| Dr. Lema Gets Personal |
| Editor’s Note:
The letter written by Roland R. Rizzi,
M.D., “Whose Side Are You On?”
in the December 2002 NEWSLETTER
was intended by Dr. Rizzi as a personal
letter to me, not for publication. We apologize
to Dr. Rizzi for the oversight. |
— M.J.L |
|
Take This Hammer, Dr. Lema
A belated response to your profound insight in the May
2002 NEWSLETTER.
Your magic hammer strikes the nail with repeated accuracy.
Bravo! We in pain management are in a dense fog concerning
the care and cutting-edge treatment of patients in pain.
After 35 years of practice, both clinical and academic,
my message to our residents, medical students and fellows
remains the same: knowing a procedure is rarely an indication
to do it.
Your insight as always is on the mark, and in this instance,
prophetic.
To quote: “Men need (the truth) dinned into their
ears many times and from all sides.” Réné
Laënnec 1781-1826.
Sheldon L. Burchman, M.D.
Milwaukee, Wisconsinn
Informed Consent Is More
Than Preventing a Lawsuit
Karin Bierstein, J.D., concluded her “Practice
Management” column on informed consent in the
December
2002 NEWSLETTER as follows:
“A lawsuit may yet result… This is precisely
what the anesthesia informed consent process and the
discipline imposed by its documentation are intended
to prevent.” As an attorney, Ms. Bierstein titled
her article, “Informed Consent Is More Than
a Signature.” As a physician, I would like to
add, “Informed consent is more than preventing
a lawsuit.”
Informed consent is fundamentally an ethical issue.
Laws are created through legislative action and judicial
interpretation to codify the values our society embraces.
Values come first. The law follows. Citizens who respect
society’s values are less likely to come into
conflict with the law than those who do not.
Autonomy — the principle that one’s decisions
should be independent from the will of others —
is an important ethical principle strongly embraced
by our society. The purpose of informed consent is
1) to ensure that patients have enough information
with which to make appropriate medical decisions independent
of the will of others and 2) to ensure that patients’
decisions are appropriately carried out.
Dilemmas associated with obtaining informed consent
become simpler if the physician’s primary goal
is not to prevent a lawsuit but to respect the patient’s
right of autonomy. The method for documenting how
the patient’s autonomy has been honored is not
crucial so long as it reflects thorough and accurate
communication. The physician must document in the
medical record what the physician told the patient
and what the patient told the physician. Subsequent
entries in the medical record should show that the
patient’s wishes have been carried out.
Informed consent is more than practice management.
It is clinical care.
Ronald A. Gabel, M.D.
Yarmouth Port, Massachusetts
Response from Karin Bierstein:
Dr. Gabel is absolutely right. I appreciate the reminder
that many anesthesiologists regard the patient’s
“autonomy” and right to be informed as
an ethical matter. Dr. Gabel articulated nicely the
main point that I attempted to make in my column:
the process of educating the patient and thus obtaining
his or her “informed” consent is more
important than the form of its documentation. As a
lawyer, it is my job to advise on the law and, in
general, not on medical ethics. In this instance,
Dr. Gabel has made the intersection clear.
This Retiree’s Having
a Blast
I can speak from personal experience on the topic of
life after anesthesiology
(January 2003 “Ventilations”).
Several years ago, I left my job as staff anesthesiologist
at one of the local hospitals and took several months
off. I was under no financial pressure to return to
work, ever! The quality of our practice had changed,
and I was sole caretaker for a terminally ill relative,
so it wasn’t like I was loafing. Initially I was
not sure if I wanted to return to practice. Well, I
got bored. I really, really missed practicing anesthesiology.
It was just like my aunt told me, “You have to
retire to something.” I now work at a
tertiary care referral center, and I really enjoy the
variety and academic stimulation this type of practice
affords. I don’t think I am ever going to retire.
With so many really cool things that you can do within
this specialty, who would want to retire? I highly recommend
hobbies, however, so my husband and I shoot competitive
trap. It’s a whole lot of fun, great exercise
and requires one’s full concentration. It really
gets your mind off of the hospital. When you are not
studying Latin and Greek, you might check out the Web
site of the Amateur Trapshooting Association for a range
near you!
Elizabeth T. Young, M.D.
Metairie, Louisiana
Reader Separates History From
Histrionics
I draw your attention to the article by Philip S. Weintraub
that ran in the January
2003 ASA NEWSLETTER.
In the second paragraph, the following statement appears:
“conjoined infant twins from Guatemala were separated
in a history-making surgical procedure...”
