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Monday, April 18, 2011
Vigilance. Physicians. Anesthesia is the Practice of Medicine.
Amr Abouleish
Posted by Amr Abouleish MD, MBA
In my March 29th blog entry (“How do our patients view risks?”), I talked about how anesthesia care was less worrisome than many other events in our daily lives, e.g., driving to work. However, I should have also added that even given that fact, I don’t take what I do every day casually.

In this month’s issue of Anesthesiology, Hindman et al. reported on an evaluation of closed claims data on cervical spine injuries and Lanier and Warner provided excellent commentary about the implications of Hindman et al.’s study and results.

In reading these articles, I am reminded that any one of us could have a “normal” patient go under general anesthesia and emerge with a catastrophic injury.

Personally, as a pediatric anesthesiologist, what I try to convey to our residents is the great trust parents put in our hands every day. They give us a “normal” child and pray that we will return their child to them with no problems.

(Pause and think about this.)

Naturally, with this great trust also comes great responsibility. This is the essence of what it means to be a physician. It is not simply a job, but a profession and a calling.

Every day and with every patient, I must always be vigilant. The articles noted remind me that even simple intubation can cause great injury if I do not evaluate the patient completely; that head positioning during surgery can potentially cause serious injury; and that hemodynamic instability can be a significant risk factor for adverse outcome.

Yes, anesthesia care is very safe. At the same time, this should neither be confused with the notion that the provision of anesthesia should be done by just anyone nor that the task be approached casually.

The seal of the American Society of Anesthesiologists is a great symbol of this responsibility and trust. Doug Bacon wrote about this symbol of our profession in his 1996 special article.(1) He quoted the original designers of our seal with regard to its symbolism:

… the pilot wheel, perfect circle, shield, stars, clouds, moon, ship, sea and lighthouse. The motto is VIGILANCE. The patient is represented as the ship, sailing the troubled sea with clouds of doubt, waves of terror, yet being guided by the skillful pilot (the [physician] anesthetist) with constant and eternal (stars), vigilance (motto) by his dependable (lighthouse) knowledge of the art of sleep (moon) to a safe and happy outcome of his voyage through the realm of the unknown. The perfect circle denotes unity of a closed group (the Society).

(Pause and think about this.)

How can anesthesia not be the practice of medicine? How can we not have a physician providing the care? How can we afford specifically to not have an anesthesiologist providing this care?

(Pause and think about this.)

Now go and take care of your patients. Above all, remain vigilant in everything that you do.

Reference: 1. Bacon DR: Iconography in anesthesiology. The importance of society seals in the 1920s and 30s. Anesthesiology 1996; 85: 414-9

Your comments are welcome.
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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