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February 2000
Volume 64 |
Number 2
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ADMINISTRATIVE UPDATE
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| Office-Based Surgery
and Anesthesia: A Continuing Challenge |
Ronald A. MacKenzie, D.O., President
The dynamics of effective communications are composed of several
time-tested techniques. Though basic, perhaps the most powerful
of these techniques is the ability to deliver a consistent, concise
message to your audience, whoever they may be. A brief message,
which is constantly reinforced, often repeated and defended when
necessary, will allow you to speak volumes.
As anesthesiologists, we do not have to look very far
to find our message. It was pervasive throughout our medical training,
it is the hallmark of our profession, and it is even incorporated
into the official seal of our Society. Our motto is "Vigilance,"
and our top priority in practice and in our messages to others
is patient safety. Period.
Recently office-based surgery has been discussed in the medical
literature as well as the general press. In part, what is at issue
here is the question of risk when a person has a surgical procedure
performed in a doctor's office where there are few, if any,
requirements for minimum safety standards. Although
a vast majority of the ASA membership do not practice in the office
setting, ASA will not abdicate its commitment to patient safety.
Therefore, ASA's leadership and members of several ASA committees
and component societies are working with legislators and regulatory
agencies to ensure that appropriate patient safety standards are
adopted for doctors' offices.
A special issue briefing was held by ASA on January 15-16
for representatives of several state component societies that
are, or soon will be, working with their state officials to address
patient safety in doctors' offices. The speakers outlined the
issues, presented model regulatory and legislative language, and
provided spokesperson training for the participants to more effectively
deliver the patient safety message.
The ASA issue briefing ironically coincided with several reports
on office-based surgery in the medical and lay press, further
emphasizing the need for our continuing involvement. A recent
report on a survey of liposuction deaths, published in the Journal
of Plastic and Reconstructive Surgery (January 2000), indicates
that 95 liposuction patients died between 1994 and 1998. That
equates to nearly one in every 5,000 procedures and is almost
50 times higher than we would expect.
This is completely unacceptable. This is a serious public
health problem. We as medical professionals have dedicated ourselves
to improving the safety of our patients, and we are proud to say
that those efforts have not gone unnoticed.
According to the recently released Institute of Medicine
(IOM) report on medical errors, the reason anesthesia is safer
today is due to "improved monitoring techniques, the development
and widespread adoption of practice guidelines, and other systematic
approaches to reducing errors" promulgated by the anesthesiology
community.
The issues surrounding office-based surgery and anesthesia
were also explored in a two-part article in the January 18 issue
of the USA Today newspaper. Three ASA members were interviewed
for the article. Rudolph de Jong, M.D., an anesthesiologist from
Columbia, South Carolina, discussed the Journal of Plastic
and Reconstructive Surgery article that he co-authored, saying
the study shows a "shocking" death rate, one that might be even
higher if every doctor who performs liposuction could be surveyed.
Ellison C. Pierce, Jr., M.D., Executive Director of the Anesthesia
Patient Safety Foundation, told USA Today that the deaths
reported in the survey are "a completely unacceptable mortality
rate." Ervin Moss, M.D., Executive Medical Director for the New
Jersey State Society of Anesthesiologists, also was interviewed
as a patient safety advocate who has lobbied for years to have
safety rules instituted in doctors' offices.
The two-part article was followed the next day by a USA
Today editorial that said, in part, "Most doctors are basically
free to do what they want in their offices. So while hospital
surgery is governed by rules dealing with staffing, equipment,
reporting and emergency procedures, most doctors performing the
same operations in their offices face no such rules. And they
aren't required to meet the same competency tests that they would
if they plied their trade in a hospital. ...These physicians need
to take a cold hard look at their priorities. Patient safety
must always come first." [emphasis added]
We could not agree more.
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