This phrase is representative of a new trend used by hospital administrators and the media, but it does not take into account or consideration that surgeons feel that they have been patient-centered all along. Indeed, many discussions have been more about the “surgeon’s ego” rather than “the quality of their work and results.”

While the concern has always been for the welfare and outcomes of the patient, the new phrase “patient-centered” care refers to the shift in focus on who determines what is necessary and who can provide input on outcomes. Patient-centered models incorporate the perceptions and needs of the patient [1]. Recent systematic review of 14 studies (seven of which were randomized clinical trials) on laparoscopic repair of ventral hernia (LVHR) [2] found that LVHR improved the overall health-related quality of life of patients (HRQoL) in 6 of the 8 studies. These authors found that LVHR demonstrated improved pain scores and improved functionality (in 12 studies). Return to work ranged from 6 to 18 days postoperatively in 50 % of studies, while the physical function scores were improved in the remaining 50 % of the studies. Overall patient satisfaction improved after LVHR in all studies assessing patient satisfaction, including improving mental and emotional well-being (in 6 of the 7 studies).

The phrase “patient-centered” is a new model of care and a specific metric that has now been incorporated into how surgeons and physicians assess results and interact with patients. Using a patient-centered focus has broadly changed the environment in which surgeons work. To this end, patients’ satisfaction with an operation has become a common theme and a focus in many important scientific deliberations and peer-reviewed journals [3].

Technology has become a major component of surgical care, and much of it is industry supported; however, technology has not always been seen as a positive influence in the surgical sciences. When the first author of this chapter was a junior resident and suggested to one of his professors that surgeons needed to learn laparoscopic cholecystectomy, since this may become the “new standard of care,” the professor’s negative reaction caused the resident to fear that he would be dismissed from the service.

Furthermore, at Yale New Haven Hospital, as a junior resident in trauma service, when he (RL) brought an article to the journal club on the use of CT scans to screen patients suspected to have suffered an aortic injury instead of using a formal aortogram [4], the article was not well received despite the fact that similar articles on the subject had been published long before that year [5].

Every resident on trauma services remembers countless hours spent in radiology looking after trauma patients undergoing a formal aortic angiogram, an expensive and toxic procedure to their kidneys. But for any patient who had any serious trauma and was “at risk for aortic injury,” this technique was once considered the gold standard of care. Today, CT angio is the new gold standard of care. Perhaps in the future something much less invasive will become the standard as technology continues to advance.

Serious doubt accompanying surgical innovations is not a new phenomenon. In 1959, there were serious doubts that Total Parenteral Nutrition (TPN) would actually be able to sustain life [6]; yet, since 1968, TPN has become the standard of care for all patients who cannot or should not be fed and will not be able to maintain their nutritional status by oral or enteral means [7].

When Dr. “Barney” Crile Jr. of Cleveland Clinic suggested that, “we do not need to perform radical Halstedian mastectomy” [8], he was expelled from the Cleveland Academy of Surgeons [9, 10]. He was not the only one rejected by his peers for innovative thinking. Prof. Dr. Med Erich Mühe of Böblingen, Germany, performed the first laparoscopic cholecystectomy (LC) on September 12, 1985 [11]. When he reported this accomplishment in 1986 to the German Surgical Society, he was rejected from the group. Yet, in 1992, he received their highest award, the German Surgical Society Anniversary Award, and, in 1999, he was recognized by SAGES for having performed the first laparoscopic cholecystectomy. Now LC is a standard of care throughout the world.

We have become highly specialized surgeons. Patients undergoing complex surgical procedures at high-volume centers have been shown to have improved outcomes. A relevant example is aortic procedures [12]. In-hospital mortality correlates to center volume (P = 0.014) with low, intermediate, and high-volume centers having mortality rates of 23.4 % (n = 187), 20.1 % (n = 62), and 12.1 % (n = 15), respectively. This relationship persisted when controlling for severity of comorbid illness (P = 0.007). The number of complications per patient varied significantly by center volume (P = 0.044) as well. Other examples of surgical excellence in high-volume centers that perform pancreatectomy have been clearly documented [13]. In a study performed in one of the major American institutions, all 1,000 pancreaticoduodenectomies performed between March 1969 and May 2003 by a single surgeon reported an unprecedented mortality rate of 1 %. In addition, the median operative time decreased significantly over the 5 decades, with 8.8 h reported in the 1970s and 5.5 h during the 2000s. Postoperative length of stay dropped from a median of 17 days in the 1980s to 9 days in the 2000s. Overall 5-year survival was 18 %; for the lymph node-negative patients, it was 32 %; and for node-negative, margin-negative patients, it was 41 %. Another report from the same institution [14] has demonstrated that patients who have cancers with favorable pathological features have statistically significant improved long-term survival.