TO some observers, American medicine appears to have lost its moorings and is drifting aimlessly in an increasingly hostile environment. The article by Waisel 1in this issue of ANESTHESIOLOGY may play a key role in reminding us of our core values and obligations, and by so doing reestablish the moral and ethical orientation necessary to guide our specialty into a new era of medicine.
How long has it been since you participated in a gathering of physicians in which the primary topic of conversation was science or clinical care? The distractions from our devotion to our patients are many, and they are real: a nation that demands more and better health care while allocating less money for its provision; a government that proclaims fraud and abuse in health care to be rampant and tries to pit patients against physicians: third-party payers who try to amass market share to increase profits, not to improve outcomes; the swift introduction of a competitive business model into an industry inexperienced in competition; and the fragmentation of collegiality at a time when unity has never been more vital. It is little wonder, then, that physicians seem embittered and disillusioned as they struggle to maintain high standards of patient care as the entire health care system leaves one model behind for the next one, which remains undefined.
Waisel refreshingly and simply reminds us of the unique obligations that are incumbent on us as physicians and anesthesiologists. These obligations arise from our relationships with individual patients, who entrust their lives to strangers; with society, which has invested unprecedented resources in our education and the advancement of medical science; and with various communities, including our professional associates and the institutions in which we practice, the community of patients (locally, regionally, and nationally), and the greater anesthesiology community that created our current opportunities and now entrusts to our care the future of the specialty.
The enormous trust and respect that society continues to accord physicians arises directly from our continued fulfillment of the obligations Waisel cites. In these times of uncertainty, anesthesiologists must be guided by our ethical principles and by our relentless commitment to placing patients’ interests above our own.
It is the understanding of the centrality of ethical obligations and a selfless devotion to their fulfillment that distinguishes the professional from a proficient technician. Waisel's reminder of our nonpatient obligations is timely, instructive, and powerful.