There is plenty to argue that physicians make outstanding health system leaders, and that anesthesiologists make the best CEOs. This is because of the training in their specialty, which orients anesthesiologists as part of a health care team rather than a solo practitioner. As anesthesiologists, you are skilled collaborators, problem solvers and multitaskers.

Other physicians often ask physician executives, “How did you get where you are?” In anesthesiology, this question usually comes from young practitioners thinking about their career options or older physicians who want to contribute in a different way. A Harvard Business Review article discusses how to train physician leaders, stating that it takes a combination of intentional, internal and external leadership experiences.

In 2019, Dr Amol Gupta, then a clinical researcher, furthered the debate over physician versus nonphysician leadership. He opined that current evidence suggested that hospitals with physician executives outperform those without, thus recognizing the positive impact that physician CEOs have on the quality of hospital care. There is a need to build a foundation of CEO characteristics that are essential to guiding positive change at hospitals and refocusing health care back to its original intention: patient care.

Certainly, an understanding of any business is critical to running it. Being clear on what makes money – to further support the mission and to care for more patients – and what loses money is what makes a successful physician, business leader, administrator or CEO. The process of how health care works and what does not work is foundational to any level of leadership in today’s health care systems. A more specific question is why might anesthesiologists in particular make great leaders?

Anesthesia specialist training – including being highly observant to changing circumstances, data-analytical from multiple sources, and precise in decision-making – is not only unique to the role of anesthesiologists in patient care but also the best foundation for a system CEO. Health system leaders have to think broadly, across the needs of the entire system; and as an anesthesiologist, one cannot be successful in the perioperative world without understanding this system-level thinking. “Management of a ‘system’ requires knowledge of the interrelationships between all of the components within that system and of everybody that works in it,” famous words from Dr. W. Edwards Deming. Systems theory has greatly influenced how we understand and change organizations. Basically, it is a way of helping one to view systems from a broad perspective that includes seeing overall structures, patterns, and cycles, rather than seeing only specific events in the system.

To give a specific current challenge we all face: as health systems begin to think beyond coronavirus disease 2019 (COVID-19), many are facing staffing issues in the OR and inpatient units. Some of this has to do with the nursing crisis that has been looming for years, but there are other variables too, including pandemic exhaustion, childcare challenges, and new working situations. When we look across our system of care, the vacancies in care management, transportation, and postacute staffing have as much to do with the ability to get patients the right level of care as bedside staffing. And the solution to our staffing challenges is more than recruitment; it will certainly involve new staffing models and new ways of interacting with external partners.

A core value of anesthesiologists is problem-solving. When we see an issue that will impact patient care, we are programmed to move into assessment, collaboration and innovation to manage the problem successfully for both the short term (get the case done safely in the patient’s best interest), and the long term (eliminate the problem that required a workaround). These attributes translate well to the skills needed by a CEO to be successful.

Physician Leadership is More Effective

Why is it that physicians are better suited to lead health systems than nonphysicians? The answer is delegation skills, communication skills and the ability to put ourselves in someone else’s shoes. It is also the credibility that comes through first-hand experience in the core functions of the purpose of the health system: keeping patients healthy. Statistics bear this out. According to the 2016 USNews & World Report (USNWR) ranking, the Mayo Clinic is America’s best hospital, and the Cleveland Clinic is the second best. The CEOs of both – Gianrico Farrugia and Tomislav Mihaljevic, respectively – are highly skilled physicians. In fact, both institutions have been physician-led since their inception around a century ago.

Other studies showed that hospital quality scores are approximately 25% higher in physician-run hospitals than in manager-run hospitals. These findings of course do not prove that doctors make better leaders, though the results are surely consistent with that assertion. In an analysis of the 2019 USNWR “Best Hospitals” list, higher ranked hospitals were more frequently managed by physician executives. Furthermore, of the 21 hospitals on the 2019 USNWR “Honor Roll,” 13 were physician-managed, and the top 6 – Mayo Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, Cleveland Clinic, New York-Presbyterian Hospital-Columbia and Cornell, and UCLA Medical Center – were physician-run.

The Envision Difference

Envision Physician Services encourages physicians to pursue their passion, whether clinical practice, teaching, leadership and/or clinical research. Experienced physicians are also offered the opportunity to help new physicians through mentorship programs. MAC (Medical Anesthesia Consultants), based in Walnut Creek, CA, has several outstanding opportunities for anesthesiologists at premier facilities in San Francisco, the North Bay, the South Bay, and the East Bay with a growing and well-respected practice of over 130 physicians.

“Envision Physician Services offers the tools and skills I need to be an effective doctor, leader and person.” – Meg Prado, M.D., MBA

Envision Physician Services’ support for physicians is unparalleled. The far-reaching national network offers coast-to-coast opportunities across 800 healthcare facilities in 48 states and the District of Columbia. Currently employing more than 25,000 physicians and advanced practice providers, each one is empowered to develop and realize their professional goals.

 

Sources:

Anesthesiologists as Health System Leaders: Why It Works. journals.lww.com

The Envision Difference. envisionphysicianservices.com

The delivery of high-quality health care at the lowest possible cost is no longer an aspiration; it is the expectation. It takes more than just excellent clinical skills to drive exemplary physician achievement for surgeons and anesthesia specialists, you need strong mental skills.

The importance of mindset, and the mental skills that comprise it, has been a staple of training in high-expectation, high-risk occupations for some time now. Often evolving from sports psychology, the military, police and firefighters understand the potential benefit of mental skills to elite performance in high-stress situations. This recognition is also suggested to be important in training for medical emergencies and surgery. 

