The Pursuit of Excellence

摘要

I OFTEN thought that there would be a day when the Rovenstine lecturer would not be old enough to have any connection to Emery Andrew Rovenstine (Professor of Anesthesia, New York University College of Medicine, New York, New York; 1895–1960), but that day has yet not arrived. Today is my second direct connection with Rovenstine. My first unknown connection was in high school. As pointed out by Mark Warner’s Rovenstine lecture, Rovenstine was a basketball coach in La Porte, Indiana.1In high school, I played in three Indiana State High School golf tournaments in La Porte and played a jazzy trumpet solo at La Porte High School just a few yards from the office he may have occupied as a coach. So this Rovenstine lecturer and Rovenstine do have a close connection in time and in geography.In the May 2008 ASA Newsletter , I was thrilled to read the article by Paul Knight and David Warltier titled “The Right Stuff.”2Knight and Warltier reminded us that John Snow’s (Physician and Surgeon, London, England; 1813–1858) remarkable curiosity and “fire of investigation” included not only chloroform anesthesia, but also the identification of the causative factors regarding transmission of cholera in the mid-1800s. How remarkable! I believe that John Snow exemplified or even initiated the principle of not only facilitating the administration of anesthesia, but also making major contributions to medicine overall. John Snow is an example of an anesthesiologist who went beyond the boundaries of anesthesiology in the pursuit of excellence. Other, more contemporary examples of this principle are highlighted in table 1.Imagine the impact that Peter Safar, M.D., Dr.h.c., F.C.C.M., F.C.C.P. (Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania; 1924–2003), had when reviving people who were near death by cardiopulmonary resuscitation! With the contributions of several individuals, John W. Severinghaus, M.D. (Professor Emeritus, Department of Anesthesia and Perioperative Care, University of California San Francisco [UCSF], San Francisco, California), created the pathway that allowed patients, especially critically ill ones, to be monitored via intense analysis of arterial blood gases. The evolution of creating separate units to take care of our sickest patients via critical care medicine was initiated by many individuals, one of whom was Henrik H. Bendixen, M.D. (Columbia College of Physicians and Surgeons, New York, New York; 1923–2004), who was originally from Denmark, then Boston, and then was the first Chair of Anesthesia at the University of California San Diego before returning to New York. John J. Bonica, M.D. (Department of Anesthesiology, University of Washington, Seattle, Washington; 1917–1994), tirelessly promoted the concept of multidisciplinary care in the treatment of patients with chronic pain. Amazingly, current concepts of pain management include all of the aspects and more that were originally recommended by Dr. Bonica in the 1950s and 1960s. And John Lundy, M.D. (Professor and Head, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; 1894–1973), was the first individual to start a blood bank in the United States at the Mayo Clinic.These are examples of anesthesiologists who went beyond the usual boundaries of anesthesiology to pursue excellence. To be sure, these individuals not only are responsible for the enhancement of anesthesia, but also were recognized as anesthesiologists for their contributions to medicine overall.How will anesthesiologists be viewed 50 yr from now? To answer that question, I would like to reflect on how we should define the path forward.Considerable conceptual evidence suggests that medical professions, including anesthesiology, are in danger of becoming trade unions. If so, what is the difference between a profession and a trade union? A trade union is often defined as a collection of skilled workers who deliver a service or product. A profession is a group