Central Line
Episode Number: 93
Episode Title: Economics,
Equity, and Patient Safety
Recorded: March 2023
(SOUNDBITE OF MUSIC)
VOICE OVER:
Welcome to ASA’s Central
Line, the official podcast series of the American Society of Anesthesiologists,
edited by Dr. Adam Striker.
DR. ADAM STRIKER:
Welcome back. I'm Dr.
Adam Striker, and this is Central Line. Today, we have a terrific episode for
you. We welcome doctors Christopher Troianos and
Grant Linde to the show. And these two happen to be guest editors for a very
hefty Monitor supplemental issue involving economics. I've already perused the
issue. It's out. I'm excited to talk about it because there is a lot to get to
today. So Doctor Troianos
and Doctor Linde, welcome to the show.
DR. CHRISTOPHER TROIANOS:
Thank you. It's our
pleasure to be here.
DR. GRANT LYNDE:
Yeah, thank you, Adam.
It's exciting to be back.
DR. STRIKER:
Well, let's delve right
into it. The interesting thing about this monitor issue, this publication is
divided into three sections that collate topics around various themes of
interest, but centrally speaking, related to economics. It's economics and
equity, economics and patient safety, and the general economics of
anesthesiology practice. And these pairings reflect the innovative
collaboration that took place between various ASA sections, both in terms of
the work product and this particular issue. And so I want to start off by talking about that dynamic,
working with the different sections to put together this issue that really
covers a lot of ground. So let's start with Doctor Troianos. Do you mind talking a little bit about that?
DR. TROIANOS:
Yeah, there may be a
reason why it has an economic focus and I'll get to that in a minute. But as we
all know, the ASA is really dedicated, as we read from its mission statement,
to raising and maintaining the standards of medical practice, particularly of
anesthesiology, and to improve patient care as a result. ASA supports its
membership of physician anesthesiologists and really all members of the acute
care teams to advocate for patients who require anesthetic care, critical care,
or relief from pain. The ASA Monitor publications is really one such way that
the ASA supports his members, and this particular April
supplement, I think, takes the publication to the next level.
In terms of the
committee work you referred to, there's a natural overlap of committee work
within a section through the oversight that I and Grant have as section chairs.
So for example, a couple of committees within my
section on professional practice are the Committee on Economics and the
Committee on Practice Management. They often work together on the best ways to
educate the membership on topics such as alternative payment models, and then
inform the membership on how that affects or may affect their medical practice.
And actually the two committee chairs of economics and
practice management actually sit on each other's committees and they often
contribute to each other's work products. But there are less obvious
opportunities to develop ASA work products across different sections,
especially within committees of other sections. And so
Doctor Lindy and I really seized this opportunity to promote that collaboration
across our committees within my section of professional practice and Doctor
Lindy section on professional standards, which are all within the Division of
Professional Affairs, which is led by Doctor Lois Conley, who serves as the ASA
Vice President for Professional Affairs.
We're really pleased on
how the topics evolve, where the various committee representatives work closely
together to create extremely valuable insights into the issues that we face
today as a specialty. We sort of just let them run with this. And then we
discovered that the topics, as you mentioned, did lend themselves to grouping
with some common themes. And so we created those three
sections you mentioned: economics and equity, economics and business, economics
and patient safety. And if it does sound like the supplement is is slanted toward economic issues, I think there may be a
couple of reasons. First of all, I chaired the ASA Committee
on Economics for a few years, so there may be some bias there. But probably
more importantly is that economic issues are placing a huge burden on our specialty as a whole. When we consider the demand for
caregivers, who command more competitive salaries for their services, while in
the context of declining payments from government payers in
particular, to the increasing complexity of our older patients who
require more intense care and oversight within the operating room and
preoperatively, it's really daunting. Many groups, both private and academic,
are increasingly dependent on hospital support to remain viable and we are very
concerned that it's not a sustainable long term
strategy for our specialty. So that's really why I
think there's a slant toward economics in many of the topics in this particular
issue.
