Talk:Anesthesia provision in the United States

Just

Just tidying up a bit

deepzCRNA 04:36, 11 February 2007 (UTC)

Take your vandalism elsewhere, sir

deepzCRNA 02:00, 12 February 2007 (UTC)

Thoughts on article

Mmm, I guess as I suggested this article might be a possibility, I shouldn't be surprised it has been created. This article offers the opportunity to go into a lot more detail about how anesthesia is delivered in the US. For one thing, I suspect a separate discussion of ACTs is appropriate here. Please note the following:

1. This article needs to offer more detailed content than that provided at Anesthesia or is likely to be deleted.
2. The article must provide balanced, neutral discussion of how anesthesia is provided in the US.
3. However, here it may be possible to have a section about Controversies in US anesthesia provision. Please baer in mind that such a section would need to present all sides of the debate equally. Also, given its controversial nature, all content would have to be reliably sourced.

Lets see where this takes us... WjBscribe 02:12, 12 February 2007 (UTC)

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Thats the funny thing WBJ. The controversy is that the MDAs (ASA) seem to think anesthesia is the practice of medicine SOLELY while US LAW says it is both nursing and medicine. The whole statement about ACT practices here is political propaganda and one sided (not to mention untrue). It should be removed.Mmackinnon 02:04, 13 February 2007 (UTC)

Stop vandalizing the article. I've restored the page as written and if you wish to make changes they should be discussed, not just made by you.

No one said that there is no practice of nursing involved in anesthesia. Just like there are nursing aspects of critical care, internal medicine, emergency medicine, etc. there are nursing practices in anesthesia. However, just because there is a role for nursing within anesthesia doesn't mean that it is not still a specialty in the practice of medicine. Uptowner 23:26, 13 February 2007 (UTC)

As I have said on your talkpage, the article was not vandalised. I agree that the addition in question could have been more neutrally written and have now changed it. But blanket deletions of content are not the way to resolve a content deletion. Please work with others to improve this article. WjBscribe 23:38, 13 February 2007 (UTC)

Sources for statistics

It would help move things forwards if sources were found for the following:

• Proportion of anesthesia administrations in the US each year done by nurses vs. physicians
• Proportion of anesthesia administrations by nurses that are supervised by physicians

Thanks, WjBscribe 23:50, 13 February 2007 (UTC)

____________________

If primary sources for the above claims (by the Georgia AA) are not presented forthwith, I would propose deletion.

Heads-up for WJB: in recent years the ASA militants have ceased to describe CRNAs as 'CRNAs' and preferentially now use only 'nurse.' That way, they can conceal the fact that CRNAs are Nurse ANESTHETISTS, full service anesthesia providers, and so, they imply that we are the hand maidens they would wish us to be.

Nurse anesthetists is the proper usage. 'Nurses' giving anesthesia is a not-so-subtle put-down.

It has often proven to be the case with ASA's so-called 'studies' that the group starts with a political preconception and then works the so-called 'science' backwards to prove their original thesis. They get their conclusions before their horse. Notably, these articles have been rejected from peer review by other journals; even an editorial by a dissenting member of the board of Anesthesiology has criticized publication of politics in the ASA journal disguised as scientific 'studies.' The real aim is professional hegemony.

deepzCRNA 04:29, 14 February 2007 (UTC)

Where is the evidence?

There wont be any reference for this statement "90% of all anesthetics administered in the US are either provided solely by physician anesthesiologists or supervised by anesthesiologists." because none exists.Mmackinnon 03:56, 14 February 2007 (UTC)

This statement is misleading and intentionally so, "outside the ACT, both types of provider caring for their own patients independently and consulting whenever collaboration is appropriate to patient outcome." The consulting is unidirectionally on the whole, not a collaboration between equaly trained individuals. Uptowner 22:30, 14 February 2007 (UTC)

Look up 'collaboration,' Mr Georgia AA. Nowhere will you find the word implies or establishes a relationship as being between two equals. I collaborate with MDs, DOs, dentists, podiatrists, and on occasion, with anesthesiologists. And sometimes an MDA asks me for my input or assistance.