More than 20 years ago, surgeons agreed that mental skills are a large component of performance excellence. More recently, this perspective has been reinforced in the surgical literature for performance and procedural preparation. Mental imagery may be the most frequently cited technique, but critical skills such as emotion regulation, negative thought stopping, affirmations, self-talk, breathing techniques and others are also effective, as are individual, group and comprehensive curricular approaches.

In an attempt to objectively document the growing surgical focus on the value of training and use of mental skills through the frequency of relevant publications, Michael J. Asken, PhD, Elizabeth Morgan, MLS, and R. Scott Owens, MD surveyed the surgical literature from 1990 to May 2021 for articles published on this topic.

A search of the literature was conducted in the databases PubMed, Web of Science and Google Scholar. Two thousand articles were retrieved and assessed for specific relevance. Their analysis was limited to articles that focused on psychological performance concepts and skills such as mental training, mental practice, mental skills and mental toughness.

There has been steadily increasing growth, with a positively accelerating trend in the past decade, of publications related to mental skills for training and performance in surgery.

Putting the Right Mindset into Positive Action

In the field of perioperative pain management, the implementation of multimodal analgesia in the pre-, intra- and postoperative periods is an effective and proven method of accomplishing the delivery of cost-effective, high-quality care. Although slight variations exist, “multimodal analgesia” can be defined as the use of several classes of analgesics with varying mechanisms of action used together to improve pain control, decrease over-reliance on opioids for analgesia, and reduce side effects associated with each class.

Because the characteristics of pain vary both between patients and within a given patient at different times, it is unreasonable to expect a single category of analgesics to adequately treat all pain. Strong mental skills are a large component of performance excellence when working in high-pressure and quick decision making conditions. 

Consistency and standardization are important when implementing a multimodal analgesia pathway for a particular surgery. Standardization based on evidence allows for the largest number of patients to receive the best treatments available. Flexibility with protocols is also needed, allowing for tailoring of pain management to the individual patient. A positive mindset for thinking outside the box may be necessary if a complication arises or a commonly used agent suddenly becomes unavailable. Anesthesiologists must expand their knowledge and clinical experience to include agents that have not been traditionally used, and so perioperative plans must be designed with flexibility.

Providing better pain control and using other modalities that result in lower opioid doses should theoretically put surgeons and other prescribing physicians in a better position to reduce doses, write shorter prescriptions or both for patients after they leave the hospital.

Given the innovative integration of mental skills training in other disciplines and the encouraging impact of mental skills and such training on surgical performance (and careers), this increasing interest and emphasis is welcome and should be disseminated and encouraged in all surgical education and training.

 

Sources:

The Surgical Mindset – Increasing Interest in Mental Skills for Training, Performance Excellence. generalsurgerynews.com

Multimodal Analgesia: The Foundation of a Successful Perioperative Experience. anesthesiologynews.com

Words are among our best tools in establishing empathy between doctor and patient. Shakespeare used words for their explicit and multiple meanings, knowing that specific connotations could determine courses of action. As an anesthesia specialist, the choice of words can be most critical. They can convey hope or despair, progress or inertia, life or death.

In a health care world under the control of administrators, robots, frustrating receptionists, designated hours, prescribed patient management and loss of physician independence, the doctor (not employee) is left in control only of the few moments allowed for patient interaction. These are the few moments for empathy. Only by empathy for the patient does the physician warrant the patient’s trust in return, and the designation of being – a healer.

Several hundred years ago, physicians spoke in Latin to each other to discuss a case secretly and in order to have patients admire them for their wisdom. Certain words for incurable afflictions of the time were spoken only to close relatives or persons of authority, but hidden from the patient. In the last century, and in some circles even today, the diagnosis of cancer is kept from the patient.

Communicating Risk

The way in which information about anesthesia risks of treatments is communicated to patients can have a significant effect on their perceptions and decision making.

“Surgeons must frequently communicate the probability of various treatment outcomes, complications and chances of cure to their patients to help them make health care decisions,” said Joshua Eli Rosen, MD, of the Surgical Outcomes Research Center at the University of Washington, in Seattle. “Prior studies have shown that how probability information is communicated can impact its interpretation and ultimately decisions that are made with it.”

Yet, despite these concerns, no standard practice exists for how surgeons should communicate such information to their patients.

An online survey was conducted that queried respondents where risk information was presented either verbally (i.e., “uncommon”), as quantitative point estimates (i.e., 3%), or via quantitative ranges (i.e., 1%-5%). Verbal risk communications were found to result in significantly higher ranges of risk estimates for each surveyed complication, and were found to consistently lead to overestimation of risk.

“However,” Dr. Rosen added, “we must recognize that by addressing these concerns with verbal descriptors alone, we are simply passing that uncertainty and variability to the patient in an uncontrollable way that may result in suboptimal decision making.”

Although verbal descriptors of probability resulted in greatly variable and inaccurate interpretations of risk, participants were able to accurately interpret numerical point estimates and ranges.

Thoughtful Speaking

But what about the words we use today in common conversation with other health care professionals and with our patients: words with double entendres, words with subtle interpretations, words of subterfuge, words with lethal connotations, words of expectations good and bad, words of joy, and words of sorrow. 

Mary E. Knatterud, PhD, has written extensively on the impact of language in medical practice. A word Knatterud greatly dislikes is “elderly.” “Elder” means a person advanced in age, and has, in the past, been a sign of respect. “Elderly” has become almost the opposite of “elder,” implying infirmity of body and/or mind. Other dictionary synonyms for elderly are neither favorable nor laudatory; they imply that the elderly are no longer in the vigorous fullness of life and that somehow this is a transgression warranting a loss of respect.

