I'm going to talk a little bit
now about something that has
been called Perioperative Medicine. And there are different
ways of looking at Perioperative Medicine, and what
I describe as my vision is not necessarily
the vision of all my colleagues, although
it is the vision of many. This developed
basically as a concept when we started
seeing patients routinely in consultation,
days to weeks before their surgery.
And we suddenly realized that we could take
patients who had serious medical problems, that
weren't really recognized by the surgeon or were
beyond the scope of the surgeon's skills to manage,
and we can organize the care
of these patients, the evaluation
of these patients, and get them stabilized in an ideal
position to go for surgery, before they go
for surgery. This has been quite a dramatic
change in our practice, but it's also
been a great improvement in the care of patients, and interestingly
now, surgeons are very keen on the process,
and have found that they can depend on the anesthesiologists
to do a lot of the background work on patients
about internal medicine problems that need
to be resolved. Diabetes, heart failure, rheumatoid
arthritis, a whole array of diseases that really
can have a negative impact on surgery
if they're not stabilized prior to surgery.
So, for many anesthesiologists,
when we talk about Perioperative Medicine,
that's as far as it goes for them. I see
something much broader occurring. What I see
is the anesthesiologist becoming
the hospital physician for surgical patients.
where we take care of them prior
to their surgery, during their surgery, and continue
to care for them after their surgery.
Surgeons are extremely skilled at dealing with surgical problems.
They can do the surgery and they can deal with
the complications of surgery very effectively.
But the majority of them are not used or skilled
in treating medical problems. We are!
We can bring internal medicine into
the mix, they're very important as well, but they tend to be
too busy to spend a lot of time with surgical patients.
So they'll come in, they'll consult, but they'll often
not carry on with the patient. I truly believe that
anesthesiologists are ideally suited as the physicians
in the operating room, to carry on
as the post operative physicians for patients
in the hospital, and perhaps even outside the hospital
in the future. That's my vision
of the future. It's starting to slowly
roll out in some parts of the world. I really
hope it continues to roll out. I won't be around
to see it, I don't think. But it, to me,
is the natural progression in my specialty
and the natural progression in improved
care for patients. So, in summary,
we've had a very long course on many,
many aspects of Anesthesiology.
I've ended this last lecture with a vision
of the future and also an indication
of some of the areas that we're expanding into
currently. I think the future for anesthesiologists
is extraordinarily exciting. I think
that the need for anesthesiologists
is unbelievable, particularly when it comes to Pain
Management. It's going to be almost impossible
to train enough pain doctors. I think
that the future for patients will be
improved by improved anesthesia care,
both at the time of surgery, before
surgery, and in the future, after
surgery. I think this is really
a very exciting vision, and it's my hope
that this is the way things will develop.
I hope this course has been of interest to you.
You've had an awful lot of material thrown at you in
a relatively short period of time. I hope you've been
able to absorb part of it. I hope from this
course you've learned what a fascinating area
of medicine Anesthesiology is, and how broad
its scope really is. Thank you
for your attention, and best
of luck in your future studies and in
your future interest in my specialty!