As to my practice and 'protocols,' you simply don't know what you are talking about. NPs and PAs utilize protocols in that they rely on a physician's delegated authority. I practice on my own authority as a CRNA in several States. Wouldn't know a protocol if it bit me.

deepzCRNA 23:58, 14 February 2007 (UTC)

_____________________________________________

WJB, what was your objection to the See Also research about Obsterical Anesthesia?

deepzCRNA 13:17, 15 February 2007 (UTC)

The law section is also misleading. It says that anesthesia is a nursing function blah blah blah. This is incorrect. Some parts of anesthesia are nursing functions and some are not. The wording should reflect that nursing covers part but not all of the practice of anesthesia. It also states that no one has questioned this which is absurd. I don't know why we keep defaulting to nursing claims and their reaching beyond their proper practice. The ASA says anesthesia is the practice of medicine. There is no reason to view the nursing lobby as the bottom line reference. Uptowner 19:44, 15 February 2007 (UTC)

Mr Goergia AA, you have editied into the law section language which is completely at odds with the legal precedents. Take it out.

deepzCRNA 02:33, 16 February 2007 (UTC)

And your comical diatribe under Anesthesiologists is just the sort of thing that will get you banned from Wiki, just as you have been banned elsewhere.

deepzCRNA 02:37, 16 February 2007 (UTC)

---

Uptowner. The ASA has no monopoly on US law. What they "think" is irrelevant. The LAW says that Anesthesia and all its functions are indeed, advance practice nursing functions. It isnt nursing lobby, its the law in the USA and it is established with more than 60 years of case law that i have used as references. Your reference is the "A$A says its the practice of medicine" yah, that carrys weight.Mmackinnon 03:26, 17 February 2007 (UTC)

add the references

Again more opinion without references. Please add them or have it removed. Also this "As the methods of altering and monitoring physiology became more advanced, so did the interest amongst American physicians in the field." is blatantly untrue. Physicians became interested in anesthesia ONLY after there was significant reimbursement NOT due to "altruistic" or "scientific" interests.Mmackinnon 20:40, 17 February 2007 (UTC)

If your making changes.....

Please, discuss it here first.Mmackinnon 14:59, 18 February 2007 (UTC)

"selfish lobbying"

The phrase "Despite intensive, selfish lobbying by the AANA..." makes me think this section has lost a neutral POV. Since I'm no expert in this area, I will have to leave it to others to work this out. —The preceding unsigned comment was added by 69.111.57.173 (talk) 22:44, 19 February 2007 (UTC).

Where were we?

Mmm, I've taken a break from looking at these articles because (a) various issues elsewhere needed attention and (b) I wondered if you might be able to work out your difficulties between you. Evidently I was mistaken about (b). So that I don't have to review about 50 edits to this page, could people indicate what they feel is wrong with the present version, how it can be improved etc. Hopefully we can have some discussion and move forwards. Oh, and were any of the illusive sources discovered in my absence? WjBscribe 07:37, 20 February 2007 (UTC)

Unacceptable POV

Anesthesiologist Assistants are another group who participate in anesthesthetic care. They earn a masters degree and practice under physican supervision in sixteen states through licensing, certification or physician delegation. Despite intensive, selfish lobbying by the AANA to, AAs are able to practice in an ever increasing number of locations. Anesthesiologist assistant's responsibilities in the ACT settings are identical to CRNAs under the direct supervision of a board certified anesthesia doctor. Anesthesiologist Assistants are happy with their position providing anesthesia under physician supervision, and unlike CRNAs, do not lobby to try to become doctors without attending medical school. As opposed to training ICU nurses to be CRNAs, training AAs does not worsen the shortage of qualified nurses and is altogether positive for heathcare provision in the US.

(Emphasis mine)

This is one of the worse examples of POV-pushing I have seen on Wikipedia outside of articles on the validity of same-sex marriage. I have warned the user responsible and further such edits will likely lead to blocks. This article is not a forum for anyone to express their opinion about the standards of care provided by other bodies. It should convery neutrally informations about who DOES provide anesthesia and when. Not who should, who is. I've added a controversy section. Sourced statements about issues between various groups belong there.

While we're at it, though not nearly as bad, this is problematic from the other side of this debate:

It is estimated by many, but the facts have repeatedly neither been confirmed nor denied by the ASA, that approximately 40 percent of the physician membership of the ASA are neither board eligible nor board certified in anesthesia.

Allegations should not be in this article, especially not if unsupported by a reliable citation (which would include a citation for the 'many' bit of it).

It should not necessary for me (or any other editor) to have to baby-sit the writing of this article. So please, write neutrally and include references. Thank you. WjBscribe 07:51, 20 February 2007 (UTC)

I suggest removing this part

"There are studies which suggest that physician and nurse anesthesia may not be substitutable services because anesthesia delivered by physicians results in fewer adverse events than undirected nurse anesthesia."

