Anesthesiologists and Dumb Pipes

  • Kotecha, Mona, MD
| Oct 03, 2011

Editor’s Introduction: This week, CSA Online First is taking a different approach in publishing an opinion piece submitted by a CSA member who is not yet in a leadership position. We encourage members who have ideas that they believe would be of interest to other CSA members to email their articles to the CSA’s Communications Manager, Merrin McGregor, at

Comcast and AT&T executives stay up late at night worrying about becoming "dumb pipe" purveyors, meaning that all they do is transfer bytes of data back and forth. They don't add any value to the flow. They're forgettable, interchangeable and easily replaced. Now anesthesiologists are in danger of becoming the "dumb pipe" specialists of the medical profession. It's no exaggeration; when I entered residency in 2005, I never would have thought that my specialty would be viewed as merely enabling the flow of patients from the preoperative area to the recovery room with as little noise and as few adverse incidents as possible. Staunchly clutching to the outdated notion that the most effective anesthesiologist—or anesthetic—is the entirely forgettable one, has contributed to the challenges our profession faces. Our life’s work has gone unnoticed for too long. We should strive to become as noticeable and unforgettable as possible.

To promote our specialty, we should first take ownership of the entire perioperative experience. Preoperative planning for any surgical patient should begin with the immediate engagement of an anesthesiologist. Not every patient needs to visit his or her primary care doctor, see a cardiologist or have any preoperative testing done at all. It’s high time we fully coordinate the decision of who needs what before surgery. This means insisting on payment for a preoperative clinic visit, accepting full responsibility for the preoperative medical workup, personally deciding upon subspecialty referrals and vigorously interfacing with the patient’s other healthcare providers.

Second, we should strive to become more visible and accessible to the patient and his or her family at every opportunity, beyond the day of surgery. I imagine a world where a newly pregnant patient selects her anesthesia care group with the same care and knowledge with which she chooses her obstetric group. She deserves the chance to learn how anesthesia care can influence her birthing experience, and she deserves a choice in who provides this important care. The informed consent discussion and the postoperative visit both serve as distinct opportunities for more visibility and continuity; both are chances to educate families and caregivers about our role in their loved ones’ care and to learn from our patients’ experiences.

Third, we should personally market our brand of services directly to hospitals and patients. Orthopedic surgeons attract patients with their cutting edge and evidence-based interventions and novel surgical
techniques. We can attract patients and surgeons with our advancing subspecialty expertise in the fields of regional, pediatric, obstetric, pain, and cardiothoracic anesthesiology, and we can potentially expand our subspecialties to other areas like hospice and palliative care. Moreover, our practicing state of the art, compassionate, and evidence-based medicine in all of our patients, even those not needing subspecialty expertise, should be marketed and deployed to draw patients to the facilities in which we practice. Patients have become more sophisticated and knowledgeable, learning about their interventions and providers on the internet. If we expand access to information about our expertise, patients will eventually demand that level of expertise in their care.

Finally—and I believe most crucially—we must fully leverage the value of our human capital by nurturing a broad set of voices within our ranks. Fostering diversity in our profession is more than paying lip service to a politically correct cliché; it is essential to our success in modern medicine and is a long term, valuable investment in the future. Without a healthy debate between anesthesiologists who draw from different backgrounds and experiences, including those who present dissenting viewpoints, we will not develop innovative solutions to the challenges our professions faces. In my opinion, homogeneity of leadership appears to be our fiercest barrier to innovation. Our future champion may be a minority or female, old or young, a transplant from another career or medical profession, a part-time worker, or one who took a break during his or her career. If we promote our field as an equal opportunity one and create inclusive work environments, we will succeed in recruiting and retaining the most gifted and creative medical students.

Fighting scope of practice laws and regulations, and lobbying legislators and regulators for higher payments and better recognition of our efforts may be useful first steps, but ultimately they will be of little help in achieving a fundamental reinvention of our field. Advancement requires each one of us to promote our specialty, to expand our services, and to build a brand of medical care that is irreplaceable and above all, benefits patients. The opportunity for the promotion of physician-led anesthesia services exists at every patient and family interaction, departmental personnel and staffing decision, and hospital staff interaction. Customers of broadband Internet providers take notice of Google, Facebook and Netflix—but ignore the pipe that delivers the experience to them. Without rethinking the fundamentals of our profession, we'll be perceived as the latest “dumb pipes,” no more than affable automatons enabling the flow of cases through the operating room with little fuss. In reality, we have the capacity to be hospital managers, advocates for equal opportunity, perioperative team leaders, and subspecialists who ultimately improve the well being of our patients. Do we have the will and courage to make it happen?

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