The practice of medicine has always been fraught with controversy across all specialties. Examples include end of life care, childhood vaccinations, circumcisions, and genetic engineering, just to name a few.
As anesthesiologists, we face controversial surgeries everyday such as organ transplantation, bariatric surgery, and abortions. Our goal, above all else, is to provide quality anesthesia care and keep the patient safe.
As a practicing pediatric anesthesiologist at VCU Health, I have faced controversial situations, such as guardianship issues or a lack of consent for blood transfusions. Taking a step back and proceeding with the welfare of the child as the guiding principle helps to procure an appropriate and safe solution.
We encounter disputes outside of the operating room as well. A legislative issue that has been controversial in medicine over the past few years is “Surprise Billing.”
Surprise Billing refers to an insured patient unexpectedly receiving a large medical bill from an out-of-network provider for services rendered. This most often occurs with emergency visits when the patient does not have the time to determine if the physician, ambulance, or hospital is in their health plan’s network.
This is unfair to the patient and ultimately represents a war between physicians and the insurance companies who want to use their own fee schedule. In the state of Virginia, we have worked tirelessly with our lobbyists and were successful in getting legislation approved towards this issue in the spring of 2020.
It allows out-of-network providers to be paid the commercially reasonable amount, based on payments for the same or similar services provided, in a similar geographic area, as determined by an advisory group, and the Virginia Health Initiative. The VSAPAC helped earn this win and we are thankful for your support.
And let us not forget the COVID-19 pandemic, which has wreaked havoc on our healthcare system and created multiple ethical dilemmas.
The lack of PPE and the need to ration available resources amongst front line workers was alarming. Another devastating reality was the limited number of ventilators in various countries, causing adequate care to be withheld from patients.
Healthcare disparities were made strikingly evident by the large number of COVID infections and deaths amongst different racial and ethnic groups.
And finally, vaccine trials created debate as trials on secondary vaccines were started after a vaccine had already been deemed safe and effective. Was an effective treatment being withheld during a pandemic or was a more novel vaccine being trialed that could improve immunity?
While COVID numbers are decreasing and the CDC has withdrawn their indoor mask mandate for vaccinated individuals, we should all maintain vigilance and continue to practice safely and cautiously in the months ahead.
I hope you enjoy this issue as we explore more controversies in Medicine and Anesthesiology including Informed Consent, Medical Malpractice, and Medical Marijuana Legislation.
There is also a review of the Anesthesia Care team model explaining the differences between Certified Anesthesiologist Assistants (CAAs) and Certified Registered Nurse Anesthetists (CRNAs).
As always, feel free to reach out to me at marie.sankaranraval@vcuhealth.org or to your local VSA representative if you have any issues you think we can offer assistance.
We are here to help and I believe our voice is stronger together.