We know that age is not irrelevant in medical and surgical practice. A person’s age may be a critical factor in determining a diagnosis or therapy.

Patients are to be cared for as fellow sentient humans, with dignity and compassion, with respect, courtesy and regard, with the empathy they are entitled to by their offer of faith in us, their physicians.

Two of the darkest words in the medical lexicon are “terminal” and “incurable.” A physician, a person of knowledge, who speaks those words to a patient is pronouncing a death sentence. Though we must at times make that pronouncement, we must do so with the greatest compassion, recognizing that life per se is terminal and that someday all of us will face the pronouncement of terminality.

Incurable is less an expression of knowledge, than an apology for helplessness. If we must tell a patient that his illness is incurable, we need to add the word “today.” We can recite to the patient diseases that were once incurable but that today are not.

Often, the most important words spoken to patients take place in the examining room in an atmosphere that should be imbued with courtesy toward the patient. A smile, a post-COVID handshake or a touch of the shoulder, and certainly greeting a patient by name, should start an interaction with a patient. Talking to the patient is ever so preferable to talking about the patient to associates in the room.

The doctor–patient relationship is a unique bond whose tone and boundaries the doctor establishes. Choosing the right words matters.

 

Sources:

Words, Words, Words. anesthesiologynews.com

Method of Communicating Risk Affects Patient Decision Making. generalsurgerynews.com

If you are just starting out in your anesthesiologist career you will quickly realize there is a lot to learn beyond what your extensive schooling has taught. Both clinical and personal, there are plenty of tips, tricks and good ol’ common sense principles a young anesthesia specialist should keep in mind as you begin your professional medical career to maximize your performance and personal fulfillment.

We’ll start by stating a concept that is simple but true… when you agree to any project, task or assignment, commit to finishing it on time while working to the best of your ability, under-promise and over-deliver. This with the tips below will serve you well in building your character and reputation.

Be Prepared – In anesthesia, this means always be prepared for airway difficulties and other complications by mentally reviewing your Plan B and your Plan C.

Make Learning Your No. 1 Priority – Seize every opportunity to learn while a resident and benefit from having someone supervising.

Ask for Help – Never hesitate to ask for help or to have a more experienced colleague in with you at the start of a tough case.

Keep Sharp – Keep your knowledge up-to-date and your technical skills sharp.

Get a Mentor – Things that seem fun during residency for a rotation or two may seem much different after you do it for six months and someone you see eye-to-eye with can help you through challenges and changes.

Active Participation – Early on in your career, consider becoming an active member of one or more professional societies.

Have a Good Financial Plan – Do not worry about every dollar, but be careful and save.

Learning to Trust Your Patients

Most doctors can attest to patients fibbing and even going to some lengths to hide relevant information. When asked why they lie to their physicians, patients said they wanted their doctors to think highly of them and not judge or lecture them. And patients seem to think their performances are convincing: 70% of women and 65% of men said they were confident their doctors do not know when they lie.

Maybe you have heard this one, “I’ve done everything you told me to, but…” The subject patients most often lie about is compliance, according to a 2018 study of more than 1,200 people by Medicare Advantage. Some 38% admitted they were not truthful about following their doctor’s orders. 50% say the reason they won’t tell you is they are simply embarrassed while another 30% said they lied because the full story was too complicated or not worth explaining.

A 2020 TermLife2Go study of 500 people found that nearly half (46%) of respondents lied to their doctor about smoking. The same goes for recreational drug use while men are much more likely to lie about how much they drink than women.

Overstating how much they exercise is also one of the top fibs people tell their doctors. As many as 43% of your patients may be lying to you about their exercise routines, exaggerating the frequency or intensity of their activity.

Patients may not realize the potential dangers of omitting information about medications and supplements they’re taking. A 2019 survey revealed that patients didn’t want to be “difficult” or waste their doctor’s time, even if it means giving you incomplete information about medications that could lead to medical errors.

The most likely liars statistically are women, younger people, and those in poor health. Both sexes are more likely to lie to a male doctor than a female doctor. Bear in mind that more than 33% didn’t tell their doctor if they disagreed with their advice, and a similar number didn’t say anything if they didn’t understand treatment instructions. By providing a welcoming, judgment-free approach, you can encourage patients to be more honest about their symptoms and be proactive in their steps toward better health.

Know What Not to Say

Every physician knows the importance of the doctor-patient relationship. Without trust and honest communication, outcomes can be worse and caring for patients may be extremely difficult. However, many doctors overestimate their ability to connect with those in their care. One study found 75% of doctors surveyed believed their discussions with patients were satisfactory, but just 21% of patients surveyed agreed.

In order to provide the best care for your patients and protect yourself from litigation, be intentional when communicating with patients—and here are a few statements to try to stay away from.

