“You’re going into anesthesia? Well, I guess you’re going to have to forget everything you’ve learned.” This is a remark I received recently from an attending physician when he asked what my plans were for upcoming residency applications. Not two weeks later, at the ANESTHESIOLOGY™2013 annual meeting in San Francisco, past ASA president Mark Warner, M.D. addressed the ASA Medical Student Component and shared his opinion that anesthesiology is the only specialty in medicine where one gets to routinely utilize everything learned in medical training.
Why are there such disparate views on anesthesiology? Perhaps part of the answer lay in a speech given in 1950 by renowned anesthesiologist Emanuel M. Papper, M.D.:
“Almost every physician, regardless of the type of medicine he practices, secretly believes that he has at least two other skills. He knows that he can deliver a baby and that he can administer anesthesia ... It appears evident, even on superficial consideration, that many physicians are totally unaware of the kind of knowledge that the anesthesiologist has at his command ...” 1
Evidently, this dichotomous view of anesthesiology has been around for years, and the advances in medicine and anesthesia since 1950 are astounding. The “kind of knowledge that the anesthesiologist has at his command” has simply grown exponentially.
The conflicting paradigm surrounding anesthesia affects and influences medical students, and, sadly, the early impressions instilled in our malleable minds often set the tone for our outlook on anesthesia as a specialty. A few common “anti-anesthesiologyisms” I have encountered include the aforementioned – the idea that anesthesiologists do not interact with patients and that the work is boring. Not surprisingly, these observations almost universally come from non-anesthesiologists.
For me, the decision to be a physician anesthesiologist was relatively easy. I am what you call a “non-traditional” medical student.
I planned on going to law school and therefore studied the humanities as an undergraduate, then (thankfully) decided a future in law was not for me. Eventually, I decided to go to medical school. There were two driving factors that pushed me toward medical school: 1) the intellectual challenge of medicine and 2) the undeniable human significance of medicine. These two factors have continued to drive me throughout my medical education and have factored enormously into my decision to be an anesthesiologist.
Examining first the human significance of anesthesia, I have heard a number of times that “you’re too personable to be an anesthesiologist.” I unequivocally disagree! What specialty affords you the opportunity to guide a person through one of the most stressful and frightening experiences of his or her life and provides you minimal time to establish rapport and gain the confidence of that patient? I would argue that anesthesiologists ought and need to be among the most compassionate and personable physicians. Recently, my sister-in-law was in labor with twins. When the anesthesiologist completed her epidural, she exclaimed, “You’re an angel!” Several weeks later, I was on a rotation and observed an anesthesiologist assuage the concerns of two young parents before carrying their young son to the O.R. where he conducted a safe and flawless anesthetic plan, and then returned the boy safely to his parents. Clearly, those physician anesthesiologists made a difference in their patients’ lives.
Intellectually, anesthesia was harder for me to gauge. Most anesthesiologists appear calm and almost nonchalant as they work. I have been fortunate to work with some outstanding mentors who challenged me and helped me realize the importance of a sound medical knowledge and the idea of vigilance. Slowly, my eyes were opened to the myriad factors an anesthesiologist must constantly assess and control. Yes, while the competent anesthesiologist may look relaxed and nonchalant, inwardly he or she is mentally analyzing, assessing and anticipating constantly. He or she must draw on a solid mastery of physiology, pharmacology, pathology, technology, and biochemistry to adapt and adjust for every individual patient. After spending time actually participating in anesthesia and not merely observing, it became apparent that anesthesiology is extremely intellectually engaging.
During third-year rotations, I kept an open mind; but the more I experienced other specialties, the more I realized how much anesthesia had to offer. In anesthesia we get to see the results of our work immediately. If something needs to be done, we typically do it ourselves rather than write an order for someone else. The skill set and technical abilities of anesthesiologists are generally unmatched in a hospital. When there are troubles with airways, I.V. access or code situations, an anesthesiologist is often called in. With the outstanding training anesthesiologists receive, we are comfortable employing some of the most dangerous drugs available and do so with near artistic abilities.
Finally, as a current medical student, awareness of the larger economic and political issues surrounding medicine is important and knowing that ASA is working to defend patient safety and the role of physician anesthesiologists is immensely reassuring. The larger issues and political conversations occurring right now will affect my future patients and my future career as an anesthesiologist. Having ASA in the political trenches helps me as I prepare for a future as a physician anesthesiologist.
In this current climate of uncertainty with health care reform, scope-of-practice concerns and compensation changes, medicine is still an outstanding profession; and in my mind, anesthesiology is the best in medicine. Few careers afford the opportunity to constantly remain engaged and challenged intellectually while working in an arena that significantly and deeply affects people’s lives. Anesthesiologists have been leaders and pioneers in medicine, and while upcoming changes are a foregone conclusion for all specialties, the future of anesthesia is bright. I am confident that we will continue to play a vital and significant role in the greater house of medicine. Above all, I am confident that I will never regret the decision to be an anesthesiologist.
1. Papper EM. Some contributions of anesthesiology to the general practice of medicine. N Engl J Med. 1950;243(19):734-737.