Notable Quotes from ASA Monitor
ASA Monitor Today
Highlights you may have missed from recent ASA Monitor issues.
How cataract surgery exemplifies inertia in medical policy
ASA Monitor staff
“Given the high utilization of cataract surgery in older adults and the rapid expansion in the number of older adults over the coming decade, during which the entire Baby Boom generation will become Medicare-eligible, any changes to cataract care must be done thoughtfully and with sufficient evidence to demonstrate that we are not sacrificing quality and safety on the altar of cost and efficiency. At the same time, ophthalmologists, anesthesiologists, nurse anesthetists, and patients, each of whom may individually benefit from maintaining the status quo, cannot continue to ignore the societal burden posed by the aggregate cost to Medicare of routine anesthesia care for cataract surgery – especially in the context of the projected shortage of anesthesia staff for other, more invasive surgical procedures that require our training and expertise.”
– Catherine L. Chen, MD, MPH, on her research studying the delivery of cataract surgery care. Read the full article here.
Postgraduate training license change jeopardizes employment for many California trainees
“While the crisis was averted for me and my co-residents, without a systems-level change, it is likely to happen again to a new cohort of residents next year. If we are to continue with the structure established by S.B. 806, a system must be set up to ensure that these applications are flagged and expedited during the 90-day period so future residents can serve their communities and health care institutions without interruption.”
— Seth White, MD, Anesthesiology Resident, Loma Linda University, shares his struggle after the state of California stopped considering transitional internships eligible for a postgraduate training license, or PTL. Read his story here.
Growth of Guyanese anesthesiologists in global program
ASA Monitor staff
“Progress within the hospital has been very evident in terms of equipment. Whereas in 2017 there had not been enough infusion pumps for every room in the OR, there are now two per OR and more than enough for the ICU. Every OR has a new Mindray machine, A3s or A5s. Gone are the days of mismatched anesthesia machines with idiosyncratic defaults (like displaying CO2 in percent instead of mmHg) and instructions and displays in Chinese-language menus. Epidurals, arterial lines, and central lines are available, and the anesthesiologists have developed the expertise to insert them and use them.”
— ASA Monitor authors Alexandra Harvey, MD, DM, Reema I. Sanghvi, MD, and Mark A. Singleton, MD, FASA, on progress at Georgetown Public Hospital Corporation (GPHC) affiliate program of the University of Guyana. This is the site of a residency program graduating multiple classes of fully trained and certified anesthesiologists in this South American country. ASA Monitor has been covering young Guyanese anesthesiologists since 2017. Read more on their accomplishments and developments.
Sustainable Global Health Partnerships
ASA Monitor staff
“Residents who have participated in such initiatives have reported an improved adaptability to new health care settings, communication with patients and professionals from different backgrounds, and increased cost-consciousness in medicine, as well as a greater appreciation for the impact of culture on health.”
— Aria Shafai, MD and Vahe S. Tateosian, MD in the April ASA Monitor article “The Path Toward a Sustainable Global Health Partnership.”
Should we be promoting ourselves as bartenders?
ASA Monitor staff
“Does the talk of ‘giving a cocktail’ undermine our professional role and decrease respect? Is this consistent with our role as the health care provider who guides patients through the perioperative period, monitors every breath and heartbeat to keep patients safe during invasive surgery, and gently guides their return to consciousness while providing reassurance and pain relief?”
—Gundappa Neelakanta, MBBS, in his article “Happy Juice” discourages the common refrain of anesthesiologists who tell patients, “Here is your cocktail” or “This is your happy juice.” He argues that professionalism is more important than ever as anesthesiologists’ roles may get blurred from the recent efforts by nurse anesthesia providers calling themselves nurse “anesthesiologists." While light humor with our patients during the preoperative period can help allay their anxiety, he implores doctors to avoid the "bartender" verbiage.
Anesthesiology and Poetry
Douglas L. Hester, MD, MFA
Don’t miss “A Brief Guide on Mouth to Mouth” by Douglas L. Hester, MD, MFA. Dr. Hester shares the background of his poem, which is actually a fictional synthesis of two patient encounters that still haunt him years later, as well as his journey as a physician poet.
Reflecting on an unpleasant patient encounter
Every physician has had rude patient encounters and there may even be an uptick in incivility lately. When Demicha D. Rankin, MD was assessing a patient’s oral civility, the patient responded to a question by raising his middle finger at her. Read “A Reflective Narrative of an Unpleasant Patient Encounter” for her tips on a professional response.
“As a physician — both a woman and an African American — I only have my experience when perceiving the world, and I strive to avoid automatic defaulting to these identities as the reason for ill treatment. Undeniably, it is exhausting to be on the receiving end of such derogatory treatment, and it feeds into career exhaustion.”
Creating and Communicating Your Value Proposition
ASA Committee on Practice Management
The ASA Committee on Practice Management compiled a compendium of resources to help groups understand the process of developing a value proposition and, if necessary, respond to a request for proposal (RFP) (asamonitor.pub/3BbBxQK).
RFP is the process that hospitals use to put a contract up for bid.
For anesthesia services, the document lists the requirements that the hospital has for the relationship and poses a series of questions for potential bidders. This may reflect that the hospital is unhappy with their current vendor, or it could be that they need to prove they are not overpaying for services. In the end, winning the bid is about establishing and communicating your value proposition.
“Clinical excellence is no longer enough; leadership, both within the group and in the environment (OR, preop, PACU, NORA, board, and community), is critical to establishing your value proposition,” according to authors Phillip J. Richardson, MD, MBA, FASA, CPE, FAACD, FACHE; and Shena J. Scott, MBA, FACMPE. Read more in this January 2023 article about winning practices in anesthesia value proposition development.
Elizabeth Rebello, RPh, MD, FASA, CPPS, CMQ; Anita Gupta, DO, MPP, PharmD, FASA; H.A. Tillmann Hein, MD, PhD and Matthew Goldan
Recent revisions to USP <797> include a clear distinction between administration and compounding, effectively ending the “one-hour rule,” a restrictive standard stating that all immediate-use sterile products must be administered within one-hour after the start of preparation. Within this revised guidance, USP made clear that administration is officially outside the scope of Chapter <797>. Read some notable quotes from this February ASA Monitor article that explores ASA’s advocacy efforts that led to this important change.
Michael Champeau, MD, FAAP, FASA, ASA President
“I see our profession as caught between the jaws of a metaphorical vise. One jaw is the unacceptable payment we receive from the federal government for our services. The other is the threat of independent nurse practice. Just as with an actual vise, each jaw enables the other to exert a greater force on our profession.” Read more in January 2023 Leadership Perspectives column.
Help Wanted! Must Have the Brain of an Internist, Hands of a Surgeon and Heart of a Psychiatrist
Talmage D. Egan, MD, FASA
“While the patient is in this objectified state, it is critical that we defend the patient's personhood, their innate dignity as human beings. This means that while the patient is under anesthesia, the anesthesiologist must take the lead on insisting that no one in the operating room speaks ill of the patient, that no one makes fun of them, and that the patient's modesty is preserved, among other similar actions of respect and reverence. Defense of patient dignity is, of course, an important duty of the entire operating room team, but because the anesthesiologist has rendered the patient unconscious and defenseless, we have a special obligation to perform this function, " said Talmage D. Egan, MD, FASA in his column.