Douglas R. Bacon, M.D., Editor

The Power of One

inner had been wonderful, and as forks went into the dessert, the “business session” for the evening began. The president of one organization rose and thanked the program committee for its hard work. The director of the other meeting sponsor made very similar comments. Interestingly both commented that this unique meeting — the “first” combined Society for Obstetrical Anesthesia and Perinatology and Obstetric Anaesthetists’ Association meeting — was the idea and effort of one anesthesiologist, Gurinder Vasdev, M.B.B.S. After a strong round of applause, the evening’s entertainment, Irish step dancers and three Irish tenors, made the evening perfect.

Beyond the social context of the night, the meeting was interesting. Universal themes and problems confronting obstetrical anesthesiologists were discussed. The Europeans described their experience with drugs that have yet to clear the Food and Drug Administration yet show great promise. The Americans ran a high-risk obstetrical anesthesia workshop. Both groups spoke eloquently about the many concerns of anesthetizing mother and bringing baby safely into the world. Experiences on both sides of the “pond” were shared and, not surprisingly, were found to be similar. Of even greater interest was the number of obstetricians who were present to give their side of the “ether screen.”

Yet what continued to impress me, besides the wonderful setting across from the library that housed the Book of Kells, was how similar anesthesiology was across the Atlantic, and how anesthesiologists shared the same values and professionalism. My son Andrew, at 17, was intrigued by the discussions and came away from the meeting even more determined to become a physician. The meeting was, in the end, the very best of what we are supposed to be as anesthesiologists.

Years ago, at the end of my first year as an attending, Nicholas M. Greene, M.D., Professor of Anesthesiology at Yale, was our visiting professor for the department’s “Dr. Terry’s Teaching Day” and resident graduation. In the morning, at Dr. Terry’s Teaching Day, the graduating residents presented the results of their research projects and then were asked questions by the visiting professor and audience in turn. That evening Dr. Greene spoke as the central part of the graduation ceremony. His talk has remained with me over the years, for it was the first time I had heard about ASA’s efforts in Africa and the Overseas Teaching Program (OTP). It was an eloquent talk, illustrated with the natural beauty of Africa.

There was, however, a stark contrast to the presentation as well. The hospital in which the teaching program was housed could not have been further from the experience of the anesthesiologists listening to Dr. Greene. Most of us had never used the “standard” equipment he described, and for those who had used it, the machines were a distant memory. We were told that textbooks were in short supply, even those considered “out of date” by American standards. I feared volunteering, not just because of the young family I had at the time, but because I would be useless trying to teach with equipment I could not make function. Universal to the discourse was the enthusiasm of the learners, which mirrored the residents in the room and the young attending staff. Yet Dr. Greene’s efforts in Africa showed the power of one individual willing to take the time and make the sacrifices to bring professionalism in anesthesiology to the world.
In the decade and a half since Dr. Greene’s visit to Buffalo, New York, the OTP has blossomed with other organizations working in underserved areas to increase the professionalism of anesthesia. Common to these efforts is the power of one — the need for an individual to step up and be counted, to be willing to make the sacrifices necessary to improve the specialty. Overseas teaching programs may be the greatest example; yet today, even here in the United States, the need is great.

Wait a minute: American anesthesiology, almost by definition the most advanced and technologically sophisticated practice in the world, needs help?

For years it has been argued that rural Americans have less access to health care than do their urban contemporaries. The nurse anesthetists have long argued that only they provide such services, yet what has not been told is the subsidy they receive to support a salary competitive with urban nurse anesthetists. Anesthesiologists, on the other hand, as physicians, have no such “help” available. Legislative initatives to remedy this situation are under consideration in Congress, but it will take individuals writing their elected representatives to change this onerous rule.

Previous editorials have dealt with the myriad other issues most deserving of our communication with Congress. These concerns remain at the forefront of our legislative efforts, yet there is a more basic need that should be filled. We are a specialty whose reputation is made and re-made daily. In other words, we are only as good as our last anesthetic. Every day as we approach the operating room, the critical care unit or the pain clinic, we, as anesthesiologists, are judged upon the care we give. How we comport ourselves and what we say and do are critically important to our personal reputation and also the reputation of the specialty. It is paramount that we use the power of one consistently and constructively — but what is the best way so to do?

Years ago, previous ASA NEWSLETTER editor and current ASA President Mark J. Lema, M.D., Ph.D., wrote about appearance as one enters the hospital and how that reflects upon the individual and the specialty. While there has been much correspondence, and ASA members have been vocal on this issue, it is a starting point for the power of one. If wearing a sport coat and tie for the gentlemen and business attire for the ladies delineates the individual as a physician (and anesthesiologist), is the minor inconvenience worth it to the long-term respect of the profession?

Clothes aside, there are other ways that the respect of the specialty and the anesthesiologist specifically can be enhanced, yet they are completely dependent on individual effort. Being a member of the operating room committee is very often a thankless job. There is tremendous pressure to do as many cases as efficiently as possible. Scrutinized items, such as turnover time, are often blamed on the anesthesia team yet may not be within our control. Who better than an anesthesiologist to help unravel the problem and work toward a solution that benefits all the players in the organization? What group other than ourselves works with all groups of surgeons, nurses and administrators throughout the hospital?

The participation of anesthesiologists in medical school committees is another venue for the power of one. The admissions committee, for example, would greatly benefit from the unique perspective of our specialty. Teaching physiology and pharmacology is important not just because it allows medical students to see practicing physicians who have mastered and use basic science, but also as an introduction to our specialty. One of my most enjoyable teaching experiences was as a mentor to a problem-based learning discussion group of first-year medical students. I team-taught with our chief of cardiac surgery — there were many laughs and some good-natured teasing and fun along the way. Yet each one of these students had the opportunity to meet what they hoped to become —practicing physicians — while still mired in the rote learning of the basic sciences.

Our county medical societies, as well as the state societies and all of organized medicine, benefit from our participation. Ranging from as simple a task as taking blood pressures at the county fair to being a member of a committee to being elected to leadership positions, anesthesiologists need to be part of the house of medicine. And let’s not forget our communities — anesthesiologists bring unique talents to the teaching of cardiopulmonary resuscitation. Volunteering to be a physician for a child’s team can be rewarding while getting the message across to a new generation about anesthesiology.

Anesthesiology needs each anesthesiologist to demonstrate the power of one daily. Actions may not be as visible as organizing a meeting that brings together professionals from various parts of the world — but that is not the critical point. Without each and every one of us stepping forward to enhance the specialty that has given us so much, we diminish our professional lives in countless ways. Improving anesthesiology, even on the most basic terms, is the responsibility of every specialist and is a large measure of professionalism. Will you demonstrate the power of one to help the medical specialty of anesthesiology? We need and welcome you!

— D.R.B.

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