Historical perspective is an important element to any organization as it serves as a reminder and a validation of why such an entity, in this case the specialty of anesthesiology, justifiably enjoys such an important role in our lives. The relief of pain is the cornerstone of our profession, and our ability to ameliorate situations in which pain would otherwise prevail is fundamental to what we do.

For anesthesiologists the celebration of this legacy traditionally takes place on Doctors Day, which occurs this year on Tuesday, March 30. This date was originally designated by the women’s auxiliary of the Barrow County Medical Society of Georgia in order to recognize that singular event when Crawford W. Long, M.D., became the first person to successfully administer a surgical anesthetic with his use of ether for a patient named James Venable in Jefferson, Georgia, on March 30, 1842. Subsequently the first public demonstration of the use of ether as an anesthetic was boldly conducted by a 27-year old dentist named William T. G. Morton on October 16, 1846, after which the distinguished Harvard surgeon, John Collins Warren, M.D., proclaimed: “Gentlemen, this is no humbug!”

In fact these mid-19th century developments are unusual in our history because the first successful administration of ether anesthesia was an American discovery rather than one that had originated in England, Germany, Austria or elsewhere. Following Morton’s demonstration, the means and knowledge of administering ether and, later, other inhalation agents such as chloroform, spread quickly to Western Europe and to other parts of the world, revolutionizing the surgical treatment of diseases and trauma.

In 1958 Congress designated March 30 as Doctors Day to recognize the contributions and commitments of all American physicians. Most doctors are well aware of the increased efforts by hospitals and local governments to acknowledge Doctors Day with celebratory lunches, informational exhibits and public proclamations. ASA, however, still uses this occasion to highlight the contributions and the diverse aspects that are unique to the specialty of anesthesiology. As part of this annual celebration and observance, ASA urges its members to use this occasion to educate patients, the media, physician colleagues, other health care workers and the public at large about the broad and varied role that anesthesiologists play in modern health care delivery. At the beginning of each year, a Doctors Day poster is sent to all ASA members for display in their hospitals, offices, patient waiting areas or other suitable locations.

Additionally, press releases and informational packets are prepared and, for the last four years, a video news release (VNR) on a relevant health-related subject has been produced for targeted news audiences across the United States. Under the inspiration of ASA Director of Communications Philip S. Weintraub, last year’s VNR focused on obstructive sleep apnea syndrome. This two-and-one-half minute public service message was seen by millions of television viewers and heard on radio by millions more. Last fall ASA sponsored the viewing of this VNR within the video presentations shown on United Airlines flights during the entire month of October.

Critical Care Theme
For 2004 the ASA Committee on Communications has chosen critical care medicine as its theme for Doctors Day. For nearly 50 years, anesthesiologists have been instrumental in adapting the hemodynamic and respiratory principles of life support used regularly in the surgical environment to nonsurgical or critical care settings. No doubt the development and evolution of physiologic monitoring systems have enhanced the many advances in critical care medicine. The fundamental skills of the fully trained anesthesiologist, who regularly provides intensive life support for the surgical patient, are the key factors that have allowed such specialists to be leaders in the critical care arena.

Although airway management, adequate oxygenation and ventilation are the most identifiable links to anesthesia care, a regular part of the anesthesiologist’s armamentarium also includes cardiac support, fluid resuscitation and electrolyte management, thus projecting the anesthesiologist as a natural player in the critical care setting. Since 1986 two months of training in critical care have been required for all anesthesiology residents in their four years of postgraduate clinical experience. There are 50 anesthesiology programs in the United States that offer fellowship training for an additional one or more years. The American Board of Anesthesiology (ABA) provides a Certificate of Special Qualifications in Critical Care Medicine for those fellows who successfully pass the examination process. Realizing that anesthesiologists need to play an even more active role in the management of critically ill patients, however, it is expected that the Residency Review Committee for Anesthesiology will soon require a minimum of six months’ experience in critical care during the four-year curriculum in anesthesiology.

The Future
While history is useful in validating our legacy, our true legacy has been the ability to look into the future and to anticipate and implement the changes that can improve health care delivery. For several years, Ronald D. Miller, M.D., the distinguished Chair of the Department of Anesthesiology at the University of California-San Francisco, has posed the question of what our specialty will look like 20 years from now. His queries have not received the in-depth analysis and response called for by the question. It is poignant that, in our reflection on the historical importance of Doctors Day to anesthesiologists, we should equally focus our energies on planning for the future of anesthesiology. I anticipate that our role in patient care will expand greatly beyond the surgical theater. The concept of the “perioperative physician” has been suggested by many and has been adopted successfully by some, with much of that concept in a consultative role. As we look to the future, it is realistic to anticipate that anesthesiologists will assume more complete responsibility for patient care in the hospital setting, especially in the intensive care units (ICUs). Solidifying our role in critical care is an important element of that concept.

Contributions
In this issue, members of the ASA Committee on Critical Care Medicine and Trauma Medicine, chaired by Gerald A. Maccioli, M.D., and members of the American Society of Critical Care Anesthesiologists (ASCCA), under the leadership of President Clifford S. Deutschman, M.D., have contributed a plethora of stimulating and informative articles on the role of anesthesiologists in critical care. It is no secret that the practice of anesthesiology is changing. While many practitioners today find it difficult to escape the confines of the operating room and/or lack the monetary incentives to maintain a presence in their ICUs, the increased presence of anesthesiologists in critical care units is expected.

As we approach Doctors Day, anesthesiologists should not be content with their historical roots. The ability to recognize and define changes will ensure our role and our legacy in the years to come — it is time to return to the future!

R. Lawrence Sullivan, Jr., M.D., is staff anesthesiologist at O’Connor Hospital, San Jose, California.