DR. STRIKER:
I do want to get into
the details a little bit before we do. Dr. Linde, how was your experience
working across the silos this way? Do you think there's something new about it
or does this evolve work products in the ASA in any way?
DR. LYNDE:
I think that's a great
question. And I think that as we look forward, there are a lot of opportunities
within ASA to break down some of the silos between groups. For example,
something near and dear to my heart, the Committee on Quality Management,
Department, Administration, or QMDA, intersects with federal regulatory bodies.
And when you think about that, amongst the many things that occur regulatory
wise, we deal a lot with equipment and facilities, which ASA happens to have a
committee on that. And so, you know, as you think through, none of us really
live in a silo, but we need the ASA. We need to work across the aisle with
people who are experts in these different areas in order to
really get the results we want and have the success that we want as an
organization. So I really do think there's a lot here.
DR. STRIKER:
Well, Dr. Linde, like I
mentioned, I want to touch on all these categories. Let's start with economics
and patient safety. Patient safety is of paramount importance to what we do,
and there is significant pressure on all of us to accomplish more with fewer
resources. How do we know when production pressure is creating an unsafe
clinical environment, and how can we preserve patient safety and provide our
well-being and response to unreasonable production pressures?
DR. LYNDE:
Last week I was at the
American College of Healthcare Executives Congress on Healthcare Leadership.
And, quite frankly, this is a question everybody's asking because, you know,
we're under a lot of pressure, especially with the health care shortages, not
only of physicians, of nurses, everybody. And hospitals are struggling to
provide the services while they're under both financial pressures and staffing
pressures. So if you think about it, just three years
ago, our hospitals were doing pretty well. And overall, they're making money
and they were looking forward to working through alternative payment models.
And, you know, we're really starting to think about this productivity model to
a degree. But COVID happened and turned everything upside down. And, you know,
as anyone who has looked at locums or hires locums, you know, our staffing
costs are absolutely out of this world and inflation
has hit the price of everything from ACE inhibitors to x rays. So there's a lot of financial hardship for hospitals across
the country. And, you know, there are questions about how various hospitals can
find their sustainability. And we all are probably asking all the same
questions.
So our anesthesiology communities should consider
having a personal checklist, asking some reflective questions before you get
going in your day, like have you completed all your necessary important safety
checks? Have you appropriately evaluated your patients? Have you communicated
with your surgeons and nurses? Or even importantly, have I, If I anticipate any
difficulties, do I have adequate backup for my plan B or plan C? You know, one
of the other ones that's near and dear to my heart, do I feel well rested? And
that can be a challenge in this environment, you know, having your basic needs
taken care of. So I think we need to reflect on all
these areas. And while we all want to take care of every patient and take care
of our surgeons, sometimes we need to stop and take a breath before we move
ahead. Because, you know, the reality is none of our patients wants to
experience harm because we're rushing ahead and trying to do everything for
everyone.
DR. STRIKER:
Well, when we talk about
patient safety, that is something that's critically important to all of us. And
I think that is a component of quality to me. When you define quality of anesthetic
care, safe care is at the top of that list. And quality can encompass a lot of
facets. And Doctor Troianos, it's a big topic
quality. And if you don't mind talking to us a little bit about how you lead or
develop a strong quality program, let's focus a little bit on leadership, how
we, individual groups or we as a specialty, develop
leaders to enhance their quality programs or utilize quality programs in such a
way that it it is beneficial to the practice at
large.
