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Like virtue,
professionalism may be easier to identify than to
define. Most dictionaries simply equate professionalism
with specialization. Serious students of the subject
take a different view, however. Among the characteristics
of a “profession,” they include formal
organization and work that is primarily intellectual
in character and based on the theories from some branches
of learning. Menke also emphasizes personal characteristics
such as a dedication to public service and a relationship
between the practitioner and client built on mutual
respect.1
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William T.G. Morton
(1819 - 1868). Image courtesy of the
Wood Library-Museum of Anesthesiology. |
As first practiced, anesthesiology had none of these
characteristics. Dr. William T.G. Morton, who gave
the first successful public demonstration of a surgical
anesthetic, saw in his discovery a means to become
rich and famous.2 Few
early practitioners made any attempt to understand
the theoretical basis of the discovery. For many decades,
in fact, anesthesiology was not even recognized as
a medical specialty. As a technical adjunct to surgery,
responsibility for its administration usually fell
to the lowest ranking member of the operative team,
a medical student, new house officer or nurse.
The Development of Anesthesiology as a Specialty
Technical innovations improved the quality of care,
but they did not transform anesthesiology into a specialty.
This process began when physicians recognized the
necessity of formal training in anesthesia and a practice
based on principles of chemistry, physiology and pharmacology.
In England, J.F.W. Silk argued for a required course
in anesthesia for all graduating students.3
Almost simultaneously, American physicians began their
own campaign. In 1901 S.O. Goldan, M.D., called for
anesthesia “properly taught by those competent
to teach, not by any means the surgeon .... The anesthetist
will not be considered a mere satellite of the surgeon
but recognized as one of a distinct class.”4
Shortly thereafter a handful of American medical schools
appointed the first anesthesiologists to their faculties:
Thomas D. Buchanan, M.D., at Flower Medical School
in New York; Orville J. Cunningham, M.D., at the University
of Kansas; and L.W. Hardy, M.D., at the University
of Iowa.
Of the early educators, many believe that Ralph M.
Waters, M.D., had the greatest impact. Dr. Waters’
experience as a “self-taught” anesthesiologist
in a small Iowa town convinced him of the need for
formal training programs. In 1927 he had an opportunity
to develop such a program when he was placed in charge
of the anesthesia service at the new State Hospital
in Madison, Wisconsin. Dr. Waters became actively
involved in research, often in collaboration with
colleagues in basic science. He developed close ties
with other anesthesiologists such as John S. Lundy,
M.D., Paul M. Wood, M.D., and Francis H. McMechan,
M.D., who also shared his views. They formed “Travel
Clubs,” which later evolved into some of the
professional organizations that sustain us today.
Together they lobbied the Advisory Board of Medical
Specialties to develop an examining board for anesthesiology.5,6
In 1940 they won approval from the House of Delegates
of the American Medical Association to become a section
independent of surgery, thus giving anesthesiologists
the opportunity to define the qualifications of a
consultant, develop an approved curriculum of study
and training and establish a procedure to evaluate
the fitness of each candidate.
Most importantly, perhaps, Dr. Waters developed a
program that set a standard for training, public service
and professional conduct. His trainees, the “Aqualumni”
as they called themselves, dispersed all over the
world to establish their own programs modeled after
the one developed in Madison by Dr. Waters. The 75th
Anniversary of Academic Anesthesiology celebration
in Madison, Wisconsin, on June 6-8, 2002, celebrated
Dr. Waters’ many contributions to the development
of professionalism in our specialty.7
The Development of Anesthesiology as a Profession
Leroy D. Vandam, M.D., suggests that “professionalism
in any field entails study with consequent progress,
the teaching and recruitment of others, integration
with the other branches of medicine and devotion to
the kind of investigation that solves its own problems.”8
During the past 50 years, many individual anesthesiologists
contributed to this professional ideal through their
own work. It is noteworthy, however, that the profession
as a whole also made such a commitment when members
of ASA voted to form and then support its three “foundations.”
To the Anesthesia Patient Safety Foundation, the Foundation
for Anesthesia Education and Research and the Wood
Library-Museum of Anesthesiology, it assigned responsibility
for the quality of patient care, improvements in research
and education, the dissemination of information and
the preservation of the history that makes our profession
unique.
Dr. Waters and many others established the standards
and traditions that made our specialty a profession.
Our institutions preserve and transmit them. Ultimately,
however, our specialty achieves and sustains its status
as a profession through the work of individuals who
accept these values and traditions and practice them.
As Menke observes, a professional relationship exists
when the physician understands and protects the needs
of the patient and when the patient trusts and respects
the physician believing in that person’s mastery
of the technical and theoretical aspects of practice
and adherence to a high standard of personal conduct
and public service.1
In the current social and political climate, it is
important to remember and to tell others about the
core values of our profession.
| References: |
| 1. Menke WG: Professional values in medical
practice. N Engl J Med. 1969; 280:930-936. |
| 2. Wolfe RJ: Tarnished Idol: William T. G.
Morton and the Introduction of Surgical Anesthesia.
San Anselmo, California: Norman Publishing,
2001. |
| 3. Silk JFW: Anaesthetics: a necessary part
of the curriculum, a plea for more systematic
teaching. Lancet. 1892; 1:1178-1180. |
| 4. Goldan SO. Anesthetization as a specialty:
Its present and future. Am Med. July
1901. Read before the Medical Association of
the Greater City of New York, March 11, 1901.
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| 5. Bacon DR. John S. Lundy, Ralph Waters,
Paul Wood: The Founding of the American Board
of Anesthesiology. Bulletin of Anesthesia
History. 1995; 13(3):1, 4-5, 15. |
| 6. Betcher AM. Historical development of the
American Society of Anesthesiologists, Inc.
In: Volpitto PP, Vandam LD, eds. The Genesis
of Contemporary American Anesthesiology.
Springfield, Illinois: Charles C. Thomas; 1982:185-221. |
| 7. Lai DC, ed. Holding Court With the
Ghost of Gilman Terrace: Selected Writing of
Ralph Milton Waters, M.D. Park Ridge, Illinois:
Wood Library-Museum of Anesthesiology, 2002.
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| 8. Vandam LD: Early American anesthetists:
The origins of professionalism in anesthesia.
Anesthesiology. 1973; 38:264-274. |
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Donald Caton, M.D., is Professor of Anesthesiology
and Obstetrics and Gynecology, University of
Florida, Gainesville, Florida. |
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