CSEN Survey : The Practice of Anesthesia - Medicine or Nursing ?


On March 3, 1998, we have sent 800 emails to anesthesiologists in 70 countries.

The content of the email was as follows:

Dear Colleague,

This email is sent to selected 800 anesthesiologists in 70
countries.
It is a new CSEN Survey on a new issue.
There are very interesting results on the two previous (unpublished
yet) surveys on the use of the LMA and the sitting/lateral position
for spinal/epidural anesthesia. For example, there are places where
the same LMA is used more than 250 times! And the sitting position
is now 53% vs. 46% of the lateral position for regional anesthesia.
These surveys` results will be published soon in the CSEN website.
Now we would like to have your response on the following question
related to the "MD-CRNA World War 3". Please look at the two ads of
AANA and ASA:
1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
million anesthetics administered in the USA annually.
2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
this doctor (anesthesiologist) during your surgery.

Since this issue is not only an American issue (HCFA Proposed
Rule) but involves also the image of Anesthesiology for the rest of
the world, I would like to pose the following question:

Do you think Anesthesia is the practice of Medicine or the practice
of Nursing?
Please answer by Medicine or Nursing.

I could ask the same question for Surgery...but it is for another
survey.

Sincerely yours,

Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia

Results:

127 emails returned as undeliverable (we really need to update this list...).

3 anesthesiologists wanted to delete their names from our list. One of them also sent the following letter to the Gasnet Discussion Group:


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Re: I thought this list had its
members protected from



To: Multiple recipients of list <anesthesiology@moe.med.yale.edu>
Subject: Re: I thought this list had its members protected from
From: "Pauline L. Wong, DVM" <plwong@ucdavis.edu>
Date: Sun, 8 Mar 98 10:26:58 EST
Reply-To: anesthesiology@moe.med.yale.edu
Sender: anesthesiology@moe.med.yale.edu



Gert Galster noted that GASNet message archives are accessible to the
public on the GASNet Web site. That's been true for quite awhile. This is
the only list to which I belong that has that feature. The other lists
restrict archive access to list members & if the archives are on the Web
they require user name & password for access.

Joseph Eldor (who runs the CSE Web site) sends out mass mailings to
anesthesia folks. When GASNet first started, list members could get a copy
from the Listprocessor of the names & email addresses of folks subscribed
to the list. Abuse of that by folks who used the address list for
commercial purposes lead to the listowner, Keith Ruskin, making the address
list unaccessible to list members. I wonder now if folks not on GASNet are
able to collect our addresses through the archives at the Web site. I've
asked Dr Eldor twice to take me off his mailing list & he replied that he
took my address off the specific mail list that I was writing about, but
that he has so many lists of addresses for mass mailing that he can't
guarantee that I won't get future messages from him. He added that he
doesn't compile the lists of addresses himself. He apparently doesn't
consider his unsolicited messages as offensive or an abuse of the Internet.

Last week, I received a message from a dog breeder seeking advice about von
Willebrand's disease in dogs. I sent him the info he wanted, but was
curious about how he'd gotten my address. He said he'd found it in a
newsgroup, that I'd sent a message on vWD to someone at Yale & he'd just
clicked on my address in the archived message to send a message to me. It
sounded like GASNet, so I looked at the archives & sure enough, in the
current archives you can send messages to the list or to anyone who posted
a message to the list by clicking on their address in the header.

Perhaps Keith Ruskin will comment to the list on the feasibility of someone
harvesting email addresses from the GASNet archive site.

Pauline




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670 anesthesiologists received this survey.

356 anesthesiologists (53.13%) sent their response.

351 anesthesiologists (98.59%) said that the practice of anesthesia is the practice of medicine.

5 anesthesiologists (1.41%; 4 CRNAs and 1 Anesthesiologist) said that the practice of anesthesia is the practice of medicine together with the practice of nursing.

No one said that the practice of anesthesia is only the practice of nursing

Discussion:

This "stupid" question of mine came after I have sent the following letter to the MD-CRNA Discussion Group:

.Subject:
MD-CRNA: Nurse Surgeons?
Date:
Tue, 17 Feb 1998 18:59:43 -0500
From:
Marc Allan Feldman MD MHS <mfeldman@welchlink.welch.jhu.edu>
Organization:
Johns Hopkins
To:
Marc Feldman MD MHS <mfeldman@welchlink.welch.jhu.edu>


Subject: CRNSs
Date: Tue, 17 Feb 1998 12:48:45 +0200
From: Joseph Eldor <a1b2c3d4@netvision.net.il>

Can you post this question to the CRNA/MD Discussion Group:
Are there anywhere CRNSs (Certified Registered Nurse Surgeons)? Not
only
assisting the Surgeons but working independently, as the CRNAs are
doing? If not - why not? If not - what can we learn from that
regarding
the CRNAs position? These are of course rhetoric/provocative questions.

