Skip Navigation LinksHome > Blogs > Webinar Blog
Webinar Blog

The American Society of Anesthesiologists and Anesthesiology have partnered to offer webinars that provide interactive opportunities to learn about issues that affect the medical specialty of anesthesiology. These webinars are based on articles published in Anesthesiology and feature respected authors discussing their research and findings on a wide variety of topics.

Tuesday, January 04, 2011

Webinar held January 13, 2011 at 11:00 a.m. (EST)

Subscribe to this Blog’s RSS Feed


Imagine, if you can, a forty-something academic anesthesiologist. He is very unhappy about coming to work every day and feels that his job is like working in a salt mine. Each morning he has a hard time waking up, but Mondays are particularly bad. Although he used to have lots of outside interests like music, exercise, reading, and travel, nowadays all his activities seem to center around work. Every night, he brings home a large briefcase with work that he honestly intends to get done. Every morning, he takes the case back to work with the papers untouched. He is really burned out.

Finally, he can take it no longer. He decides that the solution to his problems is to go to a private practice job where the money and working conditions are better, and life will be great. After a little while, he dreads getting up in the morning, he carries work home in that same briefcase, and carries it back undone. He is still burned out.

Fast-forward a few years. This same anesthesiologist is happier, feels better, and actually doesn’t mind getting up in the morning. He is even working back at his academic job and looks forward to going to it every day. Instead of dreaming of the day he retires, he wonders how long he can postpone retirement.


On January 13, we hosted a Webinar dealing with the subject of job burnout where we discussed some of the risk factors for the development of burnout and some of the signs we should be looking for. This topic is timely and important and we welcome your comments, whether or not you were able to participate in the live event.

Steve Alan Hyman, M.D., M.M.
Gildasio De Oliveira, M.D.
About the Authors
Steve Hyman

Dr. Steve Hyman is Associate Professor of Clinical Anesthesiology and Medical Director of the Medical Center East Operating Rooms at Vanderbilt Medical Center. A graduate of Indiana University (1975), he has advanced degrees from IU (MD, 1979) and Belmont University (MM in piano performance, 2004). His ongoing research includes studies of burnout and job satisfaction in healthcare workers. He is also the principal investigator at Vanderbilt for the multicenter POISE-2 study. In addition, he is an active musician involved in numerous musical activities, including international piano competitions.

Dr. Gildasio De Oliveira is an associate attending Anesthesiologist at Northwestern Memorial Hospital in Chicago and a clinical Instructor for Anesthesiology at Northwestern University. He is also a team educator coordinator for the Department of Surgery at Northwestern University. He is interested in how job burnout can affect the practice of anesthesiology and has evaluated chairmen of academic departments as well as program directors and residents. He is also pursuing research on how burnout can affect the safe practice of anesthesiology.

Friday, July 30, 2010

There is no question that performing multiple diagnostic facet blocks improves validity. The problem is the "cost" of this paradigm. Generally speaking, prognostic blocks are most useful when the treatment is much more expensive or has a higher complication rate than the blocks themselves, which is not the case for facet interventions. Therefore, the crux of the dilemma about how many blocks to perform before RF denervation comes down to this: Which do you view as more important, pain relief and functional improvement, or increased diagnostic accuracy? I believe most patients and doctors would choose the former.

In this large, randomized study, more people in the 0-block group experienced significant pain relief and functional improvement than in the 1- and 2- block group. Not only was the cost-per-effective treatment in the 0-block group less than half that of the other two groups, but the total cost was also less. In other words, less money was spent at current reimbursement rates to help more people. This is important when one is playing a "zero-sum" game.

Some experts might argue that some of the patients who proceeded straight to RF denervation may have been placebo responders. This may be true. But the decrease in pain, improvement in function, duration of benefit, and even changes in brain metabolism are indistinguishable between patients who improve from placebo and those who improve from "real" treatments. Some estimate that up to 50% of the effect of any pain treatment stems from the placebo response, which is stronger for injections than for medications, and can be repeated with comparable efficacy. Others might contend that performing two blocks is the only way to reduce the high "false-positive" rate of uncontrolled facet blocks or RF lesioning. The flip side of this argument is that the more blocks one does, the higher the "false-negative" rate becomes, which is poor tradeoff. In my opinion, I would rather do an incredibly safe RF procedure on someone who may not have the index condition, than withhold this treatment from someone who could benefit.

Steven P. Cohen, M.D., Johns Hopkins School of Medicine, Baltimore, MD


About the Author

Dr. Steven Cohen obtained his medical degree at the Mount Sinai School of Medicine in New York City, completed his anesthesiology residency at Columbia University, and a pain management fellowship at Massachusetts General Hospital. Currently, he is Associate Professor of Anesthesiology at the Johns Hopkins School of Medicine and the Uniformed Services University of the Health Sciences. In addition to his academic work, Dr. Cohen is a Colonel in the U.S. Army Reserve and serves as Chief of Anesthesia & Operative Services at the 48th Combat Support Hospital at Fort Meade, MD, and Director of Chronic Pain Research at Walter Reed Army Medical Center in Washington, DC.


On-Demand Webinar

Purchase the on-demand webinar: “Diagnostic Medial Branch (Nerve to the Facet Joint) Block Treatment Paradigms prior to Lumbar Facet Radiofrequency Denervation

Blogs Archive