Category Archives: Leadership

My First Report as CSA President

https://poweracademy.nl/6hlj0eb21pp At the first in-person House of Delegates (HOD) session since 2019, I became President of the California Society of Anesthesiologists (CSA), the first Filipino-American to do so.   This could have only happened because of the incredible mentors and sponsors that I have been fortunate enough to have in my life.

https://parisnordmoto.com/6mqtau0 Over the course of the HOD weekend in June, we held a fundraising luncheon for the CSA Foundation, listened to project presentations from the first cohort of our CSA-UC Irvine Leadership in Healthcare Management Program launched by Drs. Phillip Richardson and Ron Pearl, were treated to a special guest lecture by Sasha Strauss on how to communicate as leaders and demonstrate value, and I provided an educational session on using social media for advocacy.  We hosted Dr. Robert Wailes, President of the California Medical Association (CMA), for an update on the Medical Injury Compensation Reform Act (MICRA) since passage of AB 35 (MICRA Modernization). For more information, see Dr. Wailes’ summary.

During the HOD session, I outlined my leadership priorities for this year: expanding public-facing and internal member communications; continuing leadership development; planning the CSA’s 75th anniversary (diamond jubilee); and promoting wellbeing and professional fulfillment within the CSA membership.  I discussed the challenges facing anesthesiology and the importance of recruiting and retaining members. I summarized the value proposition as “Community, Solidarity, and Advocacy,” which also happen to have the acronym “C-S-A.” 

https://www.amnow.com/9i9dgozkt1l We followed HOD with our first Board of Directors (BOD) meeting of the governance year.  We welcomed new Directors, appointed the CSA delegations to the American Society of Anesthesiologists (ASA) and CMA, and approved committee appointments for this governance year including an expanded Committee on Professional and Public Communication (CPPC).  This new CPPC chaired by Dr. Emily Methangkool and staffed by Kate Peyser, and in partnership with Alison MacLeod and Lisa Yarbrough at KP Public Affairs, will be interfacing will all major committees, divisions, and task forces as well as the CSA Foundation to actively promote the great work by CSA members and advance the recognition, social standing, and influence of anesthesiologists. 

https://faradayvp.com/kok521p Over the summer, I was Visiting Professor at the University of Michigan, hosted by Dr. Chad Brummett, and then had the privilege of participating in the American Medical Association (AMA) annual meeting as an ASA delegate to the AMA HOD.  In this role, I was able to cast my vote for Dr. Jesse Ehrenfeld and witness him become the first anesthesiologist President-Elect of the AMA

Order Valium 10Mg My family and I visited Greece for the first time as I participated as a guest speaker at the European Society of Regional Anaesthesia and Pain Therapy (ESRA) congress in Thessaloniki, and I also welcomed attendees to my first CSA educational event as President: the 2022 CSA Summer Anesthesia Conference.  This meeting was chaired by Dr. Brendan Carvalho and featured a superstar all-women expert panel of dynamic speakers: Drs. Dalia Banks, Sapna Kudchadkar, Alana Flexman, BobbieJean Sweitzer, Romy Yun, and Elizabeth Ozery.  All week, attendees and speakers engaged in conversations related to the practice of anesthesiology, caught up with old friends, and made new connections within the meeting room and around the resort.  It was an amazing week of learning and family time and reinforced the value of CSA and its educational events in fostering community. 

https://ontopofmusic.com/2022/09/371pm5q Before leaving Hawaii, I participated in a face-to-face meeting of the Hawaii Safer Care initiative, part of the Improving Surgical Care and Recovery collaborative supported by the Agency for Healthcare Quality and Research, and led by Dr. Della Lin, Senior Fellow in Patient Safety Leadership with the Estes Park Institute and is an inaugural National Patient Safety Foundation/Health Forums Patient Safety Leadership Fellow.  Dr. Lin invited me to participate as a virtual coach during the pandemic last year and work with improvement teams focused on implementing multimodal pain management for surgical patients, so this was my first time meeting the group in person.  For this meeting, teams from three statewide health systems within Hawaii reported out the results of their projects.  The leadership and collaboration among the multidisciplinary teams to implement change despite the challenges of variable resource availability, staffing, and inter-island coordination could serve as a model to inspire our statewide efforts within CSA.

