Chevy Chase, Md.
In my last installment (Anesthesiology News July 2022), I proposed the reasons we anesthesiologists are misunderstood and, at times, disrespected. My article prompted many readers to chime in regarding many of the points raised. I also promised that I would offer some actions we can all take to improve our professional status and claim what many of us consider to be our proper place among the medical specialties. This article addresses just that.
Put simply, the ways in which we can accomplish our goals involve “ads,” those being advocate, advertise, admonish and address.
Admittedly, these “ads” are contrived and perhaps “gimmicky” approaches to reaching our goals, but, nonetheless, this construct offers a basic framework by which we might get where we want to be professionally: understood, respected and valued.
Advocate
For too long, those of us at the head of the OR table, in the ERs and ICUs, in the endoscopy suites, and wherever else anesthesia is delivered have begrudgingly accepted a role that’s best described as supportive. But we anesthesiologists know better. We know that many of the miraculous things that are achieved in medicine—be they organ transplants, coronary bypass grafting, colonoscopies, cesarean delivery, sophisticated pain management, intracranial surgery, pyloric stenosis repair and so much more—would be literally impossible without our services. When I said in my last article “try taking a gallbladder out without us” I meant it, and every one of you understood exactly what I was saying.
So, what does advocacy mean? It means showcasing our abilities, our training and our innovations. It means telling all those who use our services—the surgeons, gastroenterologists, interventional radiologists and cardiologists, obstetricians, and all the rest—what we can do for them, and how. It means sponsoring lectures, giving demonstrations, and educating administrators and our nursing colleagues. When I was in clinical practice, I gave lectures to the assembled OR staff, the medical staff and whomever else would listen on subjects as disparate as malignant hyperthermia, ultrasound-guided nerve blocks, general medical and surgical risk management, and a host of other topics. It took time and effort but it was worth it. It was worth it for the understanding, respect and attention it garnered. If you don’t tell people what you can do for them, no one else will. And why shouldn’t you? As I said in my last article, we are well versed in so many areas of medicine—surgery, obstetrics, pediatrics, pain management, critical care, coronary care, etc.—that it would be a sin not to let others know about it. To paraphrase an old and famous rabbi of past days: “If I am not for me, who will be for me?”
Advertise
Lawyers do it, plastic surgeons do it, dentists do it and so should we. These days there’s no shame in it. How else will our colleagues, let alone the public we serve, better understand what we do? For a custom print and online promotional piece, hire someone good and put together a campaign that tells people who you are and what you can do. Do you have a fellowship-trained pediatric anesthesiologist on staff? Let people know. Ditto for a colleague who has done a pain or obstetric fellowship. Do you offer sophisticated nerve blocks that will ease post-op pain? Talk it up! Do you have liposomal bupivacaine (Exparel, Pacira) on the formulary and use it? Let people know! Do you do transversus abdominis plane blocks, routinely use epidural and intrathecal catheters for ongoing pain relief, or have anesthesiologists willing to cover remote anesthetizing locations?
Make people aware. Highlight your staff’s training, especially fellowships and certifications. Give tours of the OR to kids and parents, if that’s allowed. Be represented at public health fairs and community events. Get out there and sell yourselves! No one else is going to do it. Sponsor a race, adopt a road or donate in a hospital gala. Branding is crucial!
Admonish
Gently, that is. This is a tricky one, because you don’t want to alienate the very people whose respect you seek. Wear your name tag that identifies you as an MD or a DO, and tell people how you’d like to be addressed, if that is important to you. Always introduce yourself as “Doctor,” not Mark or Susan. Give talks to the OR and hospital staff about the extent of your training, especially after residency and fellowship, and showcase the aspects of that training that will benefit your patients and make everyone else’s job a bit easier. Highlight the exam process and discuss recertification.
Educate people about what you do and what you know—tactfully. With so much ignorance regarding whether you are even a physician to begin with, do not assume this to be frivolous. (See my July article quoting the American Medical Association study in which 30% of the public did not know whether or not anesthesiologists are physicians.) You worked hard to get where you are. Own it and tell people whenever and wherever you feel it is appropriate.
Address
By that, I mean come together with your surgical colleagues and whomever else you serve (radiologists, GI doctors, the folks in the ER, ICU, etc.) and seek common ground. Discuss ways in which your collaboration as medical professionals can be enhanced. Be creative here. Think of challenges and even tensions that have arisen, and work toward solutions. For example, is there a better way both you and the GI people can perform upper endoscopies? Does the GI doctor object to you having the patient gargle with viscous lidocaine pre-procedure? Does the orthopedist know that you have suprascapular nerve block training for post-op shoulder surgery pain relief? Are the neurologists aware that you are skilled and ready to treat their post–dural puncture headache patients with an epidural blood patch? Does the ER staff know who in your department routinely carries the code phone or beeper for that particular day?
Make sure you have kept solid and consistent contact with the departments that you serve. All of this is hard and time-consuming, but it is worth it. Dedicate one member of your department to cover this outreach and rotate the role if you must.
Final Thoughts
Your job is getting harder, not easier, what with all the staffing shortages, an enduring and nasty pandemic, and a chronically sicker patient base. But if you are willing to make the effort, investing in yourself, your image and with your colleagues, it will certainly pay off in the end. Good luck.
Editor’s note: The views expressed in this commentary belong to the author and do not necessarily reflect those of the publication.
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David - a fine article; however, as someone close to retirement as well, I believe that our mantra of “be seen but not heard” DIRECTLY and IRREFUTABLY has led to our predicament. Anesthesia practice leadership care more about maintaining the status quo of their private practices than they do about the anesthesiologists making up their practices. Surgeons will complain about anything; they’re like a bunch of pre-schoolers!!