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June 2000
Volume 64 |
Number 6
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ADMINISTRATIVE UPDATE
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| Connecting Science
to Patient Care Is Still Our Strength |
James E. Cottrell, M.D.
Vice-President for Scientific Affairs
Last year I wrote a column titled "Can We Afford the Luxury of
Science?" (May 1999 NEWSLETTER)
and concluded that "Science, and the education it makes possible,
is not a luxury. It is an essential that we cannot afford to be
without. It will help us persevere and, in the end, prevail. ...[I]t
is important to much of the stuff that makes us who we are --
anesthesiologists -- a kind of doctor... not a kind of nurse."
Since then, nurse anesthetists have intensified their perennial
attempt to climb into the pilot's seat. In a stunning display
of truculence, the Health Care Financing Administration (HCFA)
decided that nurse anesthetists can fly solo and carry Medicare
passengers. Our arguments are many, sound and well-articulated.
Nevertheless, thus far, evidence and wisdom have fallen on deaf
ears. There are several reasons, both general and specific, for
this turnabout, but the most frustrating among them are painfully
banal and mundane: personal bias, Washington politics, bureaucratic
ineptitude and churlish impatience.
But allowing nurse anesthetists to play doctor would only signal
a longer struggle to protect our patients. We may need to set
up a decisive confrontation. It has already been shown that the
failure-to-rescue rate is lower when nurse anesthetists are supervised
by anesthesiologists than by nonanesthesiologist physicians.1
If HCFA's pending recommendation prevails, the question will become:
Is the failure-to-rescue rate even higher when nurse anesthetists
are not supervised by any kind of physician? If the HCFA/ nurse
anesthetists coalition gets its way, our job will be to put that
question on the table and push for a process that will find its
answer.
Put differently, the federal government wants to give a green
light to individual states to conduct an experiment on human subjects.
The consent form requirement has been waived, but it would be
difficult for even the most skilled prevaricator to argue that
there is no need to collect and analyze the results. We must be
prepared to push for data collection, record-keeping and analysis
protocols that would be up to National Institutes of Health standards
for a clinical investigation, because the nurse anesthetists issue
is ultimately an empirical issue a scientific question.
In the end, science will still be our patients' savior.
In addition to pursuing that emergent objective, we must continue
to pursue our bedrock scientific goal: the quest for new information
about how to better serve our patients. Facilitating that endeavor
is the primary concern of the ASA Scientific Council. During the
past year, we have continued our development of an electronic/digital
annual meeting program and Society Journal. The 2000 Annual Meeting
Program will be reorganized into a larger, more user-friendly
format arranged by sections presented in chronological sequence.
Conveniently located kiosks will enable users to search and print
selected information from the program.
The abstract selection process of the various editorial subcommittees
will be coordinated through the ASA Web site, and all abstracts
will be available on the Web and on CD-ROM. Eventually the print
version of the abstracts, the September Anesthesiology
Supplement, will be eliminated. The Annual Meeting vice-chair
will serve as the editor for the meeting's daily newsletter. The
first colleague to hold this position will be Roberta L. Hines,
M.D., Yale University, New Haven, Connecticut.
The Section on Clinical Care has focused on office-based anesthesia
and has published a monograph, thanks to the efforts of Burton
S. Epstein, M.D., and Rebecca S. Twersky, M.D. In addition, we
now have a liaison with accrediting bodies such as the American
Association for Accreditation of Ambulatory Surgery Facilities,
the Joint Commission on Accreditation of Healthcare Organizations,
the American College of Surgeons and the Accreditation Association
for Ambulatory Health Care, Inc. Briefing sessions for states
are being conducted by ASA and physicians involved in each area.
The Section on Clinical Care has approved a proposal by Arnold
J. Berry, M.D., chair of the Committee on Occupational Health,
to build a coalition and fund a consensus panel at the ASA Annual
Meeting on October 18, 2000, to discuss substance abuse among
health care providers. A recent study published as an abstract
in the September 1999 Anesthesiology Supplement showed
that in spite of our efforts, anesthesiologists are still dying
from substance abuse at an exceptionally high rate. Input from
outside representatives such as the National Institute of Drug
Abuse will be solicited, and an all-out effort will be renewed
to decrease mortality from this problem.
The Section on Clinical Care also decided to allow a pain outcomes
pilot study if approved by the ASA Committee on Research. The
study will be conducted using an anonymous form for patients and
providers that was developed at the Mayo Clinic. This will be
an intermediate step and may lead to a large-scale, multi-institutional
investigation.
Jan Ehrenwerth, M.D., also reported that cell phones probably
do not interfere with cardiac pacemakers. That conclusion was
based on an article in the May 1999 issue of the New England
Journal of Medicine by Hayes, et al. The study noted that
when cellular telephones were placed in the normal position over
the ear, no clinically significant interference occurred. Interference
was of clinical significance only when the telephone was held
over the pacemaker itself.
The Section on Education and Research, through the Committee
on Outreach Education and the Committee on Electronic Media and
Information Technology, will survey ASA members to determine whether
they are interested in receiving continuing education via CD-ROM.
Also, due to poor attendance, regional refresher courses will
be phased out, and additional workshops will be held in various
locations during the year. Workshops have been highly successful,
and an attempt will be made to coordinate subspecialty workshops
with their respective subspecialty societies.
ASA continues to support science that improves the care provided
to patients by physicians. A recent Institute of Medicine report
cited anesthesiology's effort to decrease morbidity and mortality
through scientific advancement. Almost as important as the science
itself, we must continue to encourage such recognition of our
contributions.
As long as the central purpose of ASA remains "to raise the
standards of the specialty by fostering and encouraging education,
research and scientific progress," all patient care setbacks will
be temporary.
Reference:
1. Silber JH, Kennedy SK, Liziol LF, et al.
Do nurse anesthetists need medical direction by anesthesiologists?
Anesthesiology. 1998; 89:3A.
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