New Chemical Dependency Intervention Resource Available

The excellent article on drug testing¹ by Michael Scott, J.D., in the April 2005 NEWSLETTER provides a useful legal context in which to highlight a recently completed work product of the ASA Committee on Occupational Health. This document, “Model Department Policy for Drug and Alcohol Testing as Part of a Comprehensive Intervention for Suspected Substance Abuse in Anesthesia Professionals,” provides a template for departments that choose to develop a program of drug screening for cause.

Mr. Scott describes the legal background in which this model policy must be considered. Several points deserve special emphasis as they pertain to this committee work product. This is a template for a policy intended only for suspicion-based testing. It is not intended for random drug screening. If a policy based on this model is adopted by a department, it should serve only as one component of a comprehensive plan to combat chemical dependency, including a focused educational program.
Most importantly, I wish to re-emphasize that this is a model policy. It is intended to serve as a resource that must be customized for any specific department’s use. It is not intended to imply ASA policy for or against such testing.

The Model Department Policy for Drug and Alcohol Testing as Part of a Comprehensive Intervention for Suspected Substance Abuse in Anesthesia Professionals” is available on the ASA Web site at <www.ASAhq.org/clinical/DrugPolFinal6_29_05.pdf>.

Jonathan D. Katz, M.D., Chair
ASA Committee on Occupational Health
Hamden, Connecticut

Reference:
1. Scott M. Legal aspects of drug testing. ASA Newsl. 2005; 69(4)25-28.

Implantable Device Training Only Scratches Surface

In response to the question of how much “exposure” pain medicine trainees should have to implantable devices before providing that service, the answer is clear.¹ In our opinion, a clearly defined period of formal surgical training should be requisite for the performance of such surgeries.

Despite the assertion by Timothy R. Lubenow, M.D., in the August 2005 NEWSLETTER, there are no “minor” surgical skills involved when foreign bodies are implanted in the neuraxis. Meticulous sterile technique as well as speed in completing the surgery is imperative. “Exposure” along with a certificate from a company-sponsored weekend course is no substitute for formal training in surgical technique. The result of the current system is that the most inexperienced and least qualified “surgeons” are performing potentially hazardous operations. The rank-and-file anesthesiology/pain medicine faculty member is neither sufficiently trained to independently perform these surgeries nor competent to direct trainees to do so. Moreover, surgical training would be quite ambitious within the confines of the one-year fellowship program.

We would suggest that proper training could be accomplished by extension of the fellowship duration to ensure sufficient training in surgical skill and technique.

Dan C. Martin, M.D.
Ines H. Berger, M.D.
Augusta, Georgia

Reference:
1. Lubenow TR, Rathmell JP. Let’s take a rational approach to technical training in pain medicine. ASA Newsl. 2005; 69(8):6-8.

Article ‘Incompleat’ Because of Editorial Change

It was with quite a degree of dismay that I discovered your uncharacteristic correction of my spelling of the title of my August submission to the NEWSLETTER, “The Compleat Pain Physician” (which was printed as “The Complete Pain Physician). The archaic “Compleat” was an intended reference to the third most published book in English literature. The Compleat Angler (1653) was written by Izaac Walton and lucidly and sweetly describes the luminous world of delicious fish, 20 inches long, caught in clear, sweet streams. As a fisherman and historian, I had hoped you would appreciate the literary allusion and the more comprehensive connotation of a special quality of gentleness of soul found in a compleat pain physician, as characterized by John J. Bonica, M.D.

Doris K. Cope, M.D.
Pittsburgh, Pennsylvania

Disclaimer Needed: Robot Intubations and No Anesthesiologists Are ‘Whopper’ Speculations

The future fascinates anesthesiologists. Just look at the numerous talks and articles that begin with “Future Trends in …” We make predictions, often wrong, but enjoy them. Last year W. Bosseau Murray, M.B., Ph.D., predicted “robotic technology will be used … to identify and cannulate the tracheas of the few patients who would need an endotracheal tube.”¹ In the recent commemorative issue of the NEWSLETTER, Ronald D. Miller, M.D., and Alexander A. Hannenberg, M.D., wrote, “Robots … could doubtless manage endotracheal intubation if asked.”²

We readily recognize these predictions as whoppers, but regulatory, political and socioeconomic speculations in the NEWSLETTER are not so obvious and should come with disclaimers. Some readers might accept such speculations as approved or foregone conclusions. These include that appropriate administration of propofol does not require anesthesia specialists and that anesthesiologists might be unnecessary by 2030.²

Predictions with apparent imprimatur of the Society can hurt. Remember the futurists of the 1990s who foresaw dramatic decreases in surgical operations, too many anesthesiologists and an oversupply crisis?³ After the Society published these predictions (the Abt Report), medical school deans talked students out of entering anesthesiology, and some competent practitioners left the specialty. The predictions were wrong. The crisis became more surgery and not enough anesthesiologists. A decade later, Alan W. Grogono, M.D., wrote, “We find it surprising that Abt reached the conclusions that it did, (and) it is completely incomprehensible that the specialty took it so seriously.”³

Envisioning possibilities, strategic thinking, public discourse and active engagement seem wise. But we need to be careful. Predicting the future is difficult, and we are not very good at it. Past futurists also predicted electroshock, intravenous alcohol and rectal ether for anesthesia. Hopefully we will maintain some skepticism about predictions, especially political, and hopefully robots won’t read old literature before placing tubes into anesthesia patients.

Robert E. Johnstone, M.D.
Morgantown, West Virginia


References:
1. Murray WB. The future of anesthesia delivery: From art-based science to science-based art. ASA Newsl. 2004; 68:(10)7-8.
2. Miller RD, Hannenberg AA. Anesthesiology’s choices for the next century. ASA Newsl. 2005; (commemorative):36-37.
3. Grogono AW. The Abt Report: What was it, and what happened? ASA Newsl. 2004; 68(9):20-21.