A prophet to modern medicine: Ernest Amory Codman

Remarkably, the outcomes of medical procedures are rarely tracked today. As a result, establishing the best medical treatment can be difficult. Trials to establish best practices are often isolated, underpowered, and lag behind widespread adoption. Moreover, standardized methods to capture complications are lacking for most interventions.

This problem is as old as medicine itself. But one man boldly sought to challenge the status quo and tackle the problem—Ernest Amory Codman (fig 1⇓). Codman was a surgeon who believed that by prospectively tracking outcomes we can learn from our patients and advance the field of medicine quickly. Codman was a scientist of quality. He helped usher in the concept of the regular morbidity and mortality conference and started the first national registry in American healthcare. Given the challenges of medicine today—endemic rates of medical errors, wide variations in quality, and an expanding cost crisis—many physicians are calling for Codman’s basic tenants to be re-visited and applied.

Born in 1869, Ernest Amory Codman was a natural academic. He won the prestigious founder’s medal at St Mark’s School as a high school senior and graduated with honors from Harvard College in 1891.1 He undertook his medical education at Harvard Medical School, where he met Harvey Cushing. In 1895, Codman graduated from medical school and joined the staff at Massachusetts General Hospital as an assistant in anatomy, where he became the apprentice of the chief of surgical services, Dr Francis Harrington. In 1900, he was appointed assistant in clinical operative surgery. Through his work with Dr Walter Bradford Cannon, among others, Codman developed strong x ray imaging skills, …