People often ask me, “Why are you so interested in public health?” With a superficial glance, public health doesn’t have much to do with anesthesiologists. After all, we are not on the front lines advocating for tobacco cessation, mammography screening, or childhood vaccinations. Furthermore, no one ever embarks on public health campaigns with anesthesiologists in mind. However, I propose to you that public health has a profound impact on our work in anesthesiology, and here is why.
Public health is about patient safety
As physician anesthesiologists, we have always been the first advocates for patient safety. We made one of the most dangerous procedures in medicine – undergoing anesthesia – one of the safest, and we are the only medical specialty to have our own patient safety foundation. Every day, our usual routine involves numerous safety checks, even before the patient enters the operating room. We should and must maintain our position as the most vocal advocates for patient safety.
Public health is about quality improvement
Patient safety and quality improvement often go hand in hand. Improvements in perioperative outcomes would not have been possible without concerted efforts in quality improvement. The stepwise nature of work in the operating room is perfect fodder for quality work, as there are numerous entry points for improvement with potentially high gains. Indeed, as “quality” and “outcomes” become more important for reimbursement, efforts in QI will become even more significant.
Public health is about epidemiology
The very first lesson any public health student learns is about John Snow, who discovered that a deadly cholera epidemic in London was linked to a contaminated water pump on Broad Street. John Snow is often called the “Father of Modern Epidemiology,” and coincidentally enough, also happens to be an anesthesiologist. As long as there continues to be morbidity and mortality that results from anesthesia, epidemiology will be important as a tool for us to understand why.
Public health is about global health
Although perioperative morbidity and mortality have declined precipitously since the 1970s, these gains are seen more in developed countries rather than developing countries. In many low-income countries, perioperative mortality (in the OR and within 30 days) is unacceptably high, due to lack of infrastructure, equipment, medicines, and qualified personnel. As the global burden of disease shifts from communicable to noncommunicable chronic disease, more and more people around the world will need surgical interventions, and the need for safe anesthesia will become even more important.
Public health is about population health
Population health, in contrast to public health, refers to outcomes of a population of interest: for example, perioperative outcomes of patients with persistent intraoperative hypotension, or outcomes of patients who underwent preoperative smoking cessation. Without research in population health, we cannot continue to innovate within our specialty.
Public health is about policy
There has been much ado about the shift from “volume-based” purchasing to “value-based” purchasing and its effect on reimbursement. In the current political climate, changes to our reimbursement system, initiated by policy reforms, can occur on a whim. It is important for us to both understand and to shape policy – we must have a seat at the decision-making table. That cannot occur without a good understanding of policy.
So what should you, as a physician anesthesiologist, do about public health? Be interested. Be vocal. Be an advocate. Be engaged in the CSA. Be passionate about a cause – whether it is the opioid crisis, or patient safety, or operational improvement. Anesthesiologists have a vested interest in public health, and in doing so will advance our specialty far into the future.