However, since I believe that the anesthesiologists are not less
important than the surgeons, so I believe that the CRNAs are not less
important than the CRNSs (if such professionals exist).Otherwise, it
means that in order to anesthetize a patient you need "only" be a CRNA
but in order to operate on a patient you MUST be MD?
Please reply to the point without flames. Leave the flames to the
Gasnet...
Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia

In response I have received the following answer from Bob Wells, CRNA from Omaha, NE:

Subject:
MD-CRNA: Re: Nurse Surgeons?
Date:
Sun, 22 Feb 1998 15:13:20 -0500
From:
Marc Allan Feldman MD MHS <mfeldman@welchlink.welch.jhu.edu>
Organization:
@Home Network
To:
MARC ALLAN FELDMAN <mfeldman@welchlink.welch.jhu.edu>


Subject: Re: MD-CRNA: Nurse Surgeons?
Date: Tue, 17 Feb 1998 22:31:19 EST
From: Bob156@aol.com

I think as a Nurse Anesthetist I am fighting a real knee jerk reaction
to this as a flame of CRNAs. I will answer as respectfully as I can.
Why do anesthesiologists practice nursing? I think given the question
posed by Dr. Eldor this is a perfectly valid point that needs to be
made. The "practice" of anesthesia was the perview of nurse
anesthetists for a longer period of time than anesthesiologists have
existed. I can see the collective unison eye rolling by the academics
out there that nurses are technicians and have no right to take air let
alone a fee for what they do, blah, blah, blah.

No one has ever given me an answer to two basic questions: 1) Who says
that anesthesia is the practice of medicine and when was this determined
and 2) When and where has it been determined that the practice of
anesthesia by nurses is less safe than that of MDs?

Bob Wells CRNA
Omaha, NE

In a message dated 2/17/98 5:05:14 PM, you wrote:
<<Can you post this question to the CRNA/MD Discussion Group:
Are there anywhere CRNSs (Certified Registered Nurse Surgeons)? Not
only
assisting the Surgeons but working independently, as the CRNAs are
doing? If not - why not? If not - what can we learn from that
regarding the CRNAs position? These are of course rhetoric/provocative
questions.

However, since I believe that the anesthesiologists are not less
important than the surgeons, so I believe that the CRNAs are not less
important than the CRNSs (if such professionals exist).Otherwise, it
means that in order to anesthetize a patient you need "only" be a CRNA
but in order to operate on a patient you MUST be MD?
Please reply to the point without flames. Leave the flames to the
Gasnet...
Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia>>

I got the permission of the following anesthesiologists to quote their following responses in this summary:

ubject:
The Practice of Anesthesia: Medicine or Nursing?
Date:
Sun, 8 Mar 1998 10:07:56 +1100
From:
Michael Bookallil <mbookall@mail.usyd.edu.au>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


>Do you think Anesthesia is the practice of Medicine or the practice
>of Nursing?
>Please answer by Medicine or Nursing.
>
>I could ask the same question for Surgery...but it is for another
>survey.
>Joseph Eldor, MD

This is typical of polling techniques. If you ask a silly question you will
get a silly answer especially if you only allow 2 answers.

I will pose a similar silly question. Is opera the practice of singing or
the practice of orchestral organisation

I recently received a survey from the Ford Co about my recently purchased
car. Hardly any of the questions were important to me and the few that were
the allowed answers did not deal with my problem. I am sure they will not
get back to me as the self centeredness of those in charge of our part of
that company would not allow them to alter their predetermined features of
the car.

I know some of the features have deteriorated as they have got worse in the
last 4 cars I have experienced from them.



Michael.