DR. TROIANOS:
Well, that's a great
question, Adam. And actually there is an article
within the supplement that deals with that precise topic. But the bottom line
is that there's an important balance between speaking up, you know, saying no
to production pressures and the role of the leader to really support a just
culture of speaking up. Anesthesiologists collaborate and interact not only
with physicians of virtually every specialty, but they also collaborate and
interact with other stakeholders such as nursing, pharmacy, accreditation, risk
management, biomedical engineering and operations,
just to name a few. And it really behooves our health care systems to leverage
our anesthesiologists’ comprehensive medical knowledge, their long history as
patient safety advocates, and their operational expertise in the perioperative
arena. Speaking of leadership, we are seeing more anesthesiologists serving in
some type of hospital wide leadership role. They may become a chief quality
officer, chief medical officer, chief operating officer. They could be
presidents of the medical staff. And we know of several that are presidents,
CEOs of a whole health care system. So it's really
somewhat natural for us to use our interpersonal and interprofessional
knowledge and communication skills that we use every day working in an
operating room to create a hospital wide patient safety culture where we
leverage our error analysis and prevention expertise to establish and implement
high reliability systems to improve patient care.
I look at us as really
being the center of the spoke, if you will, connecting the patient, the
hospital environment and all who have some type of connection with the patient,
whether it be the lab, radiology, cardiology, the surgeon
or nursing. So that's that's the way I see ourselves as leaders within the health care system,
particularly in this environment that, you know, advocates for patient safety
and promoting quality.
DR. STRIKER:
And as I was reading
these articles in the current supplement issue for the Monitor, a common theme
amidst almost every article was the involvement of anesthesiology in hospital
operations. Whether you call it the C suite, whether it's just clinical
operations, administrative duties, whatever it is, it seemed like that was a
common theme. Whatever the issue was, whether it's
ethics, equity, safety, quality, that the anesthesiologists need to be involved
in this decision making when it comes to organizational level decisions or
local hospital level decisions. Would you agree?
DR. TROIANOS:
Absolutely. And we
really, you know, shouldn't shy away from that. That is our future is to become
leaders in this area. It's no longer a matter of, you know, how well can you
squeeze the bag. It's it goes beyond in the operating room caring for that
patient, but it’s interacting with that whole system. And the other people that
intersect with that patient at that particular time,
both before and after their surgery.
DR. STRIKER:
Dr.
Linde, let's turn to equity.
The existence of bias in medicine, it's prevalent. It's confirmed by numerous
studies. There was a recent study, I believe, that found that 40% of first- and
second-year medical students believe black people's skin is thicker than white
peoples. And we have talked on this show a number of
times about the ways biases can impact health outcomes. We've talked about it
from a number of different angles. I'm wondering if
you can talk about the need for a diverse workforce and and
tell us where our specialty stands in the effort to diversify anesthesiology.
DR. LYNDE:
Yeah. As you point out,
diversity is an incredibly important subject. And, you know, to many degrees, I
think that the current political climate is preventing a thorough examination
of many aspects of this important concept. At its core, diversity is
recognition that no two humans are the same and that we all have different life
experiences and may have different goals and prioritize our needs differently.
And with that in mind, a particular interest to me is, is some of the
artificial systemic barriers to inclusivity. For example, you know, our society
in the United States emphasizes that you always need to progress in one's
career and that there's only one acceptable path to move forward. However, you
know, we've really seen this as an arbitrary rule. There's no particular reason your path has to look a certain way. And,
you know, there's certainly import to breaking that
barrier down to allow our specialty to be more inclusive to people with young
families, people who need to care for sick relatives or sick friends. And so this is a challenge that we need to work on as a whole.
Anesthesiology has been improving as a specialty, but we certainly have a long ways to go. Despite the fact that
women are around 50% of graduate medical school students. Only one third of the
current residents in anesthesiology are female. And similarly, despite the fact that 30% of the US population identifies as
black or Hispanic, only 14% of our residents identify as black or Hispanic. So,
you know, I think there is a
important direction that we all need to head to identify reasons for these
barriers and ask ourselves, what are we doing to try to bring folks into the
fold and to see what we can do as a specialty to say, okay, these are
unacceptable barriers, preventing otherwise amazing people and amazing doctors
from from joining us.