What do we have on deck for CSA? 

https://pinkcreampie.com/ua37j5c9et At the time of this report, we are receiving applications for the next CSA-UC Irvine Leadership in Healthcare Management Program cohort. Anyone interested can sign up here.  We have appointed the task forces to work on revamping the CSA website and planning activities for the 75th anniversary, including a family-friendly reception at the Annual Meeting in San Diego (April 27-30, 2023) that will be chaired by Dr. Christina Menor.  Stay up to date with CSA events through our online calendar.  Then in October, our CSA delegation heads to New Orleans for the ASA annual meeting, and CSA members will actively participate in educational programming, committee deliberations, and governance activities.  CSA will host a member reception during the conference, and our delegates will stand proudly when CSA’s very own Dr. Michael Champeau takes over as Buy Diazepam Liquid President of the ASA at the conclusion of the Wednesday ASA HOD session!

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You Are Not “Asleep” Under Anesthesia

http://pinkfloydproject.nl/qg7tl6h “You will be asleep for your surgery,” anesthesiologists often reassure their patients. Just before the start of anesthesia, a patient may hear the operating room nurse saying, “Think of a nice dream as you go off to sleep.”

https://www.kidsensetherapygroup.com/nh36xfeni9 While these statements are intended to soothe patients during a stressful time, they gloss over this critical fact: Anesthesia is not like normal sleep at all. 

Buy Valium Diazepam Online That’s why you need medical doctors – anesthesiologists – to take care of you under anesthesia, and why you don’t need us when you’re sleeping comfortably in your own bed.

https://flowergardengirl.co.uk/2022/09/14/bno2xw9s2hu https://faradayvp.com/sdveu5pzkm8 Differences between natural sleep and general anesthesia

http://www.youthministrymedia.ca/zta3e8pxae Natural sleep represents an active though resting brain state. Every 90 minutes, the brain cycles between rapid eye movement or “REM” sleep and non-REM sleep. During each of these REM cycles, the brain is active, and dreams can take place. The rest and rejuvenation that result from getting a good night’s sleep are essential for overall health and wellbeing.

https://www.amnow.com/dpq6tq2pov On the other hand, general anesthesia produces a brain wave pattern known as “burst-suppression,” where brief clusters of fast waves alternate with periods of minimal activity. In a recent article published in Frontiers in Psychology, Drs. Akshay Shanker and Emery Brown explain brain wave patterns found in patients under general anesthesia. They are similar to those of critically ill patients who fall into a coma, have a dangerously low body temperature, or suffer from other serious diseases. Under general anesthesia, patients do not dream.

Confusing general anesthesia and natural sleep seems innocent but can be dangerous. A person who falls into natural sleep doesn’t require constant monitoring or observation. A patient under anesthesia, like an intensive care unit patient in a coma, may appear peaceful and relaxed, but anesthetic drugs don’t produce natural sleep and may cause breathing to stop or have other serious side effects.  Some may recall that Michael Jackson died at home while receiving the anesthetic drug propofol in his veins without an anesthesiologist nearby to protect him.

For patients with chronic health problems, having surgery and anesthesia can put significant stress on the body. Anesthesia gases and medications can temporarily decrease the heart’s pumping ability and affect blood flow to the liver and kidneys. Patients under general anesthesia often need a breathing tube and a ventilator to breathe for them and support their lungs with oxygen.

https://flowergardengirl.co.uk/2022/09/14/1chln8j95 http://www.youthministrymedia.ca/3tvxfts39c0 Respect anesthesia, but don’t fear it

http://pinkfloydproject.nl/oqnzoqod While having anesthesia and surgery should never be taken lightly, anesthesia care today is very safe as long as it is directed by a physician specializing in anesthesiology: an anesthesiologist. Anesthesiology is a medical specialty just like cardiology, surgery, or pediatrics. Research by anesthesiologists has led to the development of better monitors, better training using simulation methods inspired by the aviation industry, and new medications and techniques to give safer pain relief.

As a medical specialty, anesthesiology focuses on improving patient safety, outcomes and experiences.  Anesthesiologists work with surgeons and other healthcare professionals to get you or your family member ready for surgery, designing an anesthesia care and pain management plan specific to the type of operation you need. The anesthesia plan will guide your care during your procedure and throughout your recovery. While general anesthesia is far different from natural sleep, the job of the anesthesiologist is to make sure that you wake up just the same.

This post has also been featured on KevinMD.com.

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#HerTimeIsNow: Be an Ally!

https://parisnordmoto.com/3zt34a31tth Today is the last day of #WIMMonth, but supporting #WomenInMedicine doesn’t stop today!

Buy Alprazolam .25 Everyone should sign this petition at Change.org.

https://poweracademy.nl/ttqf0r2km Deans, Chairs, and other healthcare leaders can go even further by reading this pledge and signing on.

https://popcultura.com.br/xqjgz3iu I have been promoting the #HerTimeIsNow campaign led by the inspirational Dr. Julie Silver throughout the month of September. This campaign represents a collaboration between the American Medical Women’s Association, She Leads Healthcare, and Executive Leadership in Academic Medicine (ELAM).