-----------------------------------------------------------------------
Michael Bookallil mbookall@mail.usyd.edu.au
Dept of Anaesthesia DO6 voice +61 2 9515 8925
University of Sydney 2006 Australia fax +61 2 9519 2455
-----------------------------------------------------------------------



ject:
FORM results
Date:
Wed, 11 Mar 1998 09:37:57 -0800 (PST)
From:
a1b2c3d4@netvision.net.il (Geocities WebMonitor mail)
To:
a1b2c3d4@netvision.net.il


Sent from Mail Form posted at: http://www.csen.com/anesthesia/survey.htm

(Name) Felisa
(Email) Felisa@jet.es
(Comment2survey)
---------------------------------------------------------------------------
I`m a anesthesiology:
Anesthesia is a part of medicine creates for and from anesthesiologist, nurses are instruments used by anesthesiology similar to surgeons use nurses for surgery.
Anesthesia is scientific medicine and very complicated for nurses.
---------------------------------------------------------------------------
(submit) Submit

Remote IP: 195.55.158.189


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Fri, 13 Mar 1998 09:54:51 EST
From:
GaseousOne <GaseousOne@aol.com>
To:
a1b2c3d4@netvision.net.il


>Dear Eric,
>I would like your permission to quote your response with your name while
>summarizing the all data.
>J. Eldor

Please quote this corrected version instead.

------------------------------------------------

Anesthesiology and Anesthesia are both the practice of MEDICINE.

Although the AANA states that CRNA's provide the majority of anesthetics
in the USA, this is an inherently misleading statement. For example, in
Illinois an anesthesiologist is the direct provider of anesthesia or
medically directs the CRNA in over 93% of all anesthetics provided in the
state; a non-anesthesiologist **physician** is the responsible party in
the remaining 7% of cases. Although CRNA's "provide" 65% of anesthetics
in our state, 100% of these cases are under the supervision of a
physician, and 90% of these cases are directed by an anesthesiologist.

Similarly, most of the progress in patient safety issues relating to
anesthesia care worldwide are due to physician-led research. Recent
studies have also demonstrated that the involvement of an
anesthesiologist in a patient's intraoperative care is associated with
the highest incidence of safety for the patient.

Would patients and their families want nursing staff directing medical
care in a critical care unit? Why would anyone then want that to occur in
an operating room?

Eric


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Mon, 9 Mar 1998 11:48:14 -0300
From:
"LUIZ CESAR ANZOATEGUI" <luizito@gold.alanet.com.br>
To:
"Joseph Eldor" <a1b2c3d4@netvision.net.il>


Dear Doctor,
Answering the survey : The Anesthesia is a practice of Medicine.

I confess that is hard to believe the way things are directioning in the
States. Hope this can become a worldwide alert to all professsionals.
Sincerely,
Luiz Cesar Anzoategui

-----Mensagem original-----
De: Joseph Eldor <a1b2c3d4@netvision.net.il>
Para: luizito@alanet.com.br; <luizito@alanet.com.br;>
Data: S?bado, 7 de Mar?o de 1998 08:49
Assunto: The Practice of Anesthesia: Medicine or Nursing?


>Dear Colleague,
>
>This email is sent to selected 800 anesthesiologists in 70
>countries.
>It is a new CSEN Survey on a new issue.
>There are very interesting results on the two previous (unpublished
>yet) surveys on the use of the LMA and the sitting/lateral position
>for spinal/epidural anesthesia. For example, there are places where
>the same LMA is used more than 250 times! And the sitting position
>is now 53% vs. 46% of the lateral position for regional anesthesia.
>These surveys` results will be published soon in the CSEN website.
>Now we would like to have your response on the following question
>related to the "MD-CRNA World War 3". Please look at the two ads of
>AANA and ASA:
>1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
>million anesthetics administered in the USA annually.
>2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
>this doctor (anesthesiologist) during your surgery.
>
>Since this issue is not only an American issue (HCFA Proposed
>Rule) but involves also the image of Anesthesiology for the rest of
>the world, I would like to pose the following question:
>
>Do you think Anesthesia is the practice of Medicine or the practice
>of Nursing?
>Please answer by Medicine or Nursing.
>
>I could ask the same question for Surgery...but it is for another
>survey.
>
>Sincerely yours,
>
>Joseph Eldor, MD
>Editor, CSEN - The Global Regional Anesthesia Website
>http://www.csen.com/anesthesia
>


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Mon, 09 Mar 1998 20:27:53 +0000
From:
dPeronnet@invivo.edu (Denis Peronnet)
To:
a1b2c3d4@netvision.net.il


In France it can only be MEDICINE


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 7 Mar 1998 22:04:03 EST
From:
Name was deleted upon request
To:
a1b2c3d4@netvision.net.il


MEDICINE!!!!!!!