So ASA has taken many steps to increase diversity
across the organization. Two examples I'll highlight right now is, first, the
Committee on Professional Diversity sponsors a mentoring grant that
successfully has developed many mentors and sponsorship pairings for a lot of
impressive people involved in that, folks who are mentees and getting engaged
in committees, their state components, and they collaboratively work on a
project in the anticipation that gets presented at the annual meeting.
Similarly, ASA, in its committee selection process, has improved the software
that helps chairs to diversify their committees. And when I talk about
diversity on committees, I'm talking not only about sex or race, but also
practice type. Private practice versus academic. Rural-urban. The geographic
diversity and even career stage that people are at. And you know, when you
think about it, why this is important, this diversity is important not only for
our patients, because we are ultimately trying to provide safe care for our
patients, but it's also important for our specialty because, quite frankly,
there are issues that perhaps are very well known within a segment of our
membership but may not be known or understood by another segment membership.
And so by having diversity on the committees, it
allows the committee work products to and ASA statements to represent us as a
specialty and not any one particular group of individuals.
DR. STRIKER:
Let's talk a little bit
about rural access, because that's another topic in
this issue. You know, the economic realities of what is happening with rural
access and specifically there's an article about pediatric rural access. And
according to a recent study, this is cited in the article, nearly 10 million
children in the United States live greater than 50 miles from a pediatric
anesthesiologist. And that's certainly one example of how rural systems have
limited resources available to them. So, Dr. Troianos,
how do you reconcile the standards and guidelines put forth by national
societies or specialties outside of anesthesiology with the reality of this
limited resource in certain areas?
DR. TROIANOS:
Yeah, that's obviously a
big challenge. I mean, as we know, children younger than the age of one have
the highest incidence of morbidity and mortality under anesthesia. They have
increased risks of hypoxemia, bradycardia, bronchospasm. And that prompts many
places to choose something like two years of age as the cutoff for an
anesthesiologist with special training or experience to care for these younger
children. The American College of Surgeons or ASC guidelines also reflect a
decreasing anesthetic risk with increasing age and subspecialty training or
experience in pediatric anesthesiology, local hospital resources and support
staff are really some of the most important safety factors to help mitigate
these risks. Besides that study, European studies have
also shown that experience of the senior member of the anesthesia team is one
of the most beneficial determinants in patient outcomes. But the premise of the
ASC guidelines is that younger patients, especially those with comorbidities,
can be more safely cared for in tertiary care centers, with advanced resources
readily available such as ECMO, supportive surgical specialties and medical
specialists. But the reality is that many children, as you pointed out, don't
live near one of those types of tertiary care centers.
So what rural hospitals grapple with is that the
decision to transfer a patient has to be weighed against the risk that a
delayed diagnosis or delayed treatment could have on that patient versus the
potential benefits of treatment at that more specialized pediatric center. So one example might be, you know, appropriate care of an
urgent or emergent medical condition, such as a teenager with testicular
torsion. That may favor actually keeping the patient
in that rural center for surgery. These patients, as has been shown and
referred to by the American Board of Urology, that they have a two and a half
times increased rate of testicular loss when the transfer is beyond just 30
miles. So the ABU considers surgical treatment of
testicular torsion to be within the bounds of core urologic care that should be
offered at a rural hospital. Similarly, care of an uncomplicated child
presenting for relatively noncomplex surgery should likely also be considered
within core anesthesiology training, and often that would afford the best
chance for the best patient outcome.
But on the other hand,
you know, rural hospitals may not provide this full spectrum of pediatric
services that might be necessary for a particular child. I'm thinking things
like neurosurgery or complicated general surgery. And they may not staff
intensive care units that are specific for pediatric patients following
surgery. And so for that situation, community and
rural hospitals often create transfer agreement with specialized centers to
facilitate that transfer of patients.
Another approach for
rural hospitals and higher capability, tertiary care hospitals, is to create a
more standardized pediatric management protocol, established and maybe further
the use of telemedicine and improve inter-facility coordination and information
transfer.
