To the Editor

I noted with great interest the letter from the anonymous surgeon/patient about his poor experience with “anesthesia providers” and his appeal for “professionalism.” I wish this were an isolated case. I know from years of both academic and private practice that it is not.

I have spent roughly half of my career in academic medicine, most recently in one of the premier anesthesia departments in the United States, at least as such things are judged. Usually academic ranking is centered on academic performance goals (grants, publications, residency pool, and so forth). Medical centers grade themselves, at least until recently, on aggregate patient outcomes. Only recently have “customer service” concepts been championed at large, prestigious university medical centers. My colleagues, brilliant men and women with an in-depth knowledge of the science of medicine and impressive academic resumés, are justifiably proud of the professional standing. However, they often act like the Rodney Dangerfield of medicine, complaining ad nauseam that they don’t get the professional respect they deserve from patients and fellow physicians, especially surgeons. The letter from a colleague/patient explains, better than any words of mine, why this is something we frequently invite upon ourselves.

During the half of my career spent in small community hospitals, I have had the chance and the will to be an actively participating member of my hospital medical staff, the community it serves, the emergency medical system that provides urgent access to healthcare, and the process of evaluating every patient that presents for anesthesia care. I learned early (from some folks in academic practice–physicians and nurses alike) that the only person having “routine” anesthesia is me. Every patient, even our surgeon/author, is appropriately concerned about his or her welfare and wants us to demonstrate through words and actions that we are as well. Quite aside from the obvious fact that a cursory review of other people’s assessment is not a safe practice, it smacks of casual disregard for the feelings of the person under our care. I cannot tell you the number of times an interview of substance (total time 10 minutes or less) reveals new information not obtained by anyone up to that point or casts important new light on available information. That chest pain diagnosis of reflux might seem inconsistent with lack of relief by acid inhibitors and occurs mostly with exertion described by the patient. Perhaps I’ll consider a beta-blocker preoperatively. You get the idea.

We, as practitioners of medicine, can complain at every opportunity, change our description of ourselves (i.e., the whole “perioperative medicine” thing), and insist that others recognize and yield to our superior training. Until such time as we as individuals consistently comport ourselves as physicians, acquiring information directly through history and physical examination where indicated and caring for, not just taking care of, our patients, those efforts will be so much smoke in the wind. Technology is an important aid to medical practice and anesthesia in particular, but it is the “laying on of hands” and the demonstration of concern and compassion that define the art and profession of medicine. Respect is earned, not applied for.

Michael W. Russell, MD
Nags Head, NC