There is still so much work to be done to achieve gender equity in academic medicine, especially for underrepresented minorities.

Read the full #HerTimeIsNow report.

https://www.kidsensetherapygroup.com/0noykncf Men in medicine, particularly those in leadership positions in academic departments, editorial boards, and professional societies, have a huge role to play as allies. Here is my full quote from the report:

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Being a Positive and Authentic Voice

Buy Soma In Us “The key is to not reflexively get defensive, but to treat people on social media as you would treat them in real life.”

Season 2 Episode 33: Being a Positive and Authentic Voice with Dr. Ed Mariano 

Drs. Shillcutt and Mariano get real and talk: 

  • Dealing with the COVID-19 pandemic information overload  
  • Discussing hard topics on social media 
  • Being a positive voice for marginalized groups 
  • Being a “Chief Cheerleader”  
  • The key to joy at work 

In this episode of The Brave Enough Show, I had a chance to speak with host Dr. Sasha Shillcutt about a variety of topics including #HeforShe, leadership, and maintaining a positive voice on social media. Enjoy!

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My Trip to Washington: Speaking Out Against Drug Shortages

UPDATE: The MEDS Act was incorporated into the Coronavirus Aid, Relief, and Economic Security (CARES) Act and passed into law on March 27, 2020. I commented on the COVID-19 pandemic’s exacerbation of ongoing drug shortages in this interview with CBS news.

On November 5, 2019, I had the opportunity to participate in a Congressional briefing related to drug shortages at the Capitol in Washington, DC. Senator Susan Collins (R-ME) opened the session and co-sponsored the Mitigating Emergency Drug Shortages (MEDS) Act with Senator Tina Smith (D-MN). I was one of only two physicians on the panel and tried to represent the voice of clinicians involved in perioperative care and the patients we care for (video). Below are the notes from my presentation.

As a physician specializing in anesthesiology, this ongoing crisis of drug shortages in the United States is frankly terrifying.

Continue reading My Trip to Washington: Speaking Out Against Drug Shortages

Anesthesiology is a unique specialty within medicine. Our patients are the most vulnerable in the hospital. Patients under general anesthesia cannot advocate for themselves and trust us with their lives.

We do not know what the next drug shortage will be or how long it will last. This week it is prefilled syringes of lidocaine, a life-saving emergency medication we give in case of a dangerous heart rhythm. Two weeks ago it was phenylephrine, a routine medication we use to increase blood pressure when it goes down after inducing anesthesia.

Last year, we had complete shortages of common injectable opioids and local anesthetics used for numbing injections. This directly affected surgical patients in terms of anesthesia and pain management. For 3 months in 2018, we did not have the local anesthetic indicated for spinal anesthesia. We know this is the safest anesthetic for patients having certain surgeries. During this shortage, we used an alternative anesthetic in order to continue providing spinal anesthesia, but our patients experienced more side effects. The reasons for this shortage were complex and involved a limited number of manufacturers and quality issues.

Thankfully, the shortage of spinal local anesthetic ended. We do not know when or if the rest of our current drug shortages will end. All we know for sure is that there will be another one.

The predictably unpredictable cycle of drug shortages puts physicians in an impossible position. Medicine is a calling, and we physicians have sworn an oath to support the well-being of our community and humanity in general.

Not having access to the right drugs at the right time for every patient and being forced to use less acceptable alternatives, if any exist at all, represents a form of moral injury. Moral injury “is being unable to provide high-quality care and healing in the context of health care” and is now recognized as a contributor to the epidemic of physician burnout.

Listen to my interview with Paul Costello on SoundCloud.

From left to right: Daniel Teich (Fairview Pharmacy Services), Dr. Peter Adamson (Children’s Hospital of Philadelphia), Senator Susan Collins, me, and Brian Marden (MaineHealth Pharmacy)

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More Reasons for Doctors to Tweet

This press release came out during the annual scientific meeting of the New Zealand Society of Anaesthetists based on my talk, “The Role of Social Media in Modern Medicine.” While in New Zealand, I was interviewed on Newstalk ZB by host Andrew Dickens and Afternoons with Jesse Mulligan.

Doctors need to be active on social media and other communication platforms to offset the noise of the anti-science movement according to a visiting professor of anaesthesiology, Dr. Ed Mariano from Stanford University in the US.

