othing strikes more fear or dread in the anesthesiologist than when a patient in the preoperative area asks a question such as: “Hey doc, I just saw a movie about awareness under anesthesia, are you going to let this happen to me?” As the readership is aware, there have been several newspaper articles, television articles and now a movie relating to the topic of awareness under general anesthesia. ASA has taken this matter quite seriously. The misfortune of this complication and the release of the movie have given ASA the opportunity to highlight all the great work that we do as anesthesiologists — the patient’s guardian in the operating room. ASA has done several things with respect to getting “our message out to our potential patients.” We are trying to address sensationalism with fact, driven by science and research.

Making Everyone Aware
For several years now, ASA has made a concerted effort to address the issue of awareness. From our practice guidelines to creation of an awareness registry to support of research to preparing a response timed to the release of the movie “Awake,” ASA has been there to help you, the clinician, improve the safety of your patients and to help allay their fears and concerns. Transmitting this information to you, our patients and the public is the responsibility of the ASA Committee on Communications (COC) and the ASA Communications Department. Working together, they have coordinated the public relations efforts of ASA.

Our efforts addressing the issue of awareness have taken place through several avenues, including press conferences at the ASA Annual Meeting, responding to regulatory agency sentinel alerts, responding to media inquiries and creation of a patient education brochure. These brochures can be placed in physicians’ offices as well as in preadmission test centers and preoperative holding areas. ASA has also held a symposium on the science of awareness under anesthesia. ASA was fortunate to have its current president, Jeffrey L. Apfelbaum, M.D., lead this discussion. The research that Dr. Apfelbaum and his cohorts brought forward demonstrated that there was no one technology of brain monitoring superior to the other and that this was still a new but exciting area of science. Again, it is the message of ASA that research and science will guide our judgment — not the profit margin of one or more brain function monitoring companies.

Wide Awake
Finally, the movie. ASA took a proactive approach that prepared us for the patient, public and media interest, and ensuing concerns anticipated with the release of “Awake.” While the movie fizzled, ASA was in a unique position to address patient and public concerns about the safety of anesthesia and what we are doing to decrease the risk of awareness. We produced public service announcements on public television in Washington D.C., as well as the Colorado market. A movie advertisement was placed in theaters in major cities and was run just before the viewing of a movie. This 20-second advertisement demonstrated the role of the anesthesiologist and stressed that if a patient has questions, he/she should contact a reliable source such as ASA’s Web site. Upon the release of the movie “Awake,” the ASA offices and our membership received many media inquiries. Our membership was well prepared to handle these inquiries because of our distribution of message points and training of members through our spokesperson training programs. At least 20 members underwent a special spokesperson training program dedicated to awareness under general anesthesia. In addition, our programs at the ASA Annual Meeting — the Leadership Spokesperson Training Program held in conjunction with our Legislative Conference, our resident’s workshop, and our regional spokesperson training programs — have all recently addressed awareness and placed us in a position to set up individual physicians in each state to become leaders and spokespersons with respect to this “hot topic.” We were able to put these state leaders in touch with their local newspaper, radio and television journalists.

Addressing Future Needs
All of this effort was expended on just one issue. Some of it was proactive, some was reactive. ASA is currently considering several consulting firms to help formulate our messages not only to the target audiences of our patients, the public, and legislative and regulatory officials, but also to our membership. This activity will help us in these and future times to supply the public with our very positive and very effective message and leave them with a long-lasting, positive image. Patient safety is at the core of our specialty. An understanding of who we are and what we do, backed by science and research, may someday minimize the efforts that our Society must expend in addressing sensationalism.

John F. Dombrowski, M.D., is Director, the Washington Pain Center, and Clinical Associate Professor, Massachusetts Avenue Surgical Center, Georgetown University, Washington, D.C.