James C. Eisenach, M.D.: ‘To hit the target of quality medical care, we need science to aim and direct the power of our motivation and compassion.’
Anesthesia, and every physician anesthesiologist, needs the right balance of science and compassion. It is not enough to be a great scientist or a great humanitarian to provide good care; one must integrate elements of both.
“To hit the target of quality medical care, we need science to aim and direct the power of our motivation and compassion,” said James C. Eisenach, M.D., FM James III Professor of Anesthesiology and Physiology and Pharmacology at Wake Forest University and Editor-in-Chief of Anesthesiology. “Why aren’t we physicists instead of physicians? Because we want to apply science to help people. And why aren’t we homeopaths? Because we want to bring science to our compassion to produce demonstrable improvements in the outcomes that patients care about.”
Dr. Eisenach discussed the need to combine the science of anesthesiology and the art of anesthesiology during Monday’s Emery A. Rovenstine Memorial Lecture, “Without Science There is Little Art in Anesthesiology.” The lecture combined the science of Dr. Eisenach and the art of Carol Cassella, M.D., Anesthesiologist at Virginia Mason Medical Center in Seattle, Anesthesiology Editor of the “Mind to Mind” section and best-selling author. Dr. Cassella read selections from her writings.
The art of medicine, compassion and caring is what brought most physicians to medical school, Dr. Eisenach said. Once they donned the white coats, science took priority. But they soon learn that medical practice needs both science and art.
Science has confirmed, for example, that smoking cessation, even just before surgery, can have dramatic effects on both short- and long-term outcomes. However, it takes compassion and caring to present that science at the right time in the right way for the patient to hear it, understand it and act on it.
Relaxation, meditation, exercise, improved diet and similar lifestyle changes can bring improvements to long-term outcomes. Patients have heard the science and heard the directives to improve lifestyle most of their lives, Dr. Eisenach said, and many have ignored the advice. The art of anesthesiology can help them hear the same information with new understanding and actually make lifestyle changes that can improve their lives and their surgical outcomes.
“The art of anesthesiology, taking good care of someone, sometimes means listening to patients more than talking to them,” he said.
Taking good care of someone also means listening more closely to science. Lorazepam, for example, is routinely used before surgery to reduce anxiety. However, recent research shows that the agent may not reduce anxiety in non-cardiac surgery patients, and it can slow recovery.
The risk of intraoperative morbidity and mortality associated with anesthesia has fallen dramatically since the days of Dr. Rovenstine, but perioperative adverse events still happen. About one patient in 200 over the age of 45 suffers stroke after non-cardiac surgery, and about one in 12 suffers some degree of cardiac injury.
“The challenge for Dr. Rovenstine was intraoperative survival,” Dr. Eisenach said.” Our challenge is to improve disability-free survival after surgery. As a profession, we need to generate more science to address these issues. “We need to generate more art to bring the science to our patients. And we need to generate more courage to stand up for our patients.”