Continue reading More Reasons for Doctors to Tweet

Dr. Mariano is speaking at the New Zealand Anaesthesia Annual Scientific Meeting in Queenstown this week on the role of social media and medicine. He says, there has been a growing anti-science movement and physicians have a moral imperative to stand up for science and evidence-based treatments.

“Surveys show that physicians are one of the most trusted professions in the eyes of the public. Yet most people in the world today get their information, including health information, from the internet. We have to be there to offset the noise,” he says. “We can’t ignore where our patients get their information, and we can join the conversation.”

Dr. Mariano, who is one of the top 10 anaesthetists on Twitter, says social media also offers a way for doctors to keep up-to-date with the latest research and new treatments. For example he cites the exponential growth of regional anaesthesia. Regional anaesthesia allows procedures to be done without the patient being unconscious and can provide targeted pain relief.

“We have more tools at our disposal. New blocks are being performed and described every month and it’s hard to keep up with the literature. Social media allows you to be part of a learning community made up of people who have similar interests and it can curate information for you,” he says.

Dr. Mariano says it works the other way too. He says he’s created great collaborations through social media. “As well as learning things, I’ve had interesting conversations on Twitter that have developed into projects. As an academic physician, I’ve found the use of social media has been invaluable. Engaging in social media gives physicians a worldwide community of colleagues who can help curate the vast and ever-growing amount of information available today.”

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How Not Planning Ahead Can Still Lead to Career Success

In this interview with BagMask.com, I discuss my personal career journey: a mix of opportunities, hard work, good timing, and a lot of luck!

https://childventures.ca/2022/09/14/aemivq9u BagMask: Looking back when you took your first job after residency. Did you envision yourself where you are today having published over 150 articles, giving presentations all over the country, and taking on different leadership roles?

Dr. Mariano: Oh there’s no way. I went into it for all the reasons that you would think that someone would want to pursue a career in medicine. I felt like it was a calling. Now I can’t picture myself doing anything else but being a physician.

Continue reading How Not Planning Ahead Can Still Lead to Career Success

When I matched for residency, it was an interesting time for anesthesiology as a specialty because it wasn’t super competitive. I believe that had it to do with a miscalculation in terms of what the demand for anesthesia services would be in the future. But as I finished my residency in 2003, I knew I was going to do a subspecialty fellowship in pediatric anesthesiology, but I was also very interested in a regional anesthesia fellowship. At the time there were very few regional anesthesia fellowship programs, but I was convinced that acute pain and regional anesthesia in kids was a great path forward as a specialty. There was an opportunity to fill a need by providing better non-opioid pain management for children.

I really thought when I finished that I would be a purely clinical anesthesiologist but I got the bug for research. I feel like it was a little bit late in my career. Up to this point, I had successfully avoided research all throughout undergrad, all throughout medical school and almost all of my residency. I didn’t participate in my first research study until the very end of my residency.

Then as a fellow I had a chance to work on a couple of different projects and write case reports. That was a turning point. I discovered this was an interesting way to share information. And I thought, well if I’m going to start my career somewhere, I should start out in academics or at least just give it a shot.

One of my mentors from residency had given me some good advice. He told me you can do anything for five years. You can choose private practice or choose academics. There’s really no wrong answer but you should decide every five years whether you stay or go and it should always be an active decision. You shouldn’t just passively stay anywhere. You want to make sure that you’re on the right track in terms of your career, that you’re still being challenged and you’re still enjoying what you do.

My chair at the time, Dr. Ron Pearl, helped me find my first job at the University of California San Diego (UCSD). They were looking for a pediatric-trained anesthesiologist to help cover pediatric call. UCSD has the Regional Burn Center for the area and provides care for kids and adults. They were looking for a pediatric-trained anesthesiologist who felt comfortable with acute pain and could provide anesthesia services for those patients when they needed dressing changes on the ward or in the operating room for debridement and skin grafts.

In addition, they had high-risk OB and a NICU with some challenging premature neonates who sometimes would need emergency surgery. They also wanted coverage for a hand surgeon with a mixed adult and pediatric practice who worked in the outpatient surgery center. I was told right off the bat that about a quarter of my clinical time would be spent doing pediatrics and then the other seventy-five percent would be taking care of adults.