1. “I don’t know.” Although you might mean that medical science has yet to find an answer to the patient’s specific question, instead say something more reassuring like, “I don’t know at the moment, but we will find out for you.”
2. “You should have come in to see me sooner.” This may make the patient feel blamed and shamed about something they can’t go back and change. Instead, recognize the patient’s barriers to treatment.
3. “The Internet isn’t your doctor, I am.” About 72% of Americans have searched online for health information, and when a patient comes in with a stack of printouts from a medical website, it can be tempting to immediately dismiss their online findings. Instead, tell them you appreciate their taking the time to learn about their condition and initiate a discussion about what concerns them from their online research and find gentle ways to explain if some of their conclusions are unlikely.
4. “Don’t worry about that right now.” This can be scary and overwhelming to hear as it minimizes their concerns. To avoid this anxiety, be as transparent as possible with the patient. Explain to them that their concerns are important, but together, you’ll need to focus on other, more urgent issues.
5. “This won’t hurt at all.” Everyone has a different pain threshold, so it’s unwise to suggest anyone will completely avoid pain during a given procedure. Instead, explain that most people find the procedure to be painless.

Just as important as what you say is how you say it. Even if you’re feeling rushed, do your best to speak calmly, slowly, and clearly, avoiding too much medical jargon. Show your patients you’re listening closely by staying silent as they speak and try not to interrupt them.

Your career will go surprisingly quickly… make it count! Never discount your dreams or what you really want to do and treat everyone well along the way. And always remember, do your best to support your younger colleagues coming up behind you!

 

Sources:

As Your Career Begins, Remember This … anesthesiologynews.com

Top Lies Patients Tell Their Doctors. healthgrades.com

6 Things Never to Say to Patients. healthgrades.com

What might we be missing out on today that could help improve the delivery of modern day anesthesia? It is a very exciting time as many explore research insights that could reshape anesthesia care and our understanding of it moving forward.

Anesthesia use began over 175 years ago, first by Crawford Long and Jefferson Georgia, then William Morton and the Ether Dome. It started as a simple practice with some ether on a handkerchief or in a glass jar, but quickly became a worldwide phenomena with well researched standards of practice and ever-evolving approaches. Eventually, anesthesiologists developed complex ways to monitor sedated patients and precise ways to measure the proper dose of anesthesia.

Throughout the nearly two centuries of advances in anesthesia drugs, practice standards and patient safety, the mystery of exactly how anesthesia works the way it does has never really been unravelled. As Dr. Kathryn McGoldrick explains, “We understand some of the physiologic consequences in terms of circulation, blood pressure and respiration, but what it’s doing to the brain we still don’t know.”

That was until very recently. Now there is a growing body of research that is deciphering the code of anesthesia use and the human brain by monitoring electrical brain patterns. Dr. Emery Brown’s research with the use of the EEG has shown there are many different neurocircuits and avenues that drugs can intersect to cause unconsciousness. With so many circuits involved and different pathways to administer anesthesia, it becomes very complicated.

Studying the brain patterns of patients in states of sleep, coma and sedated, Dr. Brown has found these three states to be very different. He suggests using a neuroscience approach to administering anesthesia will provide more personalization for each patient. This will also help to identify the best role for the different anesthesia specialists.

Performing at Optimal Capacity

“It’s time to redesign anesthesia care delivery,” according to Karen Sibert, MD, FASA, UCLA Department of Anesthesiology and Perioperative Medicine. In a recent article she states, “We should be charting the course, not executing every change of sail. We should be performing the diagnostic and intellectual work of physicians all the time, not just some of the time. If we don’t, we shouldn’t be surprised if we continue to lose control over the future of our profession. It’s way too expensive to pay a physician to do the tasks of a nurse.”

Nurses argue that they can perform many hands-on tasks of anesthesia care just as well as physician anesthesiologists can. So, why are we still doing those tasks when other physicians don’t do likewise?

Let’s look all the way back to the second half of the 19th century, when the use of ether, chloroform, and nitrous oxide for surgical anesthesia spread rapidly. During the American Civil War, according to medical historian Shauna Devine, PhD, “Union records show that of more than 80,000 operations performed during the war, only 254 were done without some kind of anesthetic.” Most often, the anesthetic was chloroform. “The practice was for the operating physician’s assistant to place the chloroform on a piece of cotton or towel, which had been fashioned into a cone, and then placed over the patient’s nose and mouth, preferably in the open air.”

Outcomes were variable and sometimes tragic. In the early 20th century a true scientist, Ralph Waters, MD, devoted his career to anesthesiology, joined the faculty of the new medical school at the University of Wisconsin in 1927, and founded the first anesthesiology residency program. However, the model of anesthesia care delivery as the practice of nursing by then was well established in America. It took decades for academic anesthesiology programs to proliferate in the U.S., but the model in America continued to be one person at the bedside, giving medications and monitoring the patient – and that person could be either a physician or a nurse.

In an ASA Monitor article a few years ago, authors Marc Steurer, MD, DESA, and Michael Ganter, MD, DESA, examined differences in the delivery of anesthesia care in the U.S. compared with Europe. Among the chief disparities are that most European countries mandate two professionals to provide anesthesia (physician and assistant, e.g., certified registered anesthesia nurse) while in the U.S. the anesthesia physician may provide anesthesia alone without a trained assistant. Also, in most western European countries, the clinical anesthesiologist is more longitudinally involved in patient care. Not only do anesthesiologists govern the prehospital portion of emergency medicine, but also once the intrahospital care begins. Together with the primary team, an anesthesiologist is usually involved in the care of the most ill medical and surgical patients in the hospital. Also in those settings, the anesthesiologist stays with the patient for the entire critical period and provides a very helpful continuum of care. In Europe there is also a heavy involvement of anesthesiologists in both medical and surgical ICUs. Additionally, operation room (OR) management, preoperative and pain clinics as well as services for palliative care have been a mainstay for even small anesthesia departments for a long time. This contrasts to most U.S. practices, where anesthesiologists have predominantly focused on the intraoperative and critical care period. The broader and more longitudinal scope of practice positions European colleagues well for the development of the field.

