Home About SPA Join SPA Education Newsletter Jobs & Fellowships Volunteer Service Abroad Links of Interest

SPA Newsletter

.

President's Message Steven C. Hall, MD SPA President Children's Memorial Hospital Northwestern University Chicago, IL

One of my favorite quotes from Antoine de Saint-Exupery's classic children's book, "The Little Prince", is "Grown-ups never understand anything for themselves, and it is tiresome for children to be always and forever explaining things to them." At the Winter Joint AAP-SPA meeting, it was interesting to watch the participants. We spent a great deal of time in sessions listening to a wide variety of scientific presentations. Everything from the subtleties of ventilator triggering to the long-term effects of opioids in neonates. But what made everyone look aside and smile was when an attendee walked by with one of their children. The Winter meeting has been designed to appeal to members who might bring their families for a brief trip to a warm environment. Consequently, it is not uncommon to have children of different ages around, especially during the breaks or social functions. However, it is easily noticeable that our membership has a true affection for all children, not just their own, and that this is evident when we meet.

The related observation is that anesthesiologists interested in pediatric anesthesia have a strong tradition of advocacy. Whether through participation in teaching of colleagues, clinical efforts in environs that have limited resources, advocacy at the ASA and other governmental venues, or helping our Society's efforts to become a resource center for those who want to volunteer their services, our membership has shown a clear commitment to activities that advance children and their care. However, the effectiveness of our activities is at risk.

These are challenging times. Although we have taken great pride in being skillful and compassionate clinicians, enterprising academicians, and all-around good people, we seem to be under assault from multiple quarters.

The recent Health Care Financing Authority (HCFA) decision is but one example. The nurse anesthesia community continually asserts that physicians do not bring a unique and necessary level of expertise to the anesthetic care of patients. This view has now been supported by HCFA's decision to permit Medicare patients to receive anesthesia care by nurse anesthetists without physician supervision. Although very few children are covered under Medicare guidelines, the implication is that this applies to all patients. The HCFA decision may or may not have a meaningful impact on who gives anesthesia care to pediatric patients, but it is important that we understand that we need to spread our advocacy for pediatric anesthesia care to areas other than the direct provision of care and education. Local, state, and federal agencies can meaningfully change our ability to practice in a manner that we think is reasonable and best for children.

It is not only governmental agencies that have opinions about how and where we practice. Insurance companies are repeatedly trying to impose requirements that limit their costs. In addition, we as physicians practicing anesthesiology are viewed by others as at the "top of the food chain". One of my friends recently sent me a newsletter from the California Dental Society of Anesthesiology. The newsletter quotes a recent journal editorial by Joel Weaver DDS of the American Dental Society of Anesthesiology (Anesthesia Progress, 46:47, 1999). In the editorial, he talks about the need for dentists to control the practice of anesthesiology in dental and oral surgery offices. He states that "If a concerted, coordinated effort by the entire dental profession, including the major specialty groups, is not made to educate the medical community, lawmakers, and the public that anesthesia is part of the practice of dentistry, it is axiomatic that the 35,547 physician-anesthesiologist members of the ASA with all of their prestige and PAC money will gladly provide the answer of who will provide office anesthesia in the 21st century, while 6,000 oral surgeons and 150 dentist anesthesiologists wonder whatever happened to anesthesia in dentistry." This editorial showed up on my desk at the same time that Dr. Charles Cote's article on adverse sedation events appeared in Pediatrics (Pediatrics 105:805-814, 2000). A third of the reported events occurred in the dental setting.

What is our responsibility for advocacy? Do we have to be political activists - calling or writing to our legislators, contributing to political action committees, supporting the efforts of organizations such as the ASA in their efforts? No, we don't have to be activists at the local, state, and federal level. We can let others do that. However, the end result of that process will then develop without our input or direction. I encourage you to become involved. If we are to provide the best of care for all children, we have to do our best to ensure that the conditions we work under are supportive of that goal.