So I was mainly trying to focus on taking good care of patients. That’s the reason why I was attracted to medicine and felt this is where I am supposed to be. Over the course of my career I’ve just tried to find where the need is and address it. I think in anesthesiology one of the things that maybe self-selects us to the specialty is we are very good at filling gaps and fixing problems. Where I’ve ended up is very much a result of trying to figure out where the gaps are and how to fill them.

https://www.radioculturasd.com.br/jwmsylgmykc BagMask: I think it’s very interesting to talk about filling needs and filling gaps. Sometimes we identify these gaps on our own. Other times we are asked to help fill a need in an area in which we do not have much expertise or maybe never thought about being involved in before. How did you identify those needs and gaps? And why get involved in projects?

https://ontopofmusic.com/2022/09/xzg9iys Dr. Mariano: I think that’s just one of those challenging questions when you’re trying to pass the answers onto others. I’ve found myself more recently in the role of mentor and coach for various other people that I’ve had a chance to interact with sometimes at the same institution or afar. And I don’t have great answers for it only because I feel like I’m still learning even 15 years outside of residency.

I can say things what worked for me early on in my career were being open-minded and looking at potential opportunities as just that – opportunities – and not as necessarily more work. And I’ll share a couple examples that both revolve around my first job.

I started working in outpatient surgery and at the time that was not an attractive assignment for some of the other new hires on faculty. I think they wanted to take on the more challenging and difficult cases. What was interesting about my early experience was I working in outpatient surgery three or four times a week. As I worked with the same two hand surgeons, the same sports surgeon, and the same foot and ankle surgeon on a regular basis, we developed a really good relationship.

I always enjoyed regional anesthesia as a trainee. To be honest I didn’t think that regional anesthesia was a career choice, but when I started taking care of a lot of these patients at the outpatient surgery center I discovered how it could play a vital role. The surgeons and I would have discussions centered around the plan for surgery, the expected timeframe for pain, how often the patients would have to stay overnight for pain management, or how often patients historically would come back to the ER. We began planning our days the day before and go over the list together. I would propose plans in terms of regional anesthesia for each of the cases when it was indicated. I would also propose not using it when I didn’t think it was indicated.

Then I would call all the patients the day before and explain the anesthetic plan for their surgery. When I would see them the next day, I would introduce myself “I am Dr. Mariano, I spoke to you last night. Do you have any questions about what we’re going to do for you today?” There was no negative impact on efficiency despite integrating regional anesthesia into routine patient care. One of the interesting studies we did together actually showed that efficiency improved with the use of regional anesthesia, at least within the context of that model.

This change in how we approached each case had many positive outcomes. It improved patient care. It filled the need of the surgeons who wanted an efficient OR and to provide a good experience for their patients. And for me, it made me appreciate the importance of the relationship between anesthesiologists and surgeons. That’s really core to our specialty and even today, as anesthesiology grows into perioperative medicine, we should never give up taking care of patients in the operating room because that’s where the trusting relationship begins.

The other example I want to share is when I was working in outpatient surgery, a new chair of surgery started at UCSD. As part of his recruitment package he was promised a two-day breakout session to revamp the perioperative process. A consulting practice separated us into different groups and we broke up all the different steps from the decision to have surgery through convalescence. Following the event, the chair called and asked me if I would lead one of the work groups to revamp the preoperative evaluation clinic.

So I originally was hired to do peds. At this point I was doing mostly regional anesthesia and outpatient surgery in adults. I had even been asked by the residency director if I would teach the residents regional anesthesia, because they didn’t have a rotation set up yet. Now I was being asked if I would be willing to redesign the pre-op clinic.

So clearly this was not something that I thought was going to be in my future. But for some reason I thought it would be a good experience for me because I had never been part of a process improvement project. I told him up front that I didn’t see myself at the end of this as being the director of the clinic, but I’d be willing to head up the work group. What made this really interesting was each group had a champion that was one of the C-suite executives and mine was the hospital CEO.

Less than a year on faculty, I was having these very regular monthly or sometimes semi-monthly interactions with the CEO of the hospital. He was unique in many ways, and he was extremely down to earth. I would see him walking around on the two different campuses of UCSD serving up food in the cafeteria or sometimes walking on the wards. That was really eye-opening for me, especially as a new faculty member having gone through all of my residency and fellowship training with never having interacted with a C-suite executive.

To be able to have that interaction was invaluable. It created a level of confidence and comfort to approach administration and share innovations within healthcare and the operating room environment that were anesthesia-driven. “Here are some things that are new and we’re the only ones that are doing this in San Diego County.” Those kinds of initiatives were really of interest to our administration.

I always assumed that someone was letting them know what we were doing. However, what that whole experience taught me was that they don’t always know what’s going on and they should want to know. So, when you find receptive executives like that keep them informed and they can provide great support.

That really made a big difference for me early in my career in ways that I’ll never even know. It helped me in terms of establishing my own system of practice for anesthesiology, regional anesthesia and acute pain medicine.

