr. Wilson does an excellent job of discussing the history of recent reforms in regard to duty hours, the reasoning behind these revisions, and the changes that have been put in place at Ochsner to accommodate to the new requirements. In reading his overview, I could not help but think that a potentially important benefit of the new duty hour guidelines is that they are conducive to a healthier balance between time needed for professional pursuits, personal development, and family. Call me an optimist, but achieving this at an early, crucial stage of training may reinforce instincts for compassion and attention to the social as well as medical needs of patients that are essential to our profession.

Dr. Wilson's article is followed by a broad review on the Code of Medical Ethics of the American Medical Association by Dr. Frank Riddick, Chief Executive Officer Emeritus of the Ochsner Clinic Foundation. I was particularly drawn to Dr. Riddick's concluding statement that, as physicians, we make these promises “freely and upon our personal and professional honor,” which reminds us of the solemnity of the patient-physician relationship and the moral imperative by which all physicians are guided.

The next article, by Dr. Gerard Rabalais, Vice-Chairman for Administrative Affairs, Department of Pediatrics, at the University of Louisville School of Medicine, offers insight into the practical advantages of telemedicine in the care of the pediatric patient. We are living in a time when patients frequently use the Internet to collect medical data and physicians can chose to communicate with their patients electronically, saving both time and other resources. Dr. Rabalais' article is a timely reminder of the reasons why all physicians should embrace such techniques wherever and whenever possible.

As physicians, we attempt to improve both the quantity and quality of survival. While we can not always be sure of success in the former, one thing that we can do reliably, and often simply, is to provide relief from pain. Dr. Mack Thomas of the Department of Anesthesiology describes the various modalities available to relieve pain; he lists the physical and psychological effects of under-treatment; and he points out ways to identify and avoid situations likely to lead to abuse. Dr. Thomas' article is extremely relevant for our day-to-day care of patients.

Next, Dr. Eric Finley of the Department of Dermatology at Ochsner discusses Mohs micrographic surgery for cutaneous neoplasms. Dr. Finley discusses the history, technique, indications, and recurrence rates for this approach which is particularly well suited for skin cancers that grow by local contiguous spread.

Drs. Chander, Lavie, Ventura, and Milani then describe a case of methemoglobinemia following benzocaine administration during transesophageal echocardiography. As a gastroenterologist, I was fascinated when I recently learned that methemoglobinemia has also been rarely described following exposure to cetacaine oropharyneal anesthesia used in preparation for upper GI endoscopy.

Dr. Jan Larson, Head of Ochsner's Children's Research Institute, provides an excellent review of the obstacles that have been seen in going from bench to bedside in regard to the therapy of cystic fibrosis. To further round out this issue, Drs. Hector Ventura of the Department of Cardiology and Dr. Eddy Randrup of the Department of Urology present a profile on Dean Holland Echols, a contemporary of the founders of the Ochsner Clinic. I hope that you enjoy this vignette of a man whose contributions to the creation and success of the Ochsner Clinic, including the idea of a Foundation and an enduring commitment to medical education, were many and varied.

The Editorial Staff hope that you find the information in this issue to be useful to your practice. I would like to remind you that all of the articles are available at no cost on the Ochsner web site—www.ochsner.journal.org. As always, we welcome any comments that you may have (ocjournal{at}ochsner.org).