The practice of nursing is following doctors' orders, cleaning bedpans
and giving baths---NOT DIAGNOSING AND TREATING MEDICAL PROBLEMS IN THE
PERIOPERATIVE SETTING!!! Anesthesia is the practice of medicine, NOT
NURSING!!!!


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sun, 8 Mar 1998 21:10:06 -0000
From:
"John Carnie" <pigeon@easynet.co.uk>
To:
"Joseph Eldor" <a1b2c3d4@netvision.net.il>


By professional I mean the entire patient care relating to anaesthesia
delivered by one individual who has sufficient training, expertise and also
the ability to deal with most situations presented within seconds of any
problem arising.
I am not arrogant enough to believe only a medically trained individual can
deleiver this service but only they have received a sufficiently diverse
medical training to deliver. 40 years as a nurse anaesthetist will allow
common pattern recognition but not cover for all eventualities.
I remember being phoned by a trainee casualty doctor who diagnosed botulinus
poisoning in three elderly patients when the last recorded case in the Uk
was in the 1910's. He had the theory and the depth of training to make the
diagnosis 60 years after the last cases.

regards,
john


John Carnie
Heartlands Hospital
Birmingham, UK

-----Original Message-----
From: Joseph Eldor <a1b2c3d4@netvision.net.il>
To: John Carnie <pigeon@easynet.co.uk>
Date: 07 March 1998 21:06
Subject: Re: The Practice of Anesthesia: Medicine or Nursing?


>John Carnie wrote:
>>
>> Medicine if you want a professional service.
>> regards,
>>
>> John Carnie
>> Heartlands Hospital
>> Birmingham, UK
>>
>> -----Original Message-----
>> From: Joseph Eldor <a1b2c3d4@netvision.net.il>
>> To: pigeon@easynet.co.uk; <pigeon@easynet.co.uk;>
>> Date: 07 March 1998 11:05
>> Subject: The Practice of Anesthesia: Medicine or Nursing?
>>
>> >Dear Colleague,
>> >
>> >This email is sent to selected 800 anesthesiologists in 70
>> >countries.
>> >It is a new CSEN Survey on a new issue.
>> >There are very interesting results on the two previous (unpublished
>> >yet) surveys on the use of the LMA and the sitting/lateral position
>> >for spinal/epidural anesthesia. For example, there are places where
>> >the same LMA is used more than 250 times! And the sitting position
>> >is now 53% vs. 46% of the lateral position for regional anesthesia.
>> >These surveys` results will be published soon in the CSEN website.
>> >Now we would like to have your response on the following question
>> >related to the "MD-CRNA World War 3". Please look at the two ads of
>> >AANA and ASA:
>> >1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
>> >million anesthetics administered in the USA annually.
>> >2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
>> >this doctor (anesthesiologist) during your surgery.
>> >
>> >Since this issue is not only an American issue (HCFA Proposed
>> >Rule) but involves also the image of Anesthesiology for the rest of
>> >the world, I would like to pose the following question:
>> >
>> >Do you think Anesthesia is the practice of Medicine or the practice
>> >of Nursing?
>> >Please answer by Medicine or Nursing.
>> >
>> >I could ask the same question for Surgery...but it is for another
>> >survey.
>> >
>> >Sincerely yours,
>> >
>> >Joseph Eldor, MD
>> >Editor, CSEN - The Global Regional Anesthesia Website
>> >http://www.csen.com/anesthesia
>> >
>> >
>
>Dear John,
>What do you mean by:
>"if you want a professional service".
>And if I don`t want??
>This is a double-edge response: A professional service for x (Rich?) and
>unprofessional for y (poor?).
>I know this is not a problem for the UK. However, the US anesthesia is
>in the mud related to the MD-CRNA situation that the UK doctors as well
>as the other doctors who thinks anesthesia is a practice of medicine
>(till now 99% responded like this; the other 1% were CRNAs who said
>both) need to help them.
>J. Eldor
>


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sun, 8 Mar 1998 19:54:21 -0500 (EST)
From:
Ahouva Shulman <sahouva@yorku.ca>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


A combination! Perhaps a new category of health care worker could practise
anaesthesia. However, all patients would be seen and screened by a
physician who would oversee the peri-operative course.