Finally, the other thing
to consider is that rural hospitals need that whole perioperative team of
anesthesiologists, surgeons, operating room nurses, and PACU nurses to maintain
at least a baseline level of comfort and expertise with the care of pediatric
patients. And this is an argument why rural centers should perform at least
some routine pediatric surgeries in order to maintain
that proficiency in the overall perioperative care of the pediatric patients.
So deliberate practice is a foundational need for the establishment of and
maintenance of skill and comfort in clinical care and transfer of children at a
high rate may prevent anesthesiologists and other members of the perioperative
team from maintaining that important skill set which becomes necessary when an
emergency occurs. So failure to use this skill set in
a routine setting does put the patient at risk of failure from lack of
experience when a true emergency arises. So the
solution then is to involve those, even without a fellowship, to develop or
maintain some level of expertise in caring for children.
DR. STRIKER:
It's a tough line to toe
for institutions that do not have access to a full complement of expertise and
resources. Just as a little bit of a tangent here. Do you feel that the ACS
guidelines have done a decent job of what they're trying to do, which is
ideally, you know, optimize care for children? Or do you think it's are rural
centers paying for this and a little a little more than they than they should? And
maybe there's no easy answer. I'm just curious to get your take on.
DR. TROIANOS:
No, I mean, they've they've served a purpose to elevate the awareness that, you
know, you have to have some specialized training and
expertise in caring for, especially the smallest patients under two years of
age. So I think that's where that role is. But, you
know, you also have to weigh that, as I mentioned, and
be realistic on what those capabilities might be, what the situation is, and is
there a risk, more risk of transferring versus keeping the patient locally. But
in the end, you know, you should have some level of expertise. But things like
neurosurgery, etcetera, everybody recognizes are best served at a tertiary care
facility. So it's a constant balance between
maintaining the expertise locally for the basic stuff and having some transfer
arrangement where, you know where the patients are going to go when they have
more complicated problems.
DR. STRIKER:
Well, I want to ask you
both some questions about economics and a little bit more about the business
aspect of anesthesiology. So if you don't mind, can
you stay with me through a short patient safety break?
(SOUNDBITE OF MUSIC)
DR. SCOTT WATKINS:
Hi, this is Doctor Scott
Watkins with the ASA Patient Safety Editorial Board. Medication errors remain
one of the greatest threats to patient safety in the operating room. Anesthesia
providers often recognize drugs by the size, color, or shape of the packaging
and use standard color labels to designate classes of drugs. For this reason,
look alike, sound alike, medications are one of the leading contributors to
medication errors in the operating room. Strategies to prevent errors from look alike sound alike drugs include:
arranging drug trays so that look alike sound alike drugs are separated; use of
color coded labels with tall man lettering; use of pre-filled medication syringes;
using technology to scan barcodes and or vials; and using generic rather than
brand names. Finally, no discussion of safe medication practice will be
complete without a reminder to always observe the five rights, the right
patient, the right drug, the right dose, the right time
and the right route.
VOICE OVER:
For more information on
patient safety, visit asahq.org/patientsafet22.
DR. STRIKER:
Well, we're back. Let's
talk a little bit more on reimbursement. Let's talk about the shift away from
siloed fee for service arrangements toward quality and efficient programs or HQEPs.
Dr. Troianos, do you mind telling our listeners a
little more about this and how anesthesiology groups can leverage their
expertise to enter HQEPs?
DR. TROIANOS:
Oh, certainly. So the concept is and the organizational frameworks we have,
I think the ASA has done a nice job to educate people through the concept of
the Perioperative Surgical Home. That serves really as
a launching pad for collaboration with our surgical colleagues on process
improvement, quality assurance, cost effectiveness to really optimize surgical
outcomes. Co-management agreements, and as you mentioned, hospital quality and
efficiency programs, the so-called HQEPs and clinically integrated networks,
CINs, are three examples of organizational relationships that allow anesthesia
groups to collaborate with perioperative stakeholders in health systems as a whole on shared goals. Co-management agreements do not
require a high level of integration, but do allow the
anesthesia groups to collaborate with health systems on achieving those goals.
