CHALLENGES FOR THE NEXT 25 YEARS OF ANESTHESIA

The past 25 years brought remarkable advances in clinical anesthesia practice, including pulse oximetry, end-tidal gas monitoring, propofol, and the laryngeal mask airway.  I posed this question to our Stanford anesthesia faculty who specialize in private practice:  In your opinion, what is the most important problem for anesthesia to address in the next 25 years?

Their answers:   “I think medicine as I have known it in my career will be unrecognizable 25 years from now.  There may be a few well-trained anesthesiologists who provide one-on-one anesthesia for the few patients who are willing to pay for it.  Our society has decided that it doesn’t want to pay for this kind of care for everyone.  I think the systems for providing anesthesia care will be unrecognizable to us in 25 years.   Since this change is going to come whether or not we like it, I would like to see our excellent academic Anesthesia Departments lead the way.  It is time for anesthesia leaders to take over the training of all those who provide anesthesia care so that we can maintain and improve the scientific advances that have been made in the last 25 years.   I think we all agree that some practitioners are over-trained and some under-trained for what they do for most of their careers.  I would like to see more sub-specialization earlier in training.  I would like to see our academics come up with possible solutions to providing high quality anesthesia care in a more cost effective way.  I think real team approaches, robotics and advances in information technologies should be tried to accomplish this goal.   If we don’t come up with more cost-effective ways it will be mandated by those who pay the bills, and I don’t think we will like their solutions.”    Lynn Rosenstock, M.D.  Past-President, Santa Clara County Medical Association;  Past-President, Associated Anesthesiologists Medical Group (AAMG), Stanford.

“I think economic pressures are driving academicians to practical efficiency and marketing pressures are driving private practitioners to offer ‘state of the art.’   In terms of tools that we use, the next 25 years will hopefully reveal enough understanding of mechanisms of consciousness, memory, sleep, and pain to allow us to have medications and techniques to more precisely target cells with minimal damage.  Real time 3-D Echo and 4-D MRI will finally get the resolution and size reduction needed for usage.  Robotic and mobile miniaturized anesthesia machines are likely coming down the pipeline too.”  Charles Wang, M.D. Department of Anesthesia, Palo Alto Medical Clinic (PAMC)..

“I hope that major improvements in pain management for the post-op patient come along before we retire.”  Bruce Halperin, M.D. AAMG.

“Problems will be:  1) to continue to increase safety while being pressured to do more for less;  and  2) to continue to train future generations of anesthesiologists when staffing and research needs at university settings don’t allow for significant one-to-one teaching.  Residents often provide manpower first and receive education as a secondary benefit.”  Chris Cartwright, M.D., PAMC.

“My thoughts are that we will find opioids without respiratory depression, and be able to use them to decrease the risk of anesthesia so that anybody can do anesthesia for any patient. That is my guess.” Joe Weber, M.D.  PAMC.

“I think that the biggest problem to be addressed in the next 25 years is finding drugs with specific desirable effects, without the side effects we deal with now, such as respiratory depression and nausea.   I am sure that more receptor-specific drugs will be in use by then.”Mike Cully, Hoag Hospital, Newport Beach.
“First, I would expect the problems of the three ‘R’s’:    Retirement, Recruitment, and Retention of anesthesiologists.  Second, I foresee models of delivering care to maximize physician extenders . . . yes, non-M.D. providers of care.   Third, there will be more delivering of care outside of our traditional settings.   Fourth, there will be more partnerships between physicians and care settings . . . i.e. the foundation model for delivery of care.   Fifth,  I expect the digitalization of information and record keeping, and finally, the impact of totally noninvasive surgery that does not require any anesthesia!”  David Berger, M.D.  Alta Bates Hospital.

“I think the biggest problem our specialty will face in the next two and a half decades is an indirect result of the epoch-changing advances you site prior to your question.   I suggest that our specialty is becoming complacent and apathetic and developing a dangerous attitude of entitlement.  The problem is the preservation of our professional status as physician specialists and our individual professionalism, ethics, and autonomy.  These things are the soul and core of what it means to be a physician, and are being eroded by the increasing power and influence of corporate business in medicine, and the ever tightening choke hold of governmental regulation.  There are a number of reasons why the practice of anesthesiology is particularly vulnerable in a way that our surgical colleagues and other physicians are more insulated.  We can accelerate this process of degradation by making short-sighted choices, or become proactive, patient advocacy oriented participants in the evolution of American medicine.  This must be a specialty-wide movement, however, not just limited to the few who are involved beyond one’s own narrow and immediate self interest, for us to successfully maintain the achievements of which we are so proud.”  Mark Singleton, M.D.,  Good Samaritan Hospital Group, San Jose.

“First, I would expect the problems of the three ‘R’s’:    Retirement, Recruitment, and Retention of anesthesiologists.  Second, I foresee models of delivering care to maximize physician extenders . . . yes, non-M.D. providers of care.   Third, there will be more delivering of care outside of our traditional settings.   Fourth, there will be more partnerships between physicians and care settings . . . i.e. the foundation model for delivery of care.   Fifth,  I expect the digitalization of information and record keeping, and finally, the impact of totally noninvasive surgery that does not require any anesthesia!”  David Berger, M.D.  Alta Bates Hospital.

“I think the biggest problem our specialty will face in the next two and a half decades is an indirect result of the epoch-changing advances you site prior to your question.   I suggest that our specialty is becoming complacent and apathetic and developing a dangerous attitude of entitlement.  The problem is the preservation of our professional status as physician specialists and our individual professionalism, ethics, and autonomy.  These things are the soul and core of what it means to be a physician, and are being eroded by the increasing power and influence of corporate business in medicine, and the ever tightening choke hold of governmental regulation.  There are a number of reasons why the practice of anesthesiology is particularly vulnerable in a way that our surgical colleagues and other physicians are more insulated.  We can accelerate this process of degradation by making short-sighted choices, or become proactive, patient advocacy oriented participants in the evolution of American medicine.  This must be a specialty-wide movement, however, not just limited to the few who are involved beyond one’s own narrow and immediate self interest, for us to successfully maintain the achievements of which we are so proud.”  Mark Singleton, M.D.,  Good Samaritan Hospital Group, San Jose.

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Published in September 2017:  The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.

KIRKUS REVIEW

In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.

Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.

Nuanced characterization and crafty details help this debut soar.

Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:

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Learn more about Rick Novak’s fiction writing at ricknovak.com by clicking on the picture below:  

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One thought on “CHALLENGES FOR THE NEXT 25 YEARS OF ANESTHESIA

  1. vi am a practicing anesthesiologist for over thirty years and i tell you nothing much has changed in the attitude of the administration of hospitals or the surgeons towards us.We have to constantly keep asking to be recognized as the most valuable physician in the team.This i am afraid will be the same

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