On Sat, 7 Mar 1998, Joseph Eldor wrote:

> Dear Colleague,
>
> This email is sent to selected 800 anesthesiologists in 70
> countries.
> It is a new CSEN Survey on a new issue.
> There are very interesting results on the two previous (unpublished
> yet) surveys on the use of the LMA and the sitting/lateral position
> for spinal/epidural anesthesia. For example, there are places where
> the same LMA is used more than 250 times! And the sitting position
> is now 53% vs. 46% of the lateral position for regional anesthesia.
> These surveys` results will be published soon in the CSEN website.
> Now we would like to have your response on the following question
> related to the "MD-CRNA World War 3". Please look at the two ads of
> AANA and ASA:
> 1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
> million anesthetics administered in the USA annually.
> 2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
> this doctor (anesthesiologist) during your surgery.
>
> Since this issue is not only an American issue (HCFA Proposed
> Rule) but involves also the image of Anesthesiology for the rest of
> the world, I would like to pose the following question:
>
> Do you think Anesthesia is the practice of Medicine or the practice
> of Nursing?
> Please answer by Medicine or Nursing.
>
> I could ask the same question for Surgery...but it is for another
> survey.
>
> Sincerely yours,
>
> Joseph Eldor, MD
> Editor, CSEN - The Global Regional Anesthesia Website
> http://www.csen.com/anesthesia
>


Subject:
RE: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sun, 8 Mar 1998 19:08:09 -0500
From:
"Michael W. Russell, MD" <mrussell@mail.med.upenn.edu>
To:
"'Joseph Eldor'" <a1b2c3d4@netvision.net.il>


Dr. Eldor,
The practice of "anesthesia" is, perhaps too narrow a question. As a physician involved in academic and private practice over 13 years, I think the concept of "perioperative medicine" (buzzword that it may be) more completely defines the role of the physician anesthesiologist. Having recently completed a fellowship in critical care medicine at the University of Pennsylvania prior to returning to academic practice, this feeling has been reinforced.

The conduct of an anesthetic can be reasonably carried out by CRNA's as well as MD's. I have worked with both throughout my career. But the evaluation and preparation of the patient, the selection of the appropriate anesthetic technique, and the immediate postoperative management of higher risk patients....particularly where disagreement between various physicians exists....can only be done by a physician trained in all aspects of perioperative medical care. Ultimately, the issue resolves to one of accountability. CRNA's cannot be expected to insist on specific aspects of perioperative preparation and care independantly of a physician. That physician will either be a surgeon, whose expertise and ability to manage patients at high risk because of medical comorbidity will vary, or a physicain anesthesiologist trained specifically to address all non-surgical perioperative issues.

I find the clinical merits of this debate to be entirely lacking. Economics, that is focusing on the cheapest way to conduct an anesthetic in isolation, are clearly driving this discussion. I know of no responsible CRNA who feels that the absence of physician anesthesiologist involvement is in the patients best interest. Nor do I know of any rational physicians who would doubt the clinical capability of well trained, dedicated CRNA's. Many, if not most, situations require the collaborative practice of both to allow the safest, most efficient use of limited resources.

I appologize for the length of this response but whether the "practice of anesthesia" is medicine or nursing is, in my mind, a specious question. No one would question whether the practice of surgery requires both physician and nursing expertise. I fail to see, from a purely clinical standpoint, why anesthetic practice is repeatedly subject to this question.

Michael W. Russell, MD
Assistant Professor
Anesthesia and Surgical Critical Care
University of Pennsylvania

----------
From: Joseph Eldor[SMTP:a1b2c3d4@netvision.net.il]
Sent: Saturday, March 07, 1998 6:30 AM
To: mrussell@mail.med.upenn.edu;
Subject: The Practice of Anesthesia: Medicine or Nursing?

Dear Colleague,

This email is sent to selected 800 anesthesiologists in 70
countries.
It is a new CSEN Survey on a new issue.
There are very interesting results on the two previous (unpublished
yet) surveys on the use of the LMA and the sitting/lateral position
for spinal/epidural anesthesia. For example, there are places where
the same LMA is used more than 250 times! And the sitting position
is now 53% vs. 46% of the lateral position for regional anesthesia.
These surveys` results will be published soon in the CSEN website.
Now we would like to have your response on the following question
related to the "MD-CRNA World War 3". Please look at the two ads of
AANA and ASA:
1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
million anesthetics administered in the USA annually.
2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
this doctor (anesthesiologist) during your surgery.