These European anesthesiologists are actually functioning as physicians.

The ICU Model of Care

“We need to do a total restructure of procedural care to function along the same lines as ICU care, where physicians direct the care of multiple patients. Pharmacists and registered nurses – sedation nurses and critical care nurses – could be involved as part of a cost-effective bedside care team, flexing the composition of the team to the complexity of the case. Cardiologists, GI and ER physicians supervise RNs giving sedation; why don’t we?” states Dr. Sibert.

With today’s technologies, it’s possible to monitor multiple sites at the same time. You don’t have to stay tethered to your patient with a plastic earpiece and a length of IV tubing to listen for breath sounds. Physicians who specialize in anesthesiology can be freed up to do actual physician work, putting medical diagnostic skills to use and functioning as team leaders, not as pawns on the OR chessboard interchangeable with nurse anesthetists.

ACT vs. CAT Models of Care

The Anesthesia Care Team model (ACT) is a more compressed version of the ICU model.The ASA defines the ACT model as “care that is led by a physician anesthesiologist who directs or supervises care of qualified anesthesia personnel and meets the ASA Guidelines for the Ethical Practice of Anesthesiology.” The anesthesiologist may delegate monitoring and some appropriate tasks, but retains overall responsibility for the patient.

This practice of anesthesiology includes the evaluation and optimization of preexisting medical conditions, the perioperative management of coexisting disease, the delivery of anesthesia and sedation, the management of postanesthetic recovery, the prevention and management of periprocedural complications, the practice of acute and chronic pain medicine, and the practice of critical care medicine. This care is personally provided, directed, and/or supervised by the physician anesthesiologist.

The Collaborative Anesthesiology Team model (CAT) is local, optimal teams of CRNAs, physician anesthesiologists or both. It is the anesthesiology version of “the right provider, at the right time, for the right patient.”

The best mix of providers is based on the following factors:

• Resources (i.e., the characteristics of the local available providers)
• Needs of the patients and facility
• All anesthesia providers are licensed, but they’re not all the same. There are no care teams designed predominantly around licensure, they’re designed based on creating value for patients

Fundamentally, the CAT is based on the idea that if true professional collaboration is to exist, each needs to recognize the other’s autonomy, which includes statutory independence, followed by specific model decisions being made at the local level. This allows effective interprofessional collaboration to occur. Collaboration and autonomy are not mutually exclusive – in fact, they are both necessary if anesthesiology professionals are going to meet the challenges of the future.

The CAT is a model that respects both major professions in anesthesiology, CRNAs and physician anesthesiologists. They are not the same – they have different professional backgrounds and licenses. However, the professions do have significant overlap in the scope of services offered.

There continues to be an ongoing push for medical progress, not only for progress in our profession itself, but more importantly for the sake of future patients. The bottom line is that during and after COVID-19, the country needs all anesthesiology professionals to make their full contribution to patient care. That’s what maximizes value. Collaborative anesthesiology teams, whatever their makeup, are the future.

 

Sources:

The Etherist: The Next Chapter of Anesthesia. anesthesiologynews.com

When, If Ever, Will We Redesign Our Work? apennedpoint.com

The Collaborative Anesthesiology Team Model of Care. anesthesiologynews.com

Physician anesthesiologists evaluate, monitor, and supervise patient care before, during, and after surgery. They deliver anesthesia, lead the Anesthesia Care Team and ensure optimal patient safety. Typically, physician anesthesiologists have 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. They have the necessary knowledge to understand and treat the entire human body.

New trends in nonoperating room anesthesia (NORA) continues to increase in popularity and scope. National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail.

In order for anesthesia specialists and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite.

Physician Anesthesiologist 

Physician anesthesiologists are usually in charge of providing the following types of anesthesia care:

• General Anesthesia – Provided through an anesthesia mask or IV. It is used for major operations.
• Monitored Anesthesia or IV Sedation – Results in various levels of consciousness ranging from minimal (drowsy but able to talk) to deep (won’t remember the procedure). Often used for minimally invasive procedures. IV sedation is sometimes combined with local or regional anesthesia.
• Regional Anesthesia – Pain medication to numb a large part of the body, given through an injection or through a catheter. You will be awake but unable to feel the area that is numbed. Often is used during childbirth and for surgeries of the arm, leg or abdomen.
• Local Anesthetic – This is an injection that numbs a small area of the body where the procedure is being performed. Often used for procedures such as removing a mole, stitching a deep cut or setting a broken bone.

Anesthesiologist Subspecialties

Certification in one of the following subspecialties requires additional training and assessment as specified by the American Board of Anesthesiology:

• Adult Cardiac Anesthesiology – Has expertise in the imaging, diagnosis, physiology, pharmacology and management of adults with advanced cardiac disease. Their practice includes medical and periprocedural care for patients with disease of the heart and great blood vessels, including diagnostic, surgical, minimally invasive and transcutaneous procedures that may require cardiopulmonary bypass or other mechanical circulatory assistance.
• Critical Care Medicine – Diagnoses and treats patients with critical illnesses or injuries, particularly trauma victims and patients with multiple organ dysfunction who require care over a period of hours, days or weeks. These physicians also coordinate patient care among the primary physician, critical care staff and other specialists and their primary base of operation is the intensive care unit (ICU) of a hospital.
• Hospice and Palliative Medicine – Provides care to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing the physical, psychological, social and spiritual needs of both patient and family.
• Neurocritical Care – The medical specialty of Neurocritical Care is devoted to the comprehensive multi-system care of the critically ill patient with neurological diseases and conditions.
• Pain Medicine – Diagnoses and treats patients experiencing problems with acute or chronic pain, or pain related to cancer, in both hospital and outpatient settings and coordinates care needs with other specialists.
• Pediatric Anesthesiology – Provides anesthesia for neonates, infants, children and adolescents undergoing surgical, diagnostic or therapeutic procedures as well as appropriate pre- and post-operative care, advanced life support, and acute pain management.
• Sleep Medicine – Has expertise in the diagnosis and management of clinical conditions that occur during sleep, that disturb sleep, or that are affected by disturbances in the wake-sleep cycle. This specialist is skilled in the analysis and interpretation of comprehensive polysomnography, and well-versed in emerging research and management of a sleep laboratory.

