Douglas R. Bacon, M.D., Editor

Why Bother?

t the recent Spring Meeting of the Minnesota Society of Anesthesiologists (MSA), a speaker approached the podium and began. The talk was centered on cerebral autoregulation, and the speaker’s argument that perhaps the agreed-upon lower limit for mean arterial pressure was, in fact, too low. The evidence presented was anecdotal, as the speaker freely admitted at the beginning of the lecture. In fact it was culled from his experience as an unsolicited reviewer of malpractice cases. While the theme that tied the cases together was neurologic impairment, there was no one specific type of injury that made up the majority of cases. It was this wide variety of experience that made the argument so compelling. Without a numerator or a denominator, the lecturer liberally acknowledged that these ideas could not be considered classic evidence-based medicine — yet, in my opinion, they formed another type of evidence-based medicine at the junction of the science and art of anesthesiology.

What the speaker conveyed, to me at least, was that our “classic” understanding of cerebral autoregulation, based heavily on work in animals, failed to explain why there was neurologic injury to these patients. It appeared from the anesthesia records, blinded to patient name and to those who provided the anesthesia service, that the standard of care had been met. All the cases presented had mean arterial pressures within the range that should have ensured that the brain was perfused. The end result of hearing about these cases was a more aggressive approach to those patients in the operating room who tend to “sag,” supporting their blood pressure in the hopes that a negative neurologic outcome would be avoided.

Learning aside, why discuss this lecture that so impressed me?

One of the last issues the MSA Executive Committee discussed, just before the scientific meeting commenced, was how we could reach every anesthesiologist in Minnesota and have him or her join the society. In many like discussions in which I have participated, the question always boils down to value. What does a member receive in return for his/her dues? If anesthesiologists feel that the society does not give them value, they will cease to be members. What should the members expect as a return on their membership?

The first thought that struck me as the lecture began was that this was continuing medical education (CME) which simply could not be obtained any other way. Attendance at the MSA Spring Meeting was free to members, a savings of several hundred dollars. While there are many venues to meet the demands of continuing professional education, very few would have the creativity of the neuroanesthesia talk. Walking the line between art and science, as our lecturer did, we received something more than the take-home message of a proposed new lower limit on mean arterial pressure over which cerebral autoregulation functions. We were being challenged as physicians to look at the paradigms under which we practice and to assess if they needed change. To be confronted in this manner was an even greater benefit than can be imagined.

Besides stressing our spring and fall educational meetings, the state society was looking at upgrading our Web site. As a means of communication in a “smaller” component society, the Web, and electronic mail, holds the promise of almost instantaneous communication with minimal cost. There are many new and interesting possibilities that electronic media offer, and they are limited only by our imagination, interest and the commitment to make sure they occur. Our upgraded Web site will add more value to being a member of the state society.

Finally there are our political responsibilities. The society’s interest in the issues before the legislature mimics the interest of the membership. There is often considerable publicity about issues thought to be of critical importance and opportunities to support the society’s legislative efforts to help advance our issues to a favorable outcome. Some members blanch at politics and feel, somehow, that medicine ought to be above such dealings. Yet if the state society does not look out for the interests of its members, just as each citizen is urged to take interest in issues that matter to the individual, then the group has failed in its mission to promote the art and science of anesthesiology.

OK — so three cheers for Minnesota, but what’s the point?

Everything that describes the MSA is also true of ASA, except on a larger scale. Think about the ASA Annual Meeting for a moment. New research into the basic concepts that underpin our specialty are reported in multiple venues. Some of the most interesting places to see this research are at the poster and the poster-discussion sessions. The panels and lectures are chosen, however, to allow for cutting-edge thought to be presented. Think of the Emery A. Rovenstine Memorial lectures over the past several years — no matter whether you liked them or believed their message, each lecturer presented ideas on the forefront of our specialty.

ASA gives its members more value than simply the CME of the Annual Meeting. One illustrative project is the ASA Closed Claims Project database, which has hinted at answers to many questions about the safe practice of the specialty. Think for a moment about the issues raised and answered suggested by the articles that have come out of the database. More importantly the database can be queried to answer questions that arise in research. As part of a paper on the history of how succinylcholine became contraindicated in open-globe surgery, I once asked if there had been a settlement for loss of eye contents when the drug was used to secure the airway. Interestingly the answer was that no such case had been recorded. While it did not definitively prove the point, it was comforting to know that no case had yet been reported on this issue in the history of the project.

The ASA Headquarters Office in Park Ridge, Illinois, is a living monument to our specialty. Sections are devoted to publicity, both to getting a favorable impression out to the world and answering the press’ and public’s questions about anesthesiology. Correcting impressions and providing accurate information only help to build the specialty in the eyes of the world. The Wood Library-Museum of Anesthesiology, an integral part of the headquarters, tells the story of anesthesiology’s past through the various displays in its gallery. The library provides free reference service on current anesthesiology practice, an aid to those in practice without a hospital library or librarian to rely upon. Subspecialty societies work with ASA to ensure that the message about their particular part of anesthesiology is heard and concerns are answered.

Finally there is the Washington Office. Here the activity centers around issues of politics important to every anesthesiologist. The gravity of the issues often lead to more publicity for politics than for science, and the Washington Office works hard to be sure that the specialty is part of the discussion in areas of import to anesthesiology. Occasionally the effort proves difficult, such as changing the Medicare anesthesiology teaching rule, but it does not mean that the effort is not being expended. Another function the Washington Office covers concerns important state issues that have national impact, thus working to help all anesthesiologists understand the political battles being waged and to understand what issues to look out for in their state.

Why bother to be a member of ASA and the appropriate component society?

These organizations, right or wrong, are the best advocates for anesthesiology, for both the science and the art, that exist. All are dedicated to making the specialty better. All depend heavily on volunteers to make it happen. Why get up at 5 a.m. to make the executive committee meeting of the component society? Because, dear readers, it is important to our profession and to ourselves. The knowledge and experience we gain through CME, political advocacy and the lessons we learn when we share our complications serves only to help the most important member of the operating room team — the patient.

If you are reading this editorial, I can only assume that you are a member of ASA, and as such, I am preaching to the choir. Now is the time to take your voice out and have it heard outside our organization. Please help to recruit every possible anesthesiologist, anesthesiologist assistant and any other appropriate professionals to join ASA. It is through our united strength that we can make anesthesiology even better. We cannot succeed as an army of one.

If you are reading this editorial as a non-ASA member anesthesiologist, then you are directly benefitting from someone else’s dues and indirectly from the work of ASA and the various component societies. It is time you came home.


For membership information, visit the ASA Web site at <www.ASAhq.org> and click on “Join ASA!”

— D.R.B.

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