Since this issue is not only an American issue (HCFA Proposed
Rule) but involves also the image of Anesthesiology for the rest of
the world, I would like to pose the following question:

Do you think Anesthesia is the practice of Medicine or the practice
of Nursing?
Please answer by Medicine or Nursing.

I could ask the same question for Surgery...but it is for another
survey.

Sincerely yours,

Joseph Eldor, MD
Editor, CSEN - The Global Regional Anesthesia Website
http://www.csen.com/anesthesia



Subject:
The Practice of Anesthesia: Medicine or Nursing?
Date:
8 Mar 1998 20:39:46 EDT
From:
Delfino@digi.com.br
To:
a1b2c3d4@netvision.net.il


A1>Dear Colleague,

A1>This email is sent to selected 800 anesthesiologists in 70
A1>countries.
A1>It is a new CSEN Survey on a new issue.
A1>There are very interesting results on the two previous (unpublished
A1>yet) surveys on the use of the LMA and the sitting/lateral position
A1>for spinal/epidural anesthesia. For example, there are places where
A1>the same LMA is used more than 250 times! And the sitting position
A1>is now 53% vs. 46% of the lateral position for regional anesthesia.
A1>These surveys` results will be published soon in the CSEN website.
A1>Now we would like to have your response on the following question
A1>related to the "MD-CRNA World War 3". Please look at the two ads of
A1>AANA and ASA:
A1>1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
A1>million anesthetics administered in the USA annually.
A1>2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
A1>this doctor (anesthesiologist) during your surgery.

A1>Since this issue is not only an American issue (HCFA Proposed
A1>Rule) but involves also the image of Anesthesiology for the rest of
A1>the world, I would like to pose the following question:

A1>Do you think Anesthesia is the practice of Medicine or the practice
A1>of Nursing?
A1>Please answer by Medicine or Nursing.

A1>I could ask the same question for Surgery...but it is for another
A1>survey.

A1>Sincerely yours,

A1>Joseph Eldor, MD
A1>Editor, CSEN - The Global Regional Anesthesia Website
A1>http://www.csen.com/anesthesia

Dear Joseph

Of course it is a practice of Medicine!!!!!
I never understood the position of American Anesthesiologysts allowing nurses
to
participate even as a support of the anesthetic procedures.
With the complete implementation of managed care in your country you will
suffer the effects of this big mistake. Hope I am wrong.
In this country the surgeons do not accept this sort of
practice.Exception for the owners of private hospitals for obvious
reasons. I suppose you know what I mean: Reductions of costs.Hope this
will never happen in this country.Believe me; It is not prejudice.
Yours,
Delfino


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Tue, 10 Mar 1998 15:09:25 +0200 (IST)
From:
"Dr. Dan Eimerl,M.D." <eimerl@cc.huji.ac.il>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Yossi Hi,
The direct answer to your Q. is ,obviously: MEDICINE !!!
Also I want to add that all the 65% of anesthstics in the U.S.A.
delivered by nurses,are supervised (Or should be) - by Physicians.
Best wishes,
Dani.



Subject:
Dear Dr. Eldor,
Date:
Wed, 11 Mar 1998 06:34:32 -0800
From:
"Brian Mack" <Brian.Mack@vmmc.org>
To:
a1b2c3d4@netvision.net.il


Dear Dr. Eldor,
The PRACTICE of anesthesia is obviously the practice of medicine, as anesthesiologists however, and for a variety of reasons (mostly financial) we have unfortunately defined our specialty in terms of the TECHNICAL aspects of what we do. Nurses can be effective TECHNICIANS, but they cannot, nor will they ever be, CONSULTANTS.
Unfortunately, this issue has become a purely financial one, and the best interests of the public (having physicians parctice medicine) have been lost.
Brian R. Mack, MD


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 07 Mar 1998 09:00:10 -0600
From:
John Hartin <jhartin@koyote.com>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>
References:
1


The answer is both. If I give it, it is Nursing, if you give it it is
Medicine. I respect Medicine, they should respect me.