Buy Valium Cheap BagMask: There are two things from that I think are very important to mention. One is just the power of yes and being open to new ideas. You never know where it’s going to lead. It could be the opportunity to meet new people or be invited to work on new projects. Second, you shared how you assumed the work you were doing was being passed along to the C-Suite. But that great work is not always being passed along. I think this revelation ties in great with a presentation you recently gave.

You talked about “The Biggest Threats to Anesthesia” and you listed three items: Loss of Identity. Fear of Technology. Resistance to change.

The thing that really stood out in my mind was the solution to Loss of Identity. It was “Establish a Brand”. I thought that was very powerful. Can you tell us about loss of identity and establishing brand and why it’s important to us?

https://flowergardengirl.co.uk/2022/09/14/jgvwkq4i938 Dr. Mariano: I think that this applies to healthcare professionals in general, but I do think specifically in terms of anesthesia professionals that there is a growing threat in becoming more and more anonymous. If you look at the trends in healthcare like these mega-mergers, you have pharmacy companies and insurance companies that are merging. You have private investment companies and traditional healthcare providers merging to form fairly innovative corporations centered around health and healthcare.

I think within the anesthesia community what we’re seeing is the growth of very large organizations that have the potential advantage of having strong contracting positions with hospitals which provides a level of job security for many individuals who practice anesthesia. But at the same time, I think that as we start to see more and more productivity-based incentives, and the corporatization of medicine and anesthesia practice, it doesn’t take a lot to think that much of what we do may become very much like making widgets.

You can imagine what a factory floor looks like and you know how each product is expected to look the same and how the individuals contribute to the various parts that go into forming that widget. They are basically nameless faceless producers that have very little identity.

That obviously is a dramatic extreme to some extent. But I do think that it’s a threat to me for a few reasons. I think that from a larger specialty perspective there’s the potential to discount the value that anesthesia services, perioperative medicine, and pain services can bring to the overall patient experience as well as the heavy influence that we can have on patient outcomes.

For the individual I worry because once a calling becomes a job, then I think that really leads down the road to what oftentimes is mistakenly called burnout. But I would probably categorize that into a loss of identity versus burnout, because I do think that they’re different. And what I mean by that is burnout, at least in the sense of overworking, is a problem that can be helped by self-care and by taking a well-timed vacation. Because to me burnout, or the product of overwork, still means intrinsically that you enjoy your work and that you still feel the calling.

The loss of identity is a bigger problem because for the healthcare professionals there’s a loss of a love for the profession and that’s really hard to recover from. There’s not enough time off or yoga that you can do to make you fall in love with your profession again.

So I think that the less value attributed to your work, to your contributions and to patient health and well-being are contributing factors that eat away at identity. I don’t think that all is lost. We must recognize the problems and then look for opportunities to reverse or prevent the loss of identity.

BagMask: One of the things I love that you said is it’s a problem when our calling becomes a job. There are two articles that you wrote four years apart that I believe really talked to your “Calling”. The first one you wrote was “What I Love about Being an Anesthesiologist” written in 2014. And then you followed it up in 2018 with, “Why I still love being an Anesthesiologist”. A couple of things, why did you think it was important to write this out, and how has it changed over the years for you?

Dr. Mariano: I appreciate your bringing those up. “What I Love about Being an Anesthesiologist” I wrote after ASA. Growing up, I didn’t necessarily know that I was going to be a physician. I remember taking my first job as a dishwasher because when you’re 16 and you just get your driver’s license, you have no experience and there aren’t that many other jobs that you’re qualified for.

The dishwashing job was at a senior assisted living facility and, after about a year of just washing dishes in the kitchen, I also started serving the residents either in the dining hall or delivering food to their apartments within the facility. I remember thinking that at some point when I finally figured out what I was going to do with my life, the concept of service would have to be part of my career. This is where I feel a job in health professions differs from a lot of other jobs.

I’m not saying that “job” itself is a negative term but it’s different. I think the difference between a job and a vocation, or a calling is there is always give and take. At the same time that you receive satisfaction, income and whatever it happens to be from the work that you produce, you also give something of yourself. And I think that’s the difference. When you’re in the health profession you intrinsically give something of yourself and that is part of the reward or at least that’s the investment that you put in that helps deliver a reward.

The role of the anesthesiologist is very unique within medicine. There are a lot of aspects to anesthesiology that many people don’t consider necessarily the role of a physician, but that’s actually what makes it so appealing to me. As an anesthesiologist I provide the most personalized form of medicine or, to phrase it another way, the most direct patient care.