While NORA is a rapidly growing field of anesthesia, as new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room. However, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. 

 

Sources:

Role of the Physician Anesthesiologist. www.asahq.org

National Trends in Nonoperating Room Anesthesia: Procedures, Facilities, and Patient Characteristics. pubmed.ncbi.nlm.nih.gov

Anesthesiology Subspecialties. www.abms.org

The subject of patient experience and consumerism in health care has been a frequent topic of discussion over the past few years. While the many reasons behind this change can be debated, one fundamental driver is the rise of Berwick’s “triple aim” concept, one which advocates for excellent clinical care, at low cost, and an exceptional patient experience.

The need to improve patient experience has gained increased importance because of newly developed payment mechanisms and concepts, such as value-based care, which advocates inclusion of patient-reported outcome measures to more traditional clinical outcomes.

The connection between a physician and patient is far more than merely a transactional money-based relationship. It is important to adopt an approach toward patients, customers and consumers as individual people with an innate desire to be treated uniquely and have their personal needs addressed.

The importance is really around personalization and the uniqueness of each individual and his or her experience within the health care system. We should recognize that a consumer of health services for the good of their body will likely have a different decision-making approach than a consumer purchasing other kinds of services (e.g., banking).

After all, it is the anesthesia specialist’s primary responsibility to ensure patients’ comfort and safety when they are exposed to the trespass of surgery and other invasive procedures.

Often, anesthesia and surgical decisions are based on fear, anxiety and depression, and the stress levels of the individuals and their families are high. Overall, consuming perioperative health care services is not a positive, leisurely experience.

A Few Evolving Trends

A number of current trends affect the evolving relationship between anesthesiologists and their patients. While anesthesiologists are highly influential in how people make decisions about their care, there is no question that the influence of physicians is diminishing for many patients. It’s frequently the case that patients come to their physicians with ample information they have collected from online sources and they are much more involved in their care. About 50% of these people are going to read online reviews and make decisions that are based on the individual experiences of other consumers.

An important trend is that of instant gratification, which is being proffered by companies such as Amazon and Lyft. A growing segment of our (younger) population now has the attitude: “I want what I want when I want it and at the price I want.”

Another noteworthy trend is obviously the increased financial responsibility that consumers have around how they access health care. With that increasing financial responsibility, people are now shopping before making decisions associated with their health care,

Patients generally come more educated and with higher level concerns about their future experiences of health care and the services to which they will have access in the next decade.

Recent survey responses among current and future physicians reveal significant gaps in readiness to implement emerging technologies. There are large gaps in readiness for some of the most critical new health care developments such as telemedicine, personalized medicine, and genetic screening.

Physicians need to think about how to continue to provide care to patients in innovative ways and need to invest in new technologies.

• Telemedicine is becoming a norm
• More and more care continues to move to the home
• Increased remote patient monitoring and wearables
• Technology for patient education and virtual care

Satisfaction May Not Mean What You Think

A study by Louis Ehwerhemuepha, Feaster and me2 found that parental recommendation of a surgical facility to friends and family depends on a number of variables, with the quality of perioperative communication with the anesthesiologist being “the most predictive item.” The investigative team was surprised to find that the most significant predictor for the decision of a parent to recommend a hospital to another parent was this item: “Did the anesthesiologist explain things in a way you could understand?” The team was also surprised to find that variables such as pain and nausea and vomiting management for the child did not achieve statistical significance.

The concept of “personas” should be introduced into the care we provide our patients. Personas are a traditional way of thinking about consumers, the retail experience and a consumer market. In this widely used marketing technique, a persona is defined as an individual representation of a group of patients (consumers) and their feelings, behaviors and wishes within the context of health care. This approach is very helpful for understanding how to activate patients/consumers in your market based on a real understanding of who they are as individuals and what is relevant and timely and important for them.

So what is the role of anesthesia specialists within this universe of consumerism and patient experience? If we are to look at the patient journey as a holistic experience, then anesthesia specialists should focus on the perioperative experience and its impact on the overall experience. As a first step, anesthesia specialists must understand the reasons behind this concept. Simply saying this is the right thing to do may or may not be persuasive for many providers. Once an anesthesia specialist understands why this is necessary, then we need to ask how can we optimize the experience.

Overall, anesthesia specialists should be good citizens and help with the hospitals’ bottom line by helping to achieve better patient experience scores and thus success in a value-based purchasing plan. There is a need to focus on variables that can be changed and develop interventions to improve items such as communication skills.

We all know the past couple of years has brought many unexpected challenges to physicians and other healthcare providers. While healthcare will likely never go back to pre-pandemic status, the next few years offer opportunities for medicine to evolve and change for the better.

