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.

Introducing …,  THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a legal mystery. Publication date September 9, 2014 by Pegasus Books.

The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book image below:

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Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.

Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.

REVIEWS:

5.0 out of 5 stars The Doctor and Mr Dylan, March 3, 2015
By
prabha venugopal (chicago, il USA) – See all my reviews
Verified Purchase(What’s this?)
Gripping from the beginning to the end. Very well written, bringing to the forefront all the human emotions seen in an operating room spill over into real life. I cannot wait for Dr. Novak to wrote another book! As another physician in the same profession, my admiration for his book knows no limits.

Bang-Up Debut Novel, November 16, 2014

By Norm Goldman “Publisher & Editor of Bookpleasures”

This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.

This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.

TwinCities.com PIONEER PRESS Entertainment

by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press mgrossman@pioneerpress.com, January 4, 2015

“The Doctor & Mr. Dylan” by Rick Novak (Pegasus Books, $17.50)

Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.

Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.

Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.

The Physician’s Late-Night Reading List

Two Pritzker alums pen captivating tales

By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine

For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.

Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan (Pegasus Books, 2014), transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.

Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”

One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.

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The Doctor and Mr. Dylan (Pegasus Books, 2014) by Rick Novak, MD’80

“I thought it was a novel way of killing someone,” said Rick Novak, deputy chief of anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.

From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”

After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.

“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”

Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:

BOOK REVIEW “THE DOCTOR AND MR. DYLAN”

This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.

Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.

Rick, I can’t wait for your next book. Bravo!

Hibbingite writes twisted medical tale

HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.

Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.

“The dialogue is sometimes funny, and there are lots of plot twists,” he said.

Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.

“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”

Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.

5.0 out of 5 stars I Sense We Have Another F.Scott Fitzgerald Emerging on the Literary Scene, December 1, 2014
By
Deann Brady (Sunnyvale, CA USA) – See all my reviews
(REAL NAME)
I found Rick Novak’s first novel, “The Doctor and Mr. Dylan,” a most exciting combination of biting sarcasm, mystery and daily activity spun with fresh new phrases that made me turn my ear back to listen to the literary cadence of his words again and again even though, on the other hand, I was anxious to turn the pages to see what would happen next. His brilliant handling of scenes is reminiscent of The Great Gatsby by F. Scott Fitzgerald. A compelling read!Deany Brady, author of “An Appalachian Childhood”

By

allan mishra

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.

Learn more about Rick Novak’s fiction writing at rick novak.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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