John Hartin, CRNA

Joseph Eldor wrote:

> Dear Colleague,
>
> This email is sent to selected 800 anesthesiologists in 70
> countries.
> It is a new CSEN Survey on a new issue.
> There are very interesting results on the two previous (unpublished
> yet) surveys on the use of the LMA and the sitting/lateral position
> for spinal/epidural anesthesia. For example, there are places where
> the same LMA is used more than 250 times! And the sitting position
> is now 53% vs. 46% of the lateral position for regional anesthesia.
> These surveys` results will be published soon in the CSEN website.
> Now we would like to have your response on the following question
> related to the "MD-CRNA World War 3". Please look at the two ads of
> AANA and ASA:
> 1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
> million anesthetics administered in the USA annually.
> 2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
> this doctor (anesthesiologist) during your surgery.
>
> Since this issue is not only an American issue (HCFA Proposed
> Rule) but involves also the image of Anesthesiology for the rest of
> the world, I would like to pose the following question:
>
> Do you think Anesthesia is the practice of Medicine or the practice
> of Nursing?
> Please answer by Medicine or Nursing.
>
> I could ask the same question for Surgery...but it is for another
> survey.
>
> Sincerely yours,
>
> Joseph Eldor, MD
> Editor, CSEN - The Global Regional Anesthesia Website
> http://www.csen.com/anesthesia




Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 07 Mar 1998 13:13:19 -0600
From:
Name was deleted upon request
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Joseph,

I have no problem with you including my opinion in your summary. I do not
want my name referenced in any way. I just don't want to deal with all the
email that might be generated by that. I am the director of nurse
anesthesia educational program with a very busy clinical practice included.
I am an assistant professor within the department of anesthesiology at a
prominent medical school in the USA. I practice in a setting which is
primarily supervised by anesthesiologists. The anesthesiologists are very
aware of my clinical abilities and have no difficulty allowing me the
freedom to make my own clinical decisions regarding clinical anesthesia
management. My practice includes both general and regional anesthetic
techniques as well as all types of cases.

I just don't have time to carry on any lengthy debate on this subject. As
you might imagine, I am passionate on the issue and therefore wanted to
provide a brief response to you. In re-reading my response, there are some
grammatical errors...I have corrected those below. I would ask that you
use the "corrected" edition of my opinion in your summary.

Thanks,


*********************************************************

Joseph,

When I administer an anesthetic, I am practicing NURSING. I am not
licensed to practice medicine...only nursing. I am a Certified REGISTERED
NURSE Anesthetist. When a physician administers an anesthetic, s/he is
practicing MEDICINE. S/he is not licensed to practice nursing.

However, there is no SIMPLE answer to this question. Why, you ask?
Because CRNAs practice in different settings offering different levels of
"direction or supervision." Some CRNAs work with NO supervision at all.
Some CRNAs work in settings where there is an anesthesiologist available
(physically or by phone) should a consult be needed. Some CRNAs work in
settings
where there is an anesthesiologist in the building if needed. Some CRNAs
work in
settings where the anesthesiologist does all pre-anesthetic evaluations,
is present for induction, and remains continuously available throughout the
case, is present for emergence, and handles the postoperative care of the
patient.
These practices vary greatly. Many times, statements by practitioners
regarding "how" their practice functions can be looked at in two ways: 1)
by "what they say happens" (reimbursement issue) and 2) by "what really
happens" (patient care issue). These issues are not necessarily the same.

What is the answer to your question of "Is anesthesia the practice of
medicine or nursing?" The answer is BOTH....depending on the license of
the provider and the setting in which they practice. In providing
anesthesia care, I do not practice delegated medicine. When I personally
carry out non-anesthesia *medical* interventions requested by a physician,
I am still practicing nursing in terms of fulfilling a physician's order.