Approximately 20 or more years ago, conjoined twins
were successfully separated here at Duke University
Hospital. I was one of the two anesthesiologists; Robert
A. Binner, M.D., was the other. About three years before
this, we had operated on another set of conjoined twins
who unfortunately did not survive.
You will appreciate that the University of California-Los
Angeles procedure referred to in your article was a
rather long way from being “history-making.”
I am sure that if you pursued the matter, you would
find many more cases.
I appreciate the NEWSLETTER and hope that you
will see fit to publish a correction in due course.
Edmond C. Bloch, M.B.
Durham, North Carolina
Dr. Papper’s Long Legacy
The announcement of the death of one of the giants of
our specialty, Emanual M. Papper, M.D.,
(January 2003 ASA NEWSLETTER)
saddens us all.
I did not train at P&S, but attended many of the
famous Tuesday evening scientific sessions where case
presentations were a forte.
One evening, the discussion concerned a child who during
induction appeared to have had a cardiac arrest. The
surgeon asked for a scalpel and began making an incision
(in those days external cardiac massage hadn’t
been disseminated widely), and the child moved!
The pros and cons of internal massage versus striking
the chest sharply, etc., were examined.
Later, at the deli, where the entire staff and visitors
were invited by Dr. Papper to partake of some New York
delicacies, a visitor with a pronounced British accent
called to Dr. Papper and stated, “Dr. Papper,
you know what I’m going to have tattooed on my
chest?” Dr. Papper asked, and the visitor replied
without skipping a beat, “Knock before entering!”
This took place some 40 years ago to the best of my
memory, and I’m sure just one of the many, many
stories that Dr. Papper’s friends are privy to.
Rest in peace, Dr. Papper.
Benson Bodell, M.D.
Houston, Texas.
Jay Jacoby, M.D., Ph.D., 1917-03:
Student, Teacher and Humanitarian to the End
On behalf of the thousands of physicians influenced
by Jay J. Jacoby, M.D., Ph.D., (1917-2003), we wish
to mark his passing with a measure of gratitude, affection
and respect. Of those thousands, many hundreds became
anesthesiologists and, subsequently, leaders in every
area of anesthesiology. His exemplary life as an anesthesiologist,
spanning 58 years — 40 of them as a university
departmental chair — was driven by a phenomenal
dedication to the medical profession and by the moral
imperative of sharing his skills and knowledge with
others. Jay could not not teach.
He literally met entering medical students at the door,
engaging in clinical training in anatomy, physiology
and pharmacology. Almost no one goes to medical school
to become an anesthesiologist, but Jay put an appealing
face on the specialty, showed the relevance of the basic
sciences to clinical practice, and by his powerful enthusiasm,
drew many young men and women to the specialty. He has
recently written of his early experiences in anesthesia
during World War II, and his irrepressible wit and warmth
pervade his account.1
Jay was a consummate clinician and a brilliant analyst
of difficult medical circumstances, cutting through
forests of information to arrive at clear diagnoses
and decisions. That said, he never lost sight of the
patient as not only the benefactor of his clinical ministrations,
but as the object of his care. He respected the dignity
of patients and freely gave them the benefit of his
humanity. He was good-natured, and the full impact of
his good nature cannot be underestimated. He continued
to be a compelling teacher long past normal retirement
age, teaching that which he loved to the end of his
days.
His long, productive life has ended, and we might be
permitted to mourn his loss, but our sorrow gives way
to thankfulness for his gifts to all of us. In his autobiography,
he reflected on the metamorphosis of anesthesiology:
“An amazing change has occurred … because
the skill and the knowledge of the anesthesiologist
is now recognized and appreciated.”1
No one did more to make that happen than he.
Peter L. McDermott, M.D., Ph.D.
ASA President, 1993
Camarillo, California
Neil Swissman, M.D
ASA President, 2001
Las Vegas, Nevada
Eugene P. Sinclair, M.D.
ASA First Vice-President, 2003
Elm Grove, Wisconsin
| Reference: |
| 1. Caton D, McGoldrick KE, eds. Careers
in Anesthesiology: Autobiographical Memoirs. Volume
VII. Ninety Percent of Life is About Showing
Up, by Bernard V. Wetchler; The Metamorphosis
of Anesthesia, by Jay Jacoby; The Accidental
Anesthesiologist, by Daniel C. Moore. Park
Ridge, Illinois: Wood Library-Museum of Anesthesiology;
2002. |
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