HQEPs build upon that collaboration as the hospitals bill alignment across
clinical service lines and departments. In terms of compensation, specific
compensation to a group or individuals could be construed in a
number of ways. They can consist of fixed payments for their time spent
on those administrative functions, or the arrangement can be in the form of
variable payments to that individual or group based on achievement of
predetermined quality or efficiency objectives. And these incentive-based
compensation arrangements are usually with respect to a single service line,
whereas the hospital quality and efficiency programs are broader in scope and
involve multiple service lines across the health system. The target performance
objectives that require coordination of care across multiple service lines
therefore need to be broader in scope. The bottom line in all this is that as
time goes on, we're going to see less fee for service arrangements where we
just get paid for doing more, and more of a focus on quality outcomes and
efficiency programs such as the HQEPs do for us.
DR. STRIKER:
Well, let's delve a
little bit into politics, which is not something we often talk about on the
show. You know, politics has always played a role in medicine to some degree,
but I feel like the last decade it's become increasingly important for a number of reasons. Economics is certainly one of them, but
there's also societal culture tentacles, regulatory tentacles to government
influences. And I'm sure there's a lot of new ways in which politics and health
care are now intersecting. Dr. Linde, I'm going to direct this to you. Number
one, why is this happening? And number two, what can we do as clinicians to
navigate all of these different stressors and hurdles,
if you will?
DR. LYNDE:
Yeah. I mean, it's
incredibly hard for me to think of a topic that doesn't have some sort of
political angle these days. You know, whether it's a
car you drive or the grocery store you shop at or even the type of vacation you
take. You know, it seems like partisan politics are everywhere and people from
both sides of the aisle have preferences that are part of their identity in
that partisan politics. You know, beyond that, you know, why do we have
disinformation? I think when you reflect on it, you know, some of this
information exists for individuals to have fame or perhaps for financial gains.
And then not to dive into conspiracies too far, but there is a degree that some
disinformation is is done as part of advertising
campaigns by organizations or even by groups of people that are trying to sway
large public interest in something for a variety of reasons. Sometimes it makes
sense. Sometimes it's hard to even decipher why they're doing it.
So why does this persist
in health care? You know, I think, first of all, our
studies in health care are difficult for laypeople to decipher. Most recently,
one thing that's sticking out in my mind is the Cochrane Review on whether or not face masks are helpful in pandemics. And the
conclusions of this study were essentially, no, they aren't. But what's
fascinating in that article is, is the authors of that particular
article actually had a political agenda. The studies that they included
were not very well controlled. And in fact, most of the studies that they
included were actually from before COVID.
And so
I think it's difficult for anyone who really is dug into that one particular
article to come away from it believing that face masks for general public have
no purpose. But I highlight this article because it highlights some of the
challenges in extinguishing some of the misinformation or disinformation that's
out there. For example, you know, again, a layperson is going to find it
difficult to be able to read all these supporting articles and to understand it
or to understand some of the politics behind the authors and their own
conflicts of interest. It also took a lot of time for me to read beyond the
headlines and actually dig into some of the underlying
data that that supported it. You know, when I think of Cochrane Review, I think
of a very trustworthy organization. And on the surface, I want to trust what I
see coming out of Cochrane or let's say Anesthesiology or JAMA. You presume
these are strong, peer reviewed manuscripts, and others have done some of that
hard work and heavy lifting for me. So when claims are
made by trustworthy groups or organizations, it's hard to overcome that.
And finally, you know,
social media spreads information incredibly quickly, and it causes
misinformation to persist for extended periods of time. And that's also another
challenge that we face. And I think it's just a completely new era from ten
years ago or 20 years ago, where it took longer for information to trickle down
through more centralized sources of news.