>> At 01:51 PM 3/7/98 +0200, you wrote:
>> >Dear Colleague,
>> >
>> >This email is sent to selected 800 anesthesiologists in 70
>> >countries.
>> >It is a new CSEN Survey on a new issue.
>> >There are very interesting results on the two previous (unpublished
>> >yet) surveys on the use of the LMA and the sitting/lateral position
>> >for spinal/epidural anesthesia. For example, there are places where
>> >the same LMA is used more than 250 times! And the sitting position
>> >is now 53% vs. 46% of the lateral position for regional anesthesia.
>> >These surveys` results will be published soon in the CSEN website.
>> >Now we would like to have your response on the following question
>> >related to the "MD-CRNA World War 3". Please look at the two ads of
>> >AANA and ASA:
>> >1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
>> >million anesthetics administered in the USA annually.
>> >2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
>> >this doctor (anesthesiologist) during your surgery.
>> >
>> >Since this issue is not only an American issue (HCFA Proposed
>> >Rule) but involves also the image of Anesthesiology for the rest of
>> >the world, I would like to pose the following question:
>> >
>> >Do you think Anesthesia is the practice of Medicine or the practice
>> >of Nursing?
>> >Please answer by Medicine or Nursing.
>> >
>> >I could ask the same question for Surgery...but it is for another
>> >survey.
>> >
>> >Sincerely yours,
>> >
>> >Joseph Eldor, MD
>> >Editor, CSEN - The Global Regional Anesthesia Website
>> >http://www.csen.com/anesthesia
>> >
>> >
>> >
>
>Dear ,
>I would like your permission to quote your response while summarizing
>the all data.
>As you have noticed I didn`t ask whether the CRNA should be paid more or
>less than the MD.From my personal point of view I think he should be
>paid more! However, I am interested in the impact of this "MD-CRNA World
>War 3" upon the profession of Anesthesia worldwide including the
>USA.Besides, most of the responses (99% till now are of course -
>Medicine).
>J. Eldor
>
>


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 07 Mar 1998 19:03:26 +0100
From:
fangio <pascal.baylon@bluewin.ch>
Organization:
bluewindow
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>
References:
1


The anaesthesia requires medical knowledge indisputably that do
not have the
nurses. It is not the case for the operational gesture which can
be practised by
any a little skilful technician, like that is done in Africa or
Asia.

Joseph Eldor a ?crit:

> Dear Colleague,
>
> This email is sent to selected 800 anesthesiologists in 70
> countries.
> It is a new CSEN Survey on a new issue.
> There are very interesting results on the two previous (unpublished
> yet) surveys on the use of the LMA and the sitting/lateral position
> for spinal/epidural anesthesia. For example, there are places where
> the same LMA is used more than 250 times! And the sitting position
> is now 53% vs. 46% of the lateral position for regional anesthesia.
> These surveys` results will be published soon in the CSEN website.
> Now we would like to have your response on the following question
> related to the "MD-CRNA World War 3". Please look at the two ads of
> AANA and ASA:
> 1. AANA (CSEN website 5, section 2036): CRNA`s give 65% of the 26
> million anesthetics administered in the USA annually.
> 2. ASA (CSEN website 5, section 2049): Medicare says you don`t need
> this doctor (anesthesiologist) during your surgery.
>
> Since this issue is not only an American issue (HCFA Proposed
> Rule) but involves also the image of Anesthesiology for the rest of
> the world, I would like to pose the following question:
>
> Do you think Anesthesia is the practice of Medicine or the practice
> of Nursing?
> Please answer by Medicine or Nursing.
>
> I could ask the same question for Surgery...but it is for another
> survey.
>
> Sincerely yours,
>
> Joseph Eldor, MD
> Editor, CSEN - The Global Regional Anesthesia Website
> http://www.csen.com/anesthesia




Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 7 Mar 1998 15:05:03 EST
From:
Pankaj Nayyar <pnayyar@bidmc.harvard.edu>
To:
Joseph Eldor <a1b2c3d4@netvision.net.il>


Medicine
The practice of anesthesiology is being a perioperative physician which
can only be done by having gone through med school


Subject:
Re: The Practice of Anesthesia: Medicine or Nursing?
Date:
Sat, 7 Mar 1998 13:04:49 EST
From:
LtCdrSpock <LtCdrSpock@aol.com>
To:
a1b2c3d4@netvision.net.il


Interesting question Mr. Eldor, the typical question which has the fabled
double edge to it. Seeing as how anesthesia was first taught to nurses by the
Mayo Brothers back some time ago, and we have also carried a long and fine
tradition ourselves. I answer the question that anesthesia is an area of
overlap of both of our jurisdictions.


 

We invite more comments on this "MD-CRNA 3rd World War"...

I believe that the conclusive result that Anesthesia is the Practice of Medicine is without no dispute in any survey that will be done even only among CRNAs.

I believe that this dispute between the CRNAs and the MDs in the USA upon financial issues should not allow a redefinition of the practice of anesthesia as the Practice of Nursing, as it was many many years ago. However, before the nurses it was the practice of surgeons, and before them it was the practice of barbers...and before them it was the practice of God (Adam and Eve). So, maybe we should redefine anesthesia as the Practice of God...

Joseph Eldor, MD

Editor, CSEN - The Global Regional Anesthesia Website

http://www.csen.com/anesthesia