Administrative Update: When Seconds Count – A Call to Communicate

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February 1, 2014 Volume 78, Number 2
Administrative Update: When Seconds Count – A Call to Communicate J.P. Abenstein, M.S.E.E., M.D.
ASA President-Elect

When I was in Washington, D.C. for the ASA Legislative Conference last spring, I found myself in Sen. Al Franken’s office talking to his legislative aid, who was a physician. We had a long conversation, ranging from anesthesiology to health care reform. I felt it was going well, that he understood the concerns of physician anesthesiologists, and I thought maybe we could gain assistance from Sen. Franken’s office. As the conversation wound down, my physician colleague asked, “J.P., I understand your issues, but what do the doctors think?” He wasn’t suggesting we weren’t physicians; he wanted to know the AMA’s position on our issues. It was crystal clear that our issues have to become medicine’s issues.

As we roll out ASA’s educational endeavor “When Seconds Count … Physician Anesthesiologists Save Lives™” (, I’m reminded of this conversation. Our educational endeavor is built on a foundation of extensive research that identified gaps in knowledge regarding anesthesiology among thought leaders and the public. Many people, even policymakers in Washington and state capitals, don’t know what we do and too many don’t know we’re physicians. This educational project is intended to bridge this gap. We need to improve our ability to communicate our message with our medical colleagues, hospital executives, regulators, politicians and the public.

On still another trip to D.C., this time for the 2013 AMA Interim Meeting, the failure to communicate was stark. Physician anesthesiologists have been making headway, at times swimming against the tide, improving AMA’s position on a number of issues important to anesthesiology. For example, in June, ASA’s AMA delegation was able to substantially improve a resolution directing AMA to work to amend the Affordable Care Act (e.g., eliminating the Independent Payment Advisory Board and “nondiscrimi-nation” language). Despite this progress, I found myself talking to a primary care physician from Minneapolis about the aggressive independent practice bills that have been introduced by advanced practice nurses throughout the country. To my shock, he refused to believe me. He believed that nurse practitioners understood they are not trained to work independently and would never ask for this change in their scope of practice. Nothing I said could change his opinion on the topic, and in his view, I simply must not understand the legislation. We have failed to educate some of our colleagues on the importance of physician-led health care teams or the threats to their existence.

On this same trip, I had the opportunity to speak at the Republican Lieutenant Governors Association meeting – I was given six minutes. The ASA staff was incredibly helpful in getting my half-hour speech down to the allotted time and improving its content. As expected, I talked about ASA, our 50,000-plus members, what physician anesthesiologists do, and examples of how our members improve the quality of care and decrease health care costs. However, what had traction was talking about a near-miss in the O.R. Briefly, my team and I were caring for a 147-kg patient for a thoracoabdominal aneurysm. We needed to place a double lumen tube, which proved unsuccessful, and we lost the airway. I was finally able to place a single lumen tube, with his oxygen saturation plunging, and then exchange it with a double lumen tube. From our perspective, this is what we do every day, and while stressful, it’s just part of the job. For the policymakers and their aids, this was by far the most important part of my brief talk – our impact on the lives of their constituents.

Physician anesthesiologists are more comfortable talking about the scientific data, methodology and sound conclusions. However, while it is true that the pleural of anecdote is not data, the reality is that it does make policy. If we are to be successful in our “When Seconds Count” educational endeavor to advocate for patient-centered, physician-led anesthesia care, we need to hear from as many physician anesthesiologists as possible. Share your experiences when your knowledge and skills have made a difference to your patients at of us are comfortable sharing these stories, but we have to get over this tendency to keep things to ourselves. We have a lot of work to do, not just ASA – all of us. If we don’t tell our story and advocate for our patients and profession, we can’t expect others to do it for us. Get involved in the When Seconds Count … Physician Anesthesiologists Save Lives™ educational endeavor. Together we will be successful in advancing our profession.

J.P. Abenstein, M.S.E.E., M.D. is a consultant, Division of Cardiovascular and Thoracic Anesthesiology, and Associate Professor of Anesthesiology, Mayo College of Medicine, Rochester, Minnesota.