So how do we address. First of all, I think we do need to continue and strengthen
their peer review process. You know, ASA and other medical organizations need
to do their very best to be out front and be the pillars of truth and help
clarify when these misperceptions are out there. I think we as individual
clinicians also need to continue to have presence on social media. You know,
some of the changes that have happened on Twitter since Elon Musk took over
have made Twitter less attractive platform for for
many of us to be on. However, I still think it's important that we all have a
presence to try to point out when when misinformation
is out there. And finally, you know, never, never discount that one-on-one
campaign with patients. So, you know, I think back when I was in medical
student in the 1990s, thinking how it was kind of a waste of time sometimes to
talk to a patient who had been chain smoking, that they should give it up. But,
you know, through talking with every patient who comes in door with a history
of smoking, you will eventually convince folks that that that's not the thing
to do. And and look where we are today. You know, the
incidence of smoking in our country is much lower and we're all much healthier
for it. So just one example of of how we as
individuals can affect the broader landscape of misinformation.
DR. STRIKER:
We mentioned social
media. I notice sometimes on social media where you have reputable physicians
that will make commentary on whatever topic that might be. It might be
pertinent at the time. And they may even be an expert in the field. Then you
see a lot of responses to that for whatever reason, whether it's political,
whether it's selfish, whatever, probably from many people that don't have the
same expertise. And this is not unique to medicine, but I'm focusing on it
because that's what we're talking about. But how do we as physicians, how do we
as a specialty, maintain that degree of reputability, that degree of
authoritativeness amidst all this noise? Because I do feel that the more we
sometimes try, the more it ends up just working against us, because all it
takes is one other person who may have a little credential or may cite some
other study or some other fact that gets a lot of traction and it just sort of
washes away or dilutes the opinion or the insight of of
a person that does have that expertise and reputation. And so how do we as a as
a field navigate this? You mentioned we need to be more involved. Do we need to
be more involved than we are? Do we need to be less involved? Do we need to
target our involvement? What do you think?
DR. LYNDE:
Yeah, that's incredibly
tough question. I am one who believes that we need to be more involved or more
than just more involved I'd say more engaged, you know. And I think that
there's a degree that we need to be comfortable saying, I don't know or we don't know yet. One thing that's interesting to
me right now is this conversation around what's what's
the origins of the COVID virus? You know, did it come from a lab? Did it come
from nature? You know, where did it come from? And there are a couple of things
that I noticed in social media. One was this idea of of,
you know, did it come from one place or another? And I think today it's still
impossible to know with absolute certainty the origins of the virus. We have
some hints and clues. One of the questions I actually keep
asking is, why does it matter and how certain do we need to be before you can
plant your flag in it? And it doesn't seem like anyone really has a good answer
to that. Now, another piece I've seen in this discussion, though, is when
people are engaged in this, they are pointing out, let's say, lack of knowledge
at the time as a lie. So one thing that I saw recently
was they quoted President Biden from I think it was two summers ago, and he was
on television saying that if you got vaccinated that you wouldn't get COVID. And,
you know, clearly several of us, many of us have have
had the vaccines and are fully vaccinated and still can get COVID. And what
we've learned since the time that the vaccines came out is that the severity of
COVID following vaccine is much lower than than what
it would could have otherwise been. It may reduce
transmission of COVID, but the degree of that is unclear. But it's certainly
clear that you can get COVID despite being vaccinated. Was that a lie at the time?
Absolutely not. You know, President Biden and the CDC said what they thought
was was correct, that, you know, the COVID vaccine
was going to be like the polio vaccine or, you know, measles vaccine, that if
you're vaccinated and you have a good immune response, that you're not going to
get that disease. But clearly, it's COVID doesn't work that way and certainly
wasn't a lie. But at the same time, it was we didn't have all the information
at the time. And that is a piece that we as health care providers need to be
open about is when we have incomplete information about a particular area.