When I’m taking care of a patient who is under general anesthesia, that person can’t speak for him or herself or can’t act for him or herself. That kind of responsibility is very different than every other physician role that I can think of in the hospital. The fact that we have to administer our own medications. We have to establish intravenous access for our patients in order to even treat them in the first place and to provide anesthesia. The fact that all the procedures that are required for our patient are done by us and then are used by us in the practice of anesthesia care.

I think it is important that as an anesthesiologist you must, by nature, learn how to work within a team because we are team. One of the powerful moments for me in every surgery is when we do a pre-surgical time out. It’s when you go through the checklist and then everyone introduces themselves to each other and everyone knows that you are all here for this one person.

I sometimes think that moment is understated. As anesthesiologists, our medical specialty exists only to make sure patients are safe and that they have a positive experience and outcome after having surgery and invasive procedures. That has to be something that each anesthesiologist has to consider and take with him or herself every time they bring a patient into the operating room.

I think because it’s a very cerebral profession in many ways, it’s hard for someone on the outside to see what an anesthesiologist is doing. So much of what we do is internal processing of information and anticipating outcomes. As anesthesia professionals, we should try to explain and share with people our thought process and our plan to achieve a safe outcome.

The time that we have to establish trust with patients and their caregivers before we bring patients to the operating room is very brief. The more patients understand what we think about and how important we take our responsibility gives them the confidence they are in good hands and promotes us as a profession. That’s why I wrote that initial article and then the follow-up one came about after attending a party with my wife.

It was the usual cocktail party conversation and the question came up of what do you do and what’s that like. It got me thinking about not only how much I still enjoy and love being an anesthesiologist, but how much more I enjoy it now.

My career has taken a lot of different directions, but I’ve always tried to follow a “One Degree of Separation Rule”. When I’m at the bedside taking care of a patient or I’m in the operating room, that is zero degrees of separation. Everything that I do will be for the patient and to improve that patient’s outcome and experience.

But when I’m doing research, teaching in the classroom, presenting at a conference, or sitting in an administrative meeting, that is “One Degree of Separation” from a patient. When I answer a research question, I can share that knowledge and someone else can then use that information to help his or her patients. When I’m teaching our fellows or residents or presenting at a national conference, they will go out and hopefully use that information to take better care of their patients.

And when I sit in an administrative meeting, it’s not unusual for me to be the only person there that has actually laid a hand on a patient within the last several years. Those are times when I feel like I’m representing not just the clinicians but I’m representing our own patients. What I say and contribute in those meetings helps create informed policies that will make it easier for our colleagues to take better care of their patients.

It is those aspects of my job that have kept me not just excited about it, but still in love with it and excited about looking forward to the future.

Buy Valium Cheapest Online BagMask: I have one last question for you. What is your hope for all the anesthesia providers during this time with so many changes in health care?

https://perfect-deal.nl/uncategorized/vaq59tohqu7 Dr. Mariano: My hope for all anesthesia professionals is that they take to heart the importance of what they do. They have to recognize their importance, because as anesthesia practices continue to grow and performance metrics continue to develop, there’s an over emphasis on productivity. As these trends continue, I really want anesthesia professionals to continue to understand their own value.

I want them to look for the opportunities to take one more step. As an example, you are taking great care of your patients and you’ve assessed a patient who has a history of postoperative nausea attributed to every type of opioid they have taken in the past. You develop and carry out an opioid-free anesthesia plan or you provide the appropriate interventions to prevent postoperative nausea and vomiting and that patient ends up doing really well.

Take the next step. The next step is let your surgeon know. Let your bosses know. Let your director of perioperative services know. What you’ve provided is exactly what everyone is trying to achieve when they talk about personalized medical care. And you’ve done that. Sometimes we don’t recognize it, but this is a huge opportunity. We do have a tendency to be anonymous, but we should highlight positives that are associated with our practice. The more attention that is brought to the good work that we’re doing not only helps promote our specialty, but more importantly helps us as individuals in terms of enjoying our career, feeling satisfied and always finding a reason to love practicing anesthesia.

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My Favorite Rejections

I tweeted recently about the idea of keeping a “failure resume” which was recommended by an article published in the New York Times.

If I have learned one thing in academics, it’s this – you have to develop thick skin.

Continue reading My Favorite Rejections

Success in scientific journal publication is built on a pile of rejections. For every trainee and junior faculty member out there, know that your mentors have survived countless rejections (failures) to get to where they are today.

Rather than bemoan these rejections, perhaps we should celebrate them instead. Each failure can be a learning opportunity. I dug through some old emails to find a few of my favorite rejections and happily share them below. They fall into one of two general themes.

https://pinkcreampie.com/alr8pq8ozb Theme 1: “It’s not you. It’s me.”

