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August 1999
Volume 63 |
Number 8
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VENTILATIONS
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| Physician Workers
of the World, Unite! |
The long-anticipated letter finally arrived. I quickly opened
the letter and read the fateful first word that every physician
today has also read, "Congratulations...". This medical school
acceptance letter opened a vista of opportunity and was a culmination
of long-term goals for every prospective medical student. I remember
thinking that I would now become part of a select class of professionals,
given special dispensation by society to inquire, probe, observe,
test, trial and experiment in an effort to prolong life. The course
work was that of a "secretive" society, and the "clinical pearls"
were uttered like vespers to an assemblage of religious scholastics.
My goals of learning how to cure illness, saving lives from the
doorstep of death and comforting with reassuring words or a magical
touch would now become my armamentaria against disease.
These notions existed over 25 years ago. It is now 1999
and the traditional physician-patient medical care paradigm has
been under assault for over a decade. Practicing medicine today
involves as much nonclinical education as it does clinical knowledge.
Last month, the American Medical Association announced plans to
seek unionization for physicians to negotiate fees with payers.
I doubt that any physician who is practicing today had visions
of aspiring to become the "Samuel Gompers" of a nascent professional
union when applying to medical school. Yet, if these plans become
a reality, some physician will indeed assume that role. While
I personally believe that unionization could be a wrong first
step, nonetheless, medical practice has changed to the extent
that rational medical minds have moved forth with this concept.
The nonclinical issues of anesthetic practice are as essential
to our survival today as knowing the pharmacology of muscle relaxants.
In this issue, practicing anesthesiologists - those one-time premedical
students who aspired to learn the secrets of caring, comforting
and curing - have taken up the standard to improve, standardize,
maintain or defend anesthetic care of high moral and scientific
quality. I do not believe that these authors would have predicted
their entrée into policy and politics, but the vagaries
of life have taken their careers in that direction.
The articles herein are, in essence, required reading
for those who must also engage in the business or politics of
anesthesia. In the "Certified Nurse
Midwives, Obstetric Anesthesia and You" article, Joy L. Hawkins,
M.D., highlights important recommendations for providing care
with nonphysician practitioners.
An article by Jeffrey Morray, M.D., examines closed claims evaluations
of pediatric cardiac arrests in an attempt to understand ways
to preempt this tragedy from occurring. Barry M. Glazer, M.D.,
ASA House of Delegates Speaker, presents a primer
on the ASA legislative process that may impact on your practice.
The realities of contracting a work-ending allergy is recounted
by Barbara Zucker-Pinchoff, M.D., in her autobiographical
article.
Carlos M. Nunez, M.D., discusses
a rapidly emerging role for anesthesiologists outside of the operating
room doors by discussing his personal account of being a hospitalist-anesthesiologist.
If you wish to know the magnitude of the task of being the Editor
of Anesthesiology, I refer you to the informative
update of where journal policy is headed by Michael M. Todd,
M.D.
As for the professional union saga, it will be the subject
of a future editorial. However, it is my hope that our business
cards will never need to read, "Trained in the U.S.A. by Union
Physicians" like our clothing labels state regarding their manufacturer.
Please read on for some fascinating changes about to occur
in your medical practice.
- M.J.L.
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