 

Sources:

Patient Experience and Consumerism in Anesthesiology: The Next Frontier. anesthesiologynews.com

Top 10 Physician Trends in 2021. merritthawkins.com

Self-confidence in a patient helps them to see their life in a positive light even when things aren’t going so well, such as going into a complex surgery.

As an anesthesia specialist, you need to inspire your patients to face their fears head-on. Self-confident people are admired by others and inspire confidence in others. Make sure they know that no matter what obstacles may come their way, together you have the ability to get past them. Put some positive enthusiasm into your interaction, and be sincerely excited to begin the procedure at hand. Don’t focus on the problems, instead focus on solutions and making a positive outcome.

With good posture and a smile, you will make others feel more comfortable around you which helps build patient confidence. Look at the person you are speaking to, not at your shoes. Keeping eye contact shows confidence. Speak slowly. Research has proved that those who take the time to speak slowly and clearly appear more self-confident to others, which again, helps build confidence in them.

Just What is Confidence?

Confidence is a person’s belief that a chosen course of action is the right choice and that they can properly perform that action. As a personality trait, confidence is sometimes referred to as self-confidence. This term describes the attitudes and beliefs people hold regarding their abilities and strengths. People who have high levels of self-confidence may feel sure they will achieve what they set out to do. 

Confidence in others is a belief that people will perform their jobs well, live up to expectations, or keep their promises. By applying active listening and using positive affirmations to improve a patient’s overall self-confidence, you help to build their faith in your abilities as the anesthesiology specialist.

Why is Self-Confidence Important?

Some people experience negative effects from a lack of self-confidence. Individuals that feel inferior in their state of mind, have little drive to succeed. In healthcare, we need as much positive energy as possible out of patients. Working to develop greater self-confidence in your patients can be very beneficial for most, as self-confidence can not only prevent difficulties but also help to increase mental and emotional well-being.

The more a person believes in the self, the more empowered that person is likely to feel, especially with regard to trying new things or going into an uncomfortable procedure. As a result, they may experience less fear and anxiety and be more likely to approach the situation with a positive mindset rather than an anxious or fearful one.

You Can Build Your Patient’s Confidence

An anesthesia specialist’s job is comprised of many tasks: evaluating, diagnosing, interpreting, counseling, treating, and more. While all of these responsibilities are significant, to be truly effective, a physician needs to do one thing exceptionally well:  listen.

Consumer preferences and expectations are changing the healthcare landscape and each patient comes with a unique experience, perspective and problem. They are looking to tell their story and have it be received with compassion and translated into actionable care.  By taking the time to really listen and understand their concerns and fears, a partnership can develop.  Essentially, a mutually beneficial plan of treatment.  Patients will become more confident, more trusting, and more motivated to take control of their health.  

Effective ways for connecting meaningfully with your patients:

1. Maintain Eye Contact – When you focus more on what your patient is saying and you are able to maintain eye contact, you might also pick up some visual emotional cues. 
2. Repeat or Summarize What Was Said – This gives the patient the opportunity to adjust or confirm their remarks.
3. When Listening, Just Listen – Often, they just need the opportunity to vent or talk it out.  Initially, try not to jump in with solutions.

Medical visits and procedures are often very scary for patients, and often times, their internet research can only exacerbate their fear and reluctance to pursue treatment.  Effectively listening to your patients can help you communicate expectations and ensure that outcomes are driven by the patient’s treatment goals. 

Better listening and communication skills provide the foundation for an optimal patient-doctor relationship. You will instill confidence in your patients, driving them to take greater control of their health and improving outcomes.  These important skills will not only lead to increased patient satisfaction but also your own.

 

Sources:

5 Remarkably Powerful Ways to Boost Your Confidence. inc.com

Confidence. goodtherapy.org

These 3 Skills Can Build Your Patient’s Confidence and Lead to Better Outcomes. healthgrades.com

The U.S. anesthesiology market is expected to increase at high growth rates during the forecasted period of 2021-2025, climbing from $26.2 Billion to $37.04 Billion according to a recent report by Research and Markets. Supported by various growth drivers, such as growing geriatric population, increase in monitored anesthesia use, increasing chronic diseases and volume of surgeries, etc., anesthesia specialists now more than ever need to focus on intentional communications with patients and adhere to strict best practices before, during and after procedures.

No one likes anesthetic complications. The goal of every anesthesia specialist is to make anesthesia as safe as possible for each and every patient. Unfortunately, complications can occur during anesthesia, and when they do occur, there is often a rapid sequence of events that can put the patient in peril if not recognized and remedied quickly.

The most effective way to prevent complications is to establish anesthetic processes organized into checklists that ensure adequate preparation of the patient and equipment, minimize the chance for human error, and prevent omission of steps that could impact anesthetic safety. So, how do you incorporate all of this into the highest level of anesthesia care? Prepare, compare, be aware.

Prepare – As described in the 2020 AAHA Anesthesia and Monitoring Guidelines, the complete anesthesia period is composed of four distinct but continuous phases: preanesthesia, induction, maintenance and recovery. Patient needs for all four phases should be addressed before anesthesia is commenced to ensure patient safety. All anesthetic machines, along with the anesthetic monitoring equipment, must be prepared to function normally.

Compare – The best way to ensure optimal and thorough preparation is to have a checklist so that the anesthesia specialist can compare their actions to the checklist actions. Checklists save lives by ensuring that nothing that the patient needs is missed. A critical point to consider is that although standardized protocols are a good thing in general, every patient is still an individual and needs individual care. Comparing equipment setup and maintenance with checklists is likely even more important than using checklists for the patient since there is no standardized order for setting up and checking equipment.