The study, Silber et al, has been debunked by its own authors are mere conjecture and not science. Even MDAs admit that. The pine study we have added however, parallels 4 others actual studies suggesting the same thing, there is no difference. Sibler is flawed and the author admits it therefore it does not count as evidence.

Here is the evidence against the study. http://www.anesthesia-analgesia.org/cgi/reprint/99/5/1578.pdf (Study Regarding Anesthesia Outcomes Cites Outdated Studies)

http://bja.oxfordjournals.org/cgi/content/full/93/4/540 Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review

http://www.aana.com/news.aspx?ucNavMenu_TSMenuTargetID=171&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=1606 Surgical mortality and type of anesthesia provider

Mmackinnon 14:48, 20 February 2007 (UTC)

I changed several things to make this less controversial and so that the constant editing re-editing can hopefully cease. It was an honest effort to provide a balanced view on both sides and I think you'll see it as such. Uptowner 21:18, 22 February 2007 (UTC)

Hey uptowner

Nice edits, very fair compromises. Thanks for meeting half way!Mmackinnon 01:12, 24 February 2007 (UTC)

I changed several things to make this less controversial and so that the constant editing re-editing can hopefully cease. It was an honest effort to provide a balanced view on both sides and I hope you'll see it as such.

deepzCRNA 05:34, 24 February 2007 (UTC)

To cite the Pine study, among others, as supporting the standard ASA agitprop that US anesthesia is 90% controlled by MDAs is simply laughable. Those references are by no means supportive of the statement and need too be removed. Otherwise the page is approaching consensus IMHO.

deepzCRNA 15:37, 27 February 2007 (UTC)

Sorry but I can't seem to find the number 90 anywhere in the article, where should I be looking? WjBscribe 15:42, 27 February 2007 (UTC)

35% plus 55%.

deepzCRNA 16:30, 27 February 2007 (UTC)

Dr Pine himself had this to say regarding ASA efforts to distort his findings:

....for the ASA to suggest that his study's data supports "the conclusion 'that anesthesiologists improve anesthesia outcomes'" is evidence of "either a woeful ignorance of the basics of data analysis or a cynical contempt for the intelligence of the intended audience.".........Dr. Pine wrote that his data actually found 34 deaths per 10,000 cases when CRNAs administered anesthesia while working together with anesthesiologists, and 45 deaths per 10,000 cases when anesthesiologists worked without a CRNA. He pointed out that this difference of 11 deaths per 10,000 cases was "even more impressive than the 7 deaths per 10,000 cases" difference cited by the ASA (see paragraph above), and that based on this data, "the AANA could claim that anesthesiologists should not be permitted to administer anesthesia unless a CRNA is present to prevent the excess mortality associated with physicians attempting to engage in the practice of nursing. However, unlike the ASA, the AANA has enough respect for its audience to avoid making such unwarranted claims."

http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=51&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=668

deepzCRNA 14:37, 1 March 2007 (UTC)

Yes im still watching

Please, dont change this entry as an anonymous person, be a man and have the balls to sign your name so that I can identify who is making up crap. Thanks.Mmackinnon 20:22, 10 April 2007 (UTC)

The ACT section needs a clean up, There are open quotes, and the section ends with an awkward unsourced statement concerning the defendants in malpractice cases. I'd edit it as I think there may be some factual info to be presented there, but I think the original author might wish to tackle it firstAestiva 22:22, 30 April 2007 (UTC)

Also, the very first reference appears to be a press release. That would not meet the standard for a citation, I assume?

74.37.249.246 12:28, 2 May 2007 (UTC) deepzCRNA 02:10, 3 May 2007 (UTC)

WjB? Is a press release a proper citation as a scientific reference?

deepzCRNA

WjB?? Any moderator?

deepzCRNA 04:10, 10 May 2007 (UTC)

We all know that a press release is not an authoritative source.

deepzCRNA 05:15, 22 August 2007 (UTC)

Turf battle enclosure

An ordinary person coming to read this article would expect to find a broad spectrum of info about anesthesia in the US. But it seems to be meant as simply a enclosure to fight battles about WHO provides anesthesia services in the US. (See Talk:Anesthesia for the tedious main battle.) I won't bother trying to intrude by suggesting other appropriate content, such as US safety statistics. But it is absurd that the article doesn't include a comprehensive discussion of the major organizations and websites related to the turf battle that it reflects, with links to articles about each of the organizations. Again, I won't try to intrude by adding content that is sure to offend some faction. But anyone interested can find such info by googling <anesthesia safety>. -69.87.200.24 21:44, 28 August 2007 (UTC)

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