Douglas R. Bacon, M.D., Editor

Auld Lang Syne, or New Directions: The January Dilemma

Should auld acquaintance be forgot, and never brought to mind? Should auld acquaintance be forgot, and auld lang syne?¹

his is the fiftieth time you have opened the ASA NEWSLETTER and hopefully read “From the Crow’s Nest,” and each time you have learned about my personal take on an interesting problem or issue facing anesthesiology. Many of you have written to me to comment, and the “Letters to the Editor” section has been one of the more interesting in the publication. Unfortunately for you, the readers, I cannot publish all the letters I receive. There are reasons for this, mostly because some letters broach issues that would put ASA at legal risk. Being the NEWSLETTER editor has been a learning process for me; an education gratefully received. Perhaps the best part of this job personally has been that I have met so many committee chairs and members, if not personally, then electronically through articles, letters and ideas for future NEWSLETTER issues.

January is often a time for reflection. For some, that comes upon waking on January 1 and a New Year’s resolution to avoid ETOH for the rest of their lives. This January issue is largely retrospective, looking back at our Annual Meeting in San Francisco. In reflecting on the NEWSLETTER over the past year, our new format and full-color publication has transformed the periodical in appearance. Content remains excellent, a credit to the authors, derived from the membership, who take the time to write and rewrite information that the membership needs to hear. Our Washington office generally, and Ronald Szabat specifically, contributes both articles and advice that strengthen our NEWSLETTER.

2007 will be remembered as a year of challenges for ASA. Gina A. Steiner, the Director of Communications, resigned last May. Gina was responsible for supervision of the Park Ridge staff that transforms the various articles into a cohesive publication. In September, Dawn M. Glossa was hired to fill Gina’s position. Thus, 2008 will be her first year directing the NEWSLETTER staff. One major change, almost unrealized by most members, has already taken place. Deadline for publication is always the first of the month before the issue is actually in the hands of ASA members. Thus, December 1 is the deadline for January. Several small procedural changes have been made in an effort to be timelier, and it is our intent to have the NEWSLETTER in your hands well before the end of the month.

ASA has undergone some major transitions in 2007. The director of communications change aside, the entire organization is being refurbished. No longer is there one overall executive, but rather two executive vice presidents, one at headquarters in Park Ridge, Illinois, and another in our Washington, D.C. nerve center. With clearly delineated responsibilities, the ability to interact with each other, and with the overall supervision of the ASA president, our Society will only get stronger. In this change, though, two long-term ASA executives have departed, Ronald A. Bruns and Denise M. Jones. As dear friends to many of us, they are “old acquaintances” who will not be forgotten.

Politically, some old friends remain. The teaching rule has, of the writing of this editorial, not been overturned by Congress. Do not view this as a failure of ASA leadership or our Washington office. Rather, in the Byzantine world of national politics, we have made significant inroads and many friends. Unfortunately it will take time and continued effort to change this rule. However, the Centers for Medicare & Medicaid Services did greatly increase Medicare reimbursement for services. While nowhere near approaching the value our services are worth on the open market, it is a major first step and indicates the effectiveness of our lobbying efforts in Washington.

Another longstanding New Year’s tradition is to look forward to making resolutions to improve oneself. So what are, or ought to be, the New Year’s resolutions for anesthesiology?

First and foremost, we need to rededicate ourselves to our patients. This means we have to make a serious commitment to being the best possible anesthesiologist we can be every day for every patient. A part of this effort has to be dedicated to continuing medical education (CME). We need to be aware of the latest and greatest innovations in our practice and cautiously apply them. It is, in the end, the responsibility of every physician to be the best possible healer. Education is a part of that, as is compassion. Let us not forget this as we speak with our patients and further resolve to spend whatever time we have with them, leaving them feeling that they are the most important people in our world.

As ASA members, we should resolve that we will welcome and work with new Executive Vice President of the ASA Park Ridge Executive office John A. Thorner, J.D., CAE, who will begin work this month on January 7. Clearly, 2008 will be a time of transition in the executive leadership of the Society, yet by working together transparently, we can make ASA better than it has ever been. We need to continue our efforts to make this the best specialty society in the world — responsive to the diverse needs of the membership but focused on what is best for the patient. We need to somehow remain free from the temptation to do what is best for ourselves in the short run and look toward the future with the patient’s best interest in mind.

As individuals, every ASA member needs to resolve to bring as many nonmember anesthesiologists as possible back to the Society. How can this be done? Attractive, cutting-edge CME can advertise the state societies and hence bring members to both organizations. Member benefits, too numerous to elucidate here but clearly spelled out on the ASA Web site, ought to be inducements to join. In the end, it is the ability of the Society to speak as the representative of our specialty, strengthened by numbers, that is important in being able to shape our own destiny.

Further, as ASA members, we need to resolve to support, with both time and money, our efforts in Washington. If the teaching rule will ever be changed, it will only come after increased lobbying and education of our legislators. This is a time-consuming process that may not show results for years, but it is an effort well worth pursuing. ASAPAC, the only national group dedicated specifically to anesthesiology issues, is our ally.  Anesthesiologists in Alabama have consistently understood the importance of having such an organization weighing in on political issues.  All anesthesiologists can learn from their experience.  As anesthesiologists, our personal political involvement, which means participating in shaping governmental policy on many levels, may be our weakest link.  It is time to resolve that each anesthesiologist will be more politically active in 2008.

A final resolution needs to be made by all anesthesiologists to support research. Each physician needs to report his/her interesting cases. It is through these dilemmas and their resolutions that we learn about rare cases and hopefully a successful way to manage the anesthetic. Oftentimes case reports beget more questions than they answer and thus lead to clinical trials. Finally, bench-top research can lead to innovative technologies, techniques and agents that will allow us to anesthetize our patients better. Quite simply, it is in our own best interest to take an active interest in the scientific and clinical development of the specialty. For many of us, it means writing, developing protocols and doing research. For others, it means investigating interesting questions on a molecular level. For others still, it means donating time and doing extra cases to allow a colleague to leave the operating room or clinical site to “do” research. And for others, it is a gift of cash that helps fund the ongoing drive to understand anesthetics and make our clinical practice both safer and better.

A few weeks ago, my son was performing an exercise in music reading during his violin lesson. The line in the book did not mean anything to me, as I lack the gift to see the written note and hear its sound. Yet, suddenly, “Auld Lang Syne” was recognizable as Tom played. Memory of the moment has helped me to create this editorial and to resolve to be the best possible editor I can be. It has also helped me remember my personal New Year’s resolution — to be the best possible anesthesiologist I can be, day in and day out, to each and every patient. Finally, as a single father, my resolution to my sons is to be the best possible parent I can be. These are not unique resolutions, yet they are the keys to our success as a Society, as physicians and as people. As the year progresses, let us remember our resolutions and act upon them.

— D.R.B.

Reference:
1. en.wikipedia.org/wiki/Auld_Lang_Syne accessed December 6, 2007.

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