Be Aware – Numerous factors have been shown to contribute to anesthesia-related complications (depth of anesthesia, body temperature, etc.), and one factor contributes significantly to decreased complications: monitoring of physiologic variables. Not a surprise, just a good reminder on the importance of being aware of the physiologic status of the patient.

Improving Patient Mood Helps Everyone

Happy patients are healthier patients, while conversely, stress can cause or contribute to illness. Patients also are less likely to tell you about their symptoms if they feel rushed or ignored, studies show. Building rapport and a relationship of trust can help them feel better about their care—and more likely to follow your instructions.

Research shows humor reduces stress, lowers blood pressure, and strengthens the immune system. You may not be a comedian, but if you can get patients laughing – or at least smiling –you’ve improved patient mood.

Use music to help patients relax. Interventional pain management physician Jessica Jameson, a classically trained singer, sings to patients as she performs spinal injections. But you don’t have to be a singer to use music to calm your patients. Have relaxing music in the waiting room or play patients’ favorite tunes during times of anxiety, such as before or during procedures.

Be empathetic in your conversations with patients. Up to 75% of patients say their doctors lack empathy, according to one study. Show you care by asking patients about themselves—not just their medical concerns. 

Sit down and make eye contact. Surveys show when doctors stand, patients feel rushed, so sit and face them. If you’re late, apologize. Use open body language, angling your body toward theirs. Make eye contact and use everyday, “non-jargony” language. Listen to their concerns and ask questions as needed.

Create rapport by sharing information about yourself. You may not be a natural conversationalist, but there are ways to show your humanity with patients, which can help them feel comfortable opening up to you. One way to build rapport and create a trust-filled, positive doctor-patient relationship is to share details about your life and your interests, such as your family or hobbies, while also soliciting information about theirs.

And don’t forget to also heal thyself. Physician burnout is linked to poorer patient outcomes. If you’re stressed and exhausted, you may be less likely to tune in to your patients and less able to provide the empathy and uplift they need. By placing a priority on your own mental well-being, you will be better prepared to help your patients feel better, both physically and emotionally.

It can be challenging at times to practice these skills consistently, but the rewards are worth the effort.

 

Sources:

Anesthesia Best Practices: Prepare, Compare, Be Aware. aaha.org

9 Ways to Lift Your Patients’ Spirits. healthgrades.com

To become a successful doctor, you need to do the work of creating and sticking to sustainable personal and professional habits. With the required physician skills mastered, it then comes to what you can bring to the table as a person.

We live in the instant era where people have grown increasingly impatient and life has grown increasingly hectic, including the lives of anesthesia specialists. This can’t be ignored.

It is time to make punctuality a priority, work on improving communication to make sure to articulate your desires clearly and succinctly, and then be adamant about protecting your down time. You need this time to recharge so that you can be more effective and more successful in your practice.

• Be punctual
• Communicate clearly
• Establish boundaries
• Make rest and recovery a priority
• Learn something from others
• Block out time to think
• Read on a regular basis

Learn what you can from other doctors, even those with less experience. Teaching is one of the better ways of learning something. By asking them to educate you, you’re helping to cultivate the next generation of doctors.

If you’re busier than ever, devote some time to thinking. Regardless of your level of activity, your personal and professional problems aren’t going anywhere. In fact, they might be piling up. The only way to solve them is to consider them. And the only way to consider them is to devote time to thinking.

Even if you spend just five minutes at the beginning of your day thinking about the day’s most important question (MIQ). At the end of the day, spend another five minutes revisiting your MIQ. What insights or solutions did you come up with? Repeat the process the next day.

Reading helps take your mind off of work stresses, can stave off late-life cognitive decline, can make you more empathetic, and you might even learn a few things. The average American adult is spending about 45 minutes daily on social media. Imagine how much knowledge you could acquire if you spent that time reading something useful.

Excellent Medical Leaders Inspire Others and Create Positive Change

Not all physicians or healthcare providers are cut out to be health leaders, as medical leadership requires both professional knowledge and essential leadership traits. At its core, leadership is about inspiring others to work toward a better tomorrow. You must have a positive outlook and strong sense of hope for the future if you are to lead others. Key leadership qualities include:

• Optimism
• Vision
• Integrity
• Introspection
• Empathy
• Adaptability
• Patience
• Vigilance

Leaders can see beyond what is, to what might be – and they can convey that vision to others. They must be reliable and honest as they set the moral tone of their organizations, and their personal behavior should be consistent with their stated values.

A leader must be able to recognize when they need to adapt their behavior. They deliberately cultivate habits to help regulate their emotions and manage stress.

Good medical leaders stay abreast of industry news and pending legislation. They are often involved in professional organizations and frequently attend conferences and read trade publications. They monitor social media and community chatter for both positive and negative news about their organization so they can respond appropriately.

Results take time. Leaders typically have grand visions, but good leaders know that change is incremental. They appreciate small steps and continue the course.

The best leaders empower others. Understanding others allows you to put them in positions where they will flourish, which will help your organization flourish in turn.

As medical leader, you’ll be required to deal with all sorts of challenges – some predictable, some not. You will not have the luxury of working in an ideal environment; instead, you must be prepared to lead through chaos.

If you possess these qualities of a good leader, you just may be poised to make a big difference in your anesthesia practice or professional organization.

 

Sources:

8 Traits of Good Medical Leaders. healthgrades.com

7 Habits of Successful Doctors. mdlinx.com