Operating Room and Beyond

  • Matevosian, Rima, MD
| Aug 29, 2011

Some fifteen years ago, I was approached by the chief of my department with a challenge – to take on the job of Anesthesia OR Director. Of course, I was grateful for the recognition and for the opportunity to develop my professional acumen, but not without a measure of trepidation at the new responsibilities the position implied.

This new role represented a significant departure from the practice to which I had become accustomed. To this point in my professional career, I had focused primarily on delivering one-on-one care to patients – this new position brought with it some uncharted territory that required me to move outside of my comfort zone. For the first time, I was on the front lines of every case that came through the OR, concerned not only with patient care, but also collaborating extensively with other departments, hospital administrators, and OR staff to ensure a safe surgical environment.

At the time, I could not have envisioned the importance of these encounters and interactions. While I was keenly aware of my responsibilities in the operating room, the promotion and the added responsibility it brought proved to be an education on the roles that we as anesthesiologists must play beyond the OR, for the benefit of our department, our institution and the larger medical communities to which we belong.

Indeed, the depth and breadth of our participation in the perioperative process and our extensive collaboration with other departments and specialties throughout a range of surgical procedures affords our discipline with both a unique perspective as well as a platform for engineering impactful change at a fundamental level, in hospital operations, but also – and importantly – in the way anesthesiologists are perceived by our colleagues.

As anesthesiologists, we are justifiably proud of our specialty’s long history of innovation and achievement, both in and out of the operating room. Before the terms had found a place in the medical community at large, anesthesiologists championed patient safety and system-based practice, pioneering changes in practice that contributed to dramatic reductions in mortality and catastrophic morbidity as a result of anesthesia administration. Anesthesiologists were amongst the first to draw upon advances in other industries, and apply that knowledge to the practice of medicine, such as borrowing critical incident analysis techniques from the aviation industry to better understand anesthesia-related injuries.

And yet, in spite of this track record for leadership and innovation, the role of the anesthesiologist is sometimes regarded as limited in a modern hospital setting. Too often, the discipline is perceived by our colleagues as having a singular function in the operating room, or worse, accused of being aloof to the day-to-day operations of the hospital. In reality, the precise opposite is true – modern anesthesiology techniques and practices compel the continuous, active engagement of the provider throughout the surgical process, beginning well outside of the OR.

First, it’s important to understand what makes our specialty unique and how this contributes to misconceptions about our role in the broader hospital setting.

With an emphasis on the practice of medicine during the perioperative period, our practice is more aptly described as “systematized” rather than “routine” – while the specific provisions for care may vary, the underlying principles and methodologies remain consistent. And this is advantageous, as during the course of a typical week, it is not uncommon to encounter patients ranging from neonates to adolescents to the elderly, each presenting their own, unique considerations and challenges. In a similar spirit, anesthesiologists work closely with most every department and surgical specialty, participating in every type of operation, from emergent ER cases to planned, elective procedures and most everything in between.

This breadth of exposure would seem to predispose our specialty to broad involvement in the hospital community, though this is too often not the case. Although the misconception that anesthesiologists are responsible solely for the administration of anesthesia is gradually eroding, many of our colleagues, residents and interns, and certainly our patients, still believe this to be the anesthesiologist’s sole function, limited exclusively to the operating room. To be sure, while preparing and administering anesthetic agents remains a central concern of our department, the anesthesiologist’s role is – and must be – broader, if our specialty is to succeed in engineering a paradigm shift in how we are perceived by our colleagues.

Active intraoperative participation by anesthesiologists is one avenue for affecting this sort of meaningful change. As our practice necessarily brings us into close contact with an almost exhaustive range of departments, how we do things is almost as important as the things we do. These procedures afford us with an opportunity to lead by example and to demonstrate not only the merits of our clinical expertise, but also the value of our approach, principles and methodologies. By maintaining the highest standards of professionalism in both attitude and action, we become the very change we wish to see, and can be assured of representing our department in the best light possible.

This constitutes only one piece of the puzzle, however. No matter how impressive our systems, how thorough our documentation, or how effective the care we deliver, our successes will mean little if they take place in the relatively insulated world of the operating room, or worse yet, shared only amongst ourselves.

As physicians, we belong to broader medical communities – foremost, we are members of the medical profession; beyond this, we are integral members of a hospital community, private practice, or medical group. To catalyze a meaningful, enduring change in how anesthesiologists are perceived by our colleagues, we must enthusiastically engage both of these communities of which we are members – beyond the operating room.

On the macro-level, an array of research organizations, professional associations, and working groups would benefit from our involvement. Historically, organizations such as these have contributed to significant advances in our profession, pioneered new techniques and cutting edge research, and fostered a sense of community amongst physicians throughout the world. Our participation directly benefits the profession by furthering the principles of self-regulation, community and the open exchange of ideas, approaches, and methodologies, while at the same time connecting with our colleagues in a manner that’s entirely different than our interactions in the operating room.

On a smaller scale, participation in hospital committees, quality improvement projects and collaborations with other departments aimed at increasing efficiency and safety can serve to not merely increase, but to deepen our specialty’s visibility to the colleagues we work alongside every day. Our engagement in these initiatives contributes to a team-oriented approach and lends our institutions a new perspective to address the most pressing challenges and issues confronting them. At the same time, we have the privilege of serving as ambassadors for our discipline, gradually unraveling the misperceptions and stereotypes associated with our practice through our diligence, dedication and commitment to being part of the team.

Although the specific settings, patients and cases may vary, we are united as anesthesiologists by a set of common principles and objectives that are the legacy of our profession. As the heirs to this proud history, we must demand the highest standards not just in the care of our patients and in the practice of medicine, but also for the welfare of our colleagues, our institutions and our communities. Through a willingness to take ownership, active community participation and our continued involvement throughout the surgical process, we build upon our specialty’s legacy for leadership and innovation, helping to ensure a safer future for our patients, and sharing the experience and unique perspective of our profession.

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