Theme 2: “It’s not me. It’s you.”

Don’t let these rejections get you down. Good research and good writing will eventually find a home in a journal. If you get stuck, reach out to a mentor for guidance. When you see your article published finally, you can look back at those earlier rejections as badges of honor and proof that persistence pays off.

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5 Reasons to Put Physicians in Charge of Hospitals

This post was first released on KevinMD.com.

Putting physicians in charge of hospitals seems like a no-brainer, but it isn’t what usually happens unfortunately. A study published in  http://mgmaxilofacial.com/kzcdddb Academic Medicine states that http://pinkfloydproject.nl/fdqjpaa only about 4% of hospitals in the United States are run by physician leaders, which represents a steep decline from 35% in 1935. In the most recent 2018 Becker’s Hospital Review “100 Great Leaders in Healthcare,” only 29 are physicians. 

The stats don’t lie, however. Healthcare systems run by physicians do better. When comparing quality metrics,  Buy Valium Diazepam Uk physician-run hospitals outperform non-physician-run hospitals by 25%. In the 2017-18 U.S. News & World Report Best Hospitals Honor Roll, the top 4 hospitals (Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, and Massachusetts General Hospital) have physician leaders. Similar findings have been reported in other countries as well.

While not all physicians make good leaders, those that do really stand out. For those physicians who may consider applying for hospital leadership positions, there are certain characteristics that should distinguish them from non-physician applicants and help them make the transition successfully. Of course, this is my opinion, but I think it comes down to these 5 things:

  1. https://popcultura.com.br/37npjc3m Physicians are bound by an oath. The Hippocratic Oath in some form is recited by every medical school graduate around the world. This oath emphasizes that medicine is a calling and not just a job: “May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” Physicians commit themselves to the treatment of disease and the health of human beings. There is no similar oath for non-physician healthcare executives.
  2. Physicians know how to make tough decisions. This is crucial to every informed consent process. Physicians need to curate available evidence, weigh risks and benefits, and share their recommendations with patients and families in situations that can literally be life or death. This is essential to the art of medicine. Effectively translating technical jargon into language that lay people can understand allows others to participate in the decision making process. This applies both to the bedside and the boardroom.
  3. https://parisnordmoto.com/19znx0tcy3 Physicians are trained improvement experts. They learn the diagnostic and treatment cycle which requires listening to patients (also known as taking a history), evaluating test results, considering all possible relevant diagnoses, and instituting an initial treatment plan. As new results emerge and the clinical course evolves, the diagnosis and treatment plan are refined. In my medical specialty of anesthesiology, this cycle occurs rapidly and often many times during a complex operation. These skills translate well to diagnosing and treating sick healthcare systems.
  4. http://mgmaxilofacial.com/4sn9ers Physicians are lifelong learners. When laparoscopic surgical techniques emerged, surgeons already in practice had to find ways to learn them or be left behind. Medicine is always changing. To maintain medical licensure, physicians must commit many hours of continuing medical education every year. New research articles in every field of medicine are published every day. For these reasons, physicians cannot hold onto “the way it has always been done,” and this attitude serves them well in healthcare leadership.
  5. https://www.radioculturasd.com.br/4oj5dtmyy Physicians work their way up. Every physician leader started as an intern, the lowest rung of the medical training ladder. Interns rotate on different services within their specialty, working in a team with higher-ranked residents under the supervision of an attending physician. As physicians progress in training through their years of residency, they get to know more and more hospital staff in other disciplines and take on more patient care responsibility. A very important lesson learned during residency is that the best ideas can come from anyone; occasionally the intern comes up with the right diagnosis when more senior team members cannot.

While these qualities are necessary, they are not sufficient. To be effective healthcare leaders, physicians need to develop their administrative skills in personnel management, team building, and strategic planning. They will have to learn to understand and manage hospital finances, meet regulatory requirements and performance metrics, and find ways to support and drive innovation. For physicians who have already completed their medical training, a commitment to effective healthcare leadership will require as much time and dedication as their medical studies. However, if they don’t do this, there are plenty of non-physicians who will.

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Starting an Acute Pain Medicine Program: Strategies for Success

Initiating an acute pain medicine program can add significant value to a hospital and anesthesiology practice through improved postoperative pain control, faster recovery, decreased side effects, and higher patient satisfaction. In a special issue of Anesthesiology News, I published an article which presents a few suggested strategies. You can view and download this article here.

In an accompanying video interview, I was asked about the evolution of ultrasound in regional anesthesia practice as well as the growing role of ultrasound in perioperative medicine.

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