Nathan Waxer, DO
Can a machine perform anesthesia as well as a human?
This
is a question that is not necessarily unique, however is certainly
worth discussing. A recent paper published in the February 2012
Journal, Anesthesiology by Liu et al. entitled "Feasibility of
Closed-loop Titration of Propofol and Remifentail Guided by the Spectral
M-Entropy Monitor" essentially compared humans and a machine in their
ability to maintain patients sedated at a predetermined state entropy
level. The findings of their study suggest that a Dual closed-loop
controller (a machine) outperformed manual control (a human).
Although
this was a machine programmed to only control a few limited specific
parameters and was not able to perform any other of the multitude of
duties and responsibilities required of an anesthesiologist, it is
fascinating to think of the possibilities that an "anesthesia machine"
could provide.
We are already in full flight of the
technological age with the majority of new anesthesia machines having
electronic charting and vital sign monitoring. If there was a machine
able to safely titrate medications to maintain blood pressure and heart
rate within a specific set of parameters, this could ultimately free up
the hands of the Anesthesiologist to perform other important duties in
the operating room. Oftentimes when there is an unstable patient having
an extra pair of hands is invaluable, but if a computer could
essentially provide that pair of hands, it could perhaps make a
challenging case more manageable and routine.
Of
course there are naysayers who will argue that a machine could never
replace what an anesthesiologist does and is not able to multitask and
provide the critical thinking and problem solving that a human can. I
for the most part am in agreement with this statement, at least for the
recent foreseeable future. However, we already have 'mechanical'
ventilators, video laryngoscopes, echocardiography and a number of
computerized devices that aid physicians already, and I only see that
increasing as time goes on. But at least for now, a human physician is
able to see a patient, elicit a succinct but pertinent history and
physical from a patient and determine an anesthetic plan in the matter
of seconds. At this time, there is no machine that could replace the
airway management an anesthesiologist provides with induction of
anesthesia. And what if induction does not progress as planned, would a
machine be able to quickly assess and skillfully utilize the difficult
airway algorithm when necessary? I feel that this is just the
beginning of where we are headed. And although one can look at these
changes in a negative light, I feel that there is so much opportunity
and potential that will prove to aid anesthesia providers in the future
and improve the practice of anesthesia. Let the future begin now.
Showing posts with label Practice Management. Show all posts
Showing posts with label Practice Management. Show all posts
Friday, May 25, 2012
News Update: CRNA's in California-editorial, Dr. Waxer
Nathan Waxer, DO
In California on March 15, 2012 in the suit California Society of Anesthesiologists v. Superior Court of City and County of San Francisco it was ruled by the appellate court that CRNAs are allowed to practice anesthesia in California without direct physician supervision. The implications of this ruling are huge. If this appeal holds, then CRNAs can now practice and bill for anesthesia services. Current federal law denies Medicare reimbursements to hospitals that allow nurses to give anesthesia without supervision, unless, however, a state’s governor formally opts out of that requirement after consulting with the state’s medical board. In California, that is what Governor Schwarzenegger did while he was still in office. On the surface this seems like a disastrous ruling for the CSA and Anesthesiologists. Now physicians are being forced to "compete" head to head with lesser trained practitioners of Anesthesia for their share of the pie. One could make the argument, why not hire a nurse anesthetist? I can get more or less the "same" care for about a third of the cost of hiring an Anesthesiologist. On the surface it seems like a simple economic decision. More hospitals should hire CRNAs if that is the case.
However, it is not that simple. Physician Anesthesiologists provide so much more than just direct anesthesia care in the operating room or OB.
First off, for the price of an anesthesiologist, one typically gets a physician who typically works 60-80 hour weeks, sometimes a lot more, day and night. Physicians are not bound by any 6-2 working hours. Their duty is to provide patient care from start to finish, not shift work. Nurse anesthetists on the other hand, typically work 40 hour weeks, usually during the daytime hours. When their time is done, they can usually just clock out. An anesthesiologist on the other hand on a typical day may be supervising multiple rooms, taking care of a busy OB suite, monitoring patients in the PACU, fielding consults from the ICU, ED and dealing with hospital administrative duties. Not to mention a physician is also often on call multiple times a week, available to provide care at any hour of the day. Anesthesiologists can't just "clock out" after a certain number of hours. Anesthesiologists breadth of duties are expansive and beyond just the anesthetic care of patients in the operating room or OB suite. After rigorous training in medical school and even more demanding training while in residency, anesthesiologists become skilled problem solvers with a skill set that places them above and beyond being just a well trained anesthesia provider. Anesthesiologists are first and foremost, physicians, and with that distinction also comes with it a wealth of knowledge and unique skills that cannot ever be replaced or supplanted by certified registered nurse anesthetists. Perhaps one day we will look back on this ruling as a blessing, because it will serve to remind us that there is so much more to being an anesthesiologist than just providing "anesthesia".
http://www.scribd.com/doc/
In California on March 15, 2012 in the suit California Society of Anesthesiologists v. Superior Court of City and County of San Francisco it was ruled by the appellate court that CRNAs are allowed to practice anesthesia in California without direct physician supervision. The implications of this ruling are huge. If this appeal holds, then CRNAs can now practice and bill for anesthesia services. Current federal law denies Medicare reimbursements to hospitals that allow nurses to give anesthesia without supervision, unless, however, a state’s governor formally opts out of that requirement after consulting with the state’s medical board. In California, that is what Governor Schwarzenegger did while he was still in office. On the surface this seems like a disastrous ruling for the CSA and Anesthesiologists. Now physicians are being forced to "compete" head to head with lesser trained practitioners of Anesthesia for their share of the pie. One could make the argument, why not hire a nurse anesthetist? I can get more or less the "same" care for about a third of the cost of hiring an Anesthesiologist. On the surface it seems like a simple economic decision. More hospitals should hire CRNAs if that is the case.
However, it is not that simple. Physician Anesthesiologists provide so much more than just direct anesthesia care in the operating room or OB.
First off, for the price of an anesthesiologist, one typically gets a physician who typically works 60-80 hour weeks, sometimes a lot more, day and night. Physicians are not bound by any 6-2 working hours. Their duty is to provide patient care from start to finish, not shift work. Nurse anesthetists on the other hand, typically work 40 hour weeks, usually during the daytime hours. When their time is done, they can usually just clock out. An anesthesiologist on the other hand on a typical day may be supervising multiple rooms, taking care of a busy OB suite, monitoring patients in the PACU, fielding consults from the ICU, ED and dealing with hospital administrative duties. Not to mention a physician is also often on call multiple times a week, available to provide care at any hour of the day. Anesthesiologists can't just "clock out" after a certain number of hours. Anesthesiologists breadth of duties are expansive and beyond just the anesthetic care of patients in the operating room or OB suite. After rigorous training in medical school and even more demanding training while in residency, anesthesiologists become skilled problem solvers with a skill set that places them above and beyond being just a well trained anesthesia provider. Anesthesiologists are first and foremost, physicians, and with that distinction also comes with it a wealth of knowledge and unique skills that cannot ever be replaced or supplanted by certified registered nurse anesthetists. Perhaps one day we will look back on this ruling as a blessing, because it will serve to remind us that there is so much more to being an anesthesiologist than just providing "anesthesia".
http://www.scribd.com/doc/
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