“If you want this anesthesia thing to be a career instead of a mindless job… our challenge is to put more health into healthcare.”
The 2019 Rovenstine Lecture was given by Surgeon General Jerome Adams, MD, MPH. Dr. Adams is the first anesthesiologist to serve in this capacity, and the 20th Surgeon General since the office was created in 1871.
Dr. Adams led Indiana’s response to Ebola, Zika, and AIDS when he served as the State Health Commissioner. He reminded us all that healthcare does not equal health. We only spend about 4% of our dollars on healthy behaviors, and 88% on medical services.
Dr. Adams was born and raised in rural Maryland, and got his first job at age 10 to help his parents (both teachers) stretch to feed and clothe the family. He worked in the southern Maryland tobacco fields, as did his grandfather. His grandfather suffered and died from lung cancer. Despite the medical concerns, his top priority at that time was how to generate income.
That experience has helped him to understand that physicians need to take into account each patient’s priorities. Most of us tend to prioritize financial wellbeing — over sleep, healthy food, exercise, or time with family. We all do what we must to pay the bills. Surveys all indicate this is the most important issue for all groups, and healthcare follows behind.
Patient outcomes are more determined by circumstance and environment than most people realize. An asthma patient who is discharged to a housing complex full of second-hand smoke will continue to have exacerbations. A grandfather who needs a gun to drive the coyotes away from the chicken coop can’t feed his family if the gun is taken away. The coal miner who loses his job when the mine is shut down “because of climate change” turns to drink and drugs.
Dr. Adams noted that in Indiana the biggest complaint from business was an inadequate pool of healthy job applicants. Over 2/3 of the young people in this country are not eligible to join the military if they wanted to because of obesity and other chronic illness. Amazon placed their newest site in Virginia in part because it was a very healthy community (so has a healthy pool of workers).
Dr. Adams took office in September 2017. Since that time, he has issued the first Surgeon General’s Advisory in 13 years (April 5, 2018), urging more Americans to carry Naloxone. He pulled his out of his pocket to demonstrate how easy it is to use. He told of his family’s struggle with addiction, with his younger brother addicted to heroin and now in jail.
He has a Digital Postcard on Opioid Misuse, as a part of the Spotlight on Opioids. Anyone can download the postcard, or the full report from the Surgeon General’s website.
When discussing his advisory on E-cigarette epidemic among youth, he commented that his 9-year-old daughter knew what Juul was.
Dr. Adams reminds us that the definition of a physician is a professional who practices medicine: promoting, maintaining, restoring health. We are not just proceduralists, and the future of a “proceduralist anesthesiologist” has limited room for growth. Out future needs to include advocating beyond the operating room: encourage those new parents to stop smoking while you’re putting in that labor epidural; remind everyone to get their vaccinations when you see them in preop; talk about safe storage and disposal of opioids.
Dr. Adams has been engaged all of his career, starting as a member of the ASA Resident Component and serving as the Alternate and Delegate to the ASA House in 2004-2006, before moving up with the Indiana Society of Anesthesiologists, the Indiana Medical Association, and the State of Indiana. He challenges all of us to do our part by staying engaged. We may not all be The Nation’s Doctor, but we can all be a doctor to the nation.
To view the Surgeon General’s website, click here.