October 2000
Volume 64 |
Number 10
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RESIDENT'S REVIEW
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| A Recovery
of Faith |
Maneesh Sharma, M.D.
I am writing here on the dignity of our profession, our roles
as residents and the destiny of anesthesiology. Resident involvement
has been covered very eloquently in prior issues, and I shall
continue this effort by delving into topics that were not covered
before.
Many residents feel a loss of faith in the system because they
see senior members of the anesthesiology community run ASA and
related associations and may view our input as simple trainees
as unimportant. Additionally, it seems that a lack of experience
in dealing with legislation and political issues holds the rest
of us back. I shall try to dispel these misconceptions and offer
some guides to approaching these forums.
In 1988, the Resident Component of ASA emerged. Various reasons
for this action can be found in the Residents' Guide to the ASA;
but the major reason for this event was to encourage resident
participation. The Board of Directors understands the importance
of this and supports our involvement. As residents, we form a
vital component of the anesthesia society; we are the present
and, most importantly, the future governors of the profession.
Our views and insights often offer refreshing new angles to issues
in deliberation. We do make a difference. My interactions in ASA,
the ASA Legislative Conference and the Maryland Society of Anesthesiologists
have demonstrated nothing but reinforcement and support for resident
involvement.
But what does involvement mean, and how do we approach problems
in the political process? The method must be one that is systematic
and allows for problems to be dissected, thought through and communicated
effectively. Below is a short and easily remembered guide that
I have found useful in organizing thoughts to tackle political
issue problem solving, conflict resolution and arbitration:
• Be Constructive. Always keep
the main issue and goal at the forefront of your mind. Do not
get discouraged. Do not be bogged down by side issues. Always
think of it as your job to make it happen. Be positive: Moving
forward is faster.
• Be Critical. Examine the problem
and be aware of everything it effects. Any issue and decision
is likely to have rippling effects on what is around it.
• Be Collective. This goes hand in hand with
being critical. Be aware of all the effects, then re-examine the
solution again to see if it really is what is best for the problem.
Also, remember that no solution is perfect in this imperfect world.
• Be Creative. Most problems have multiple
solutions. Kept in mind, that will allow you to think of options
that may lead to a better solution. Perhaps rather extreme, but
food for thought, is a quote from Einstein: "For an idea
that does not at first seem insane, there is no hope."
• Be Calm. Basically, the world likes homeostasis;
there may be sudden jerks and swings, but the tendency is to always
come back to equilibrium. Inertia is a natural property in matter
and a tendency in humans. Initiation of any change requires the
most energy, and the effects of such change require time to surface,
especially if it affects a large system and large groups of people.
Scientists/anesthesiologists probably find this step the hardest.
So let us put this model to use. I will use the Health Care Financing
Administration's (HCFA's) proposal to grant unsupervised nurse
anesthetist practice. Without rehashing issues of which all of
you are aware, the question is: What can we do? In previous NEWSLETTERs,
it has been mentioned that one way is to contact local and national
legislators. This is needed, but even with that effort and ASA
lobbying, the issue is bound to resurface at a later time.
• Be Constructive. One interesting observation
I have noticed is the lack of public awareness as to who anesthesiologists
are and what we do. I have had many people close to me (including
some Ph.D. scientists) tell me that they thought anesthesiologists
were nurses! That seems like a pretty big problem. A whole society's
image of us has to be changed.
• Be Calm. Maybe just a few extra minutes
per patient, over the long run, can make a difference. I find
it amazing that surgeons talk to the family after the surgery
and give updates, but we rarely do. We should. After all, we essentially
keep the patient alive during the procedure. The only reason people
do not know this fact is because we never tell them.
• Be Critical. We meet most of the patients
a few minutes before the surgery and see them for a few minutes
after the surgery (and for some of that time, they are amnestic
anyway!). Unlike surgeons or internists, our relationship with
the patient is not fostered over time. Our relationship is built
quickly and must embody trust.
• Be Creative. This relationship can be nurtured
further. Postoperative checks mean a lot: I have received the
greatest praise on these rounds, including letters from patients
well after the surgery. During the surgery, have the nurse give
your report in addition to the surgeon's report. After the case,
you or the attending should immediately update the family.
• Be Collective. All these little things,
over time, will make a difference on our field's popular image;
I have had good response with this from families and attendings.
Between resident and attending, it is possible to make all of
this happen within the short turnover time constraints.
Our active participation is needed for us to charter a course
to best serve the profession. The above examples offer ways to
systematically approach and add to this one particular issue.
It is clear that unless our patients are informed, safety will
be sacrificed Many active issues, such as the one discussed and
some others very close to us residents, are constantly in need
of ideas and support.
Please consider contributing your talents to the activities of
ASA, state organizations and respective departments; it is rewarding,
and it can be fun. We need voices, and your view is important
for us to succeed. Have faith in this system it is trying to give
us a chance to make a difference. Let us continue to heal in the
operating room, but also let us step out and use that faith to
mold the future and work toward the most basic mission: to further
the health of all.
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Maneesh
Sharma, M.D., is a CA-2 resident at the Department of Anesthesiology
and Critical Care, Johns Hopkins Medical Center, Baltimore,
Maryland. He is Resident Delegate from the Maryland Society
of Anesthesiologists. |
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