DR. STRIKER:
This is a big problem
for a number of fields, not just medicine, but there's
so much information out there, so much information and so much access to information.
And it is being wielded and utilized in many different manners and not
oftentimes with the nuance and expertise that is necessary to utilize it as
appropriately as it should be. So this will be
something we'll have to continue to to talk about.
DR. TROIANOS:
Well Adam that's that's exactly right. And if I can add to I think the take
home message is that that our patients are friends, families are going to
question things more than maybe they did 10 or 20 years ago because they have
such ready access to that information and because there's so much information
out there. So one of our pain doctors told me about a
patient who came to see her not because of a pain problem, but she wanted to
know whether she should take the vaccine. And she trusted that doctor's
opinion, despite, you know, everything that was in in the press. It's that kind
of thing that sometimes we lose when we don't have that personal long-term
relationship with our doctors that we once did.
DR. STRIKER:
Yeah, absolutely. Well,
it is a meaty supplemental issue. And and this
discussion is just skim the surface. There's there's articles in there discussing the No Surprises act,
the impact of that, the future of the specialty as it relates to the economic
realities of what of what we will face. Because we just skimmed the surface and
we don't have an unlimited amount of time, I would love if each of you could
tell me one thing you learned or took away from working on this project or
something that you'd like our listeners to know about or something that you
think is important. Dr. Troianos, why don't we start
with you?
DR. TROIANOS:
Sure, sure. Well, the
one take home message, I think, is that we are truly at a crossroads within our
specialty. And, you know, we know the challenges in trying to recruit health
care workers in general in our specialties. And we know that payments are being
challenged as well. But those who lead well during these challenging times will
provide great benefit to our health care systems and our patients for years to
come. The good news is, is that anesthesiologists are especially well suited to
lead their hospital systems right now and to guide the right decisions being
made that will allow for a financially viable approach going into the future.
And we know it's in our DNA to serve and protect our patients in order to ensure those best outcomes. Those are the
biggest take home messages that I had from this supplement. And the one other
thing is that, my goodness, the ASA is filled with
such talented individuals that are willing to probably spend time at home
weekends, evening writing these articles, sharing their insights and knowledge
and support of our specialty, our patients and our members to being the best
they can be. And I specifically want to thank our ASA leadership, particularly
Dr. Connolly, for entrusting Dr. Linde and me to shepherd this important project
for our members. So thank you for the opportunity to
do that and for sharing our thoughts here during this podcast.
DR. STRIKER:
Of course. Of course.
Dr. Linde.
DR. LYNDE:
I think what really
stood out to me was how absolutely incredible our organization is and how
incredible the people within the committees are and what wonderful things you
can see when you take people and you have them work on
a task together and outside their silos of one single perspective. I think that
this is one of the best series collections of Monitor articles that that I've
read. And granted, I'm kind of biased here, but, um, you know, I think that
these articles, there's something in it for everyone. And I think that there's,
there's a lot for the members of all the professional affairs committees can be
proud of. And I'm very hopeful for where we're headed as a specialty based upon
what I read here. And I think that the best is yet to come.
DR. STRIKER:
Well, I completely
agree. I think this issue is it's a it's a fantastic issue. It's well done. Covers a lot and
chock full of information. I certainly highly recommend to anybody listening to
this podcast, read this this particular issue of the Monitor,
even if you don't read the whole thing, there's plenty to pick and choose from,
and I guarantee you're going to be the better for it. And I just want to thank
both of you for joining us today and giving us some insight on the production
of this issue, but also the content of it. I just really appreciate you both both joining us today.
DR. LYNDE:
Thank you very much.
DR. LYNDE: Thank you so
much.
(SOUNDBITE OF MUSIC)
DR. STRIKER:
You can check out the
monitor issue at asamonitor.org. It is out now online. We will be back next
week. So please tune in again next time. And thanks to all our listeners. Take
care.
VOICE OVER:
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