The American Society of Anesthesiologists: A Century of Challenges and Progress. Edited by Douglas R. Bacon, M.D., Kathryn E. McGoldrick, M.D., Mark J. Lema, M.D., Ph.D. Park Ridge, Illinois, Wood Library-Museum of Anesthesiology, 2005. Pages: 225. Price: $55.00.
The aptly named A Century of Challenges and Progress details the history of the American Society of Anesthesiologists (ASA) from 1905 to the present. Chapters organized chronologically describe each era, with additional chapters devoted to specific stories such as the creation of Anesthesiology, the tribulations of the Wood Library-Museum of Anesthesiology, and the role of women anesthesiologists in the ASA. Colorful writing, frank reporting, and taut chapters complement the thorough accounts.
What startled me was the unceasing sameness of our history. Our concerns today—How do we recruit talent into anesthesiology? Develop academic anesthesia? Preserve patient safety? Receive appropriate reimbursement?—are not new.
Consider: As early as 1926, organized anesthesiology in New York supported a bill to limit the practice of “lay” anesthetists. During the Depression, hospitals sought low-cost anesthesia providers to maximize profits, organized anesthesiology fought for respect from organized medicine, and the ASA highlighted the importance of physician anesthesia through an exhibit at the 1939 World’s Fair. In the 1950s, the ASA vigorously debated the economic practices of anesthesiologists, particularly whether anesthesiologists should be hospital employees. The ASA also began to focus on propagation through the distribution of a medical school anesthesiology curriculum. In the 1960s, still concerned about the attractiveness and reputation of anesthesia within medicine, the ASA started the Medical Student Preceptorship, which not only attracted students into anesthesiology but also enabled future colleagues to better understand the practice of anesthesiology. The ASA continued to address reimbursement, including the development of the Relative Value Guide, and spearheaded legislative battles to keep anesthesiologists classified as fee-for-service practitioners. The 1970s and 1980s brought concerns about liability, rancor with organized nurse anesthesia, and legislative and regulatory issues regarding practice and reimbursement. Efforts to improve patient safety and education were formalized through the development of standards of care and practice guidelines. Dedication to patients became codified through the inception of the Anesthesia Patient Safety Foundation and the Foundation for Anesthesia Education and Research. Continued focus on public opinion included an early 1980s media tour designed to emphasize the role of anesthesia as a “traditional physician practitioner” and to nullify the view of anesthesia as an institutional service. A study in 1985 noted that “the man on the street … is not the least bit concerned about anesthesiology, let alone anesthesiologists” (and members of the federal government had the same opinions). In the past 15 yr, workforce, academic anesthesia, reimbursement, and patient safety continue to be central issues.
Like all good books, this one leaves you wanting more. Specifically, I wish these knowledgeable writers had taken the liberty of providing a synthesis of anesthesiology history. I foolishly will take a stab at that here. The first century of the ASA centered on convincing the public, organized medicine, and government that medical specialization in anesthesia is unique, vital, and worthy of support. Indeed, this quote, written about the early 1960s, could just as well have been written any time in our history (including last week): “The [ASA] officers were concerned that the public (and even our colleagues in other medical specialties) held false impressions of the value of our service and the mode of our practice.” Although the specifics change, the driving nature of patient safety, finances, and competition reappear continuously in the history of anesthesiology. There is no reason to think this will change. One implication of this view is that for anesthesiologists to be consultants, they should be able to participate in the debates that shape the practice of anesthesiology. History permits us to understand the present so we can anticipate and shape the future. To that end, knowledge of the relevant history of 20th-century anesthesiology should be required to earn certification and recertification.
This book is a healthy reminder of the actors, events, and causes that have brought us to today. A Century of Challenges and Progress should be read by every anesthesiologist. Further, I suggest that training programs make this book central to the study of citizenship in organized anesthesiology. A collective understanding of our history is necessary to permit anesthesiology to use the “wisdom of crowds” (in the best democratic tradition of the ASA) to guide our future.
Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts. david.waisel@childrens.harvard.edu
