Interview with Prof Johannes T.A. Knape
Prof. Johannes T.A. Knape, MD, PhD, FRCA, FCARCSI, FSSAB, is president of the European Society of Anaesthesiology (ESA) and Deputy Chair of the Department of Anaesthesiology, Division of Perioperative and Emergency Care, at the University Medical Center Utrecht.
View the original post at www.lwwpartnerships.com
The European Journal of Anaesthesiology is the Official Journal of the European Society of Anaesthesiology.
Susan: What do you think have been the greatest advances in anaesthesiology in recent years?
Dr Knape: In my opinion, there have been many advances in anaesthesiology in the last few years that meet the challenges posed to the specialty today. Although the number of new drugs that have advanced our specialty are limited (e.g., sugammadex), great progress has been made in monitoring and information technologies that not only provide the anaesthesiologist with adequate and relevant information, but also enable anaesthesiology departments to develop a stronger position in hospitals and to take the lead in organising operating room (OR) departments, thus leading to improved efficiency and quality of care.
In Europe, the harmonisation of training requirements and examinations (the European Diploma) has definitely benefited the overall quality of care and the exchange of ideas between anaesthesiologists of various countries, which would not have been possible before.
The greatest advance for anaesthesiology in my opinion has been the leading role of the specialty for patient safety in OR departments, emergency departments and intensive care departments in many hospitals, thereby contributing significantly to the reduction of patient morbidity and patient mortality now and in the years to come. Safety in medical practice is one of the cornerstones of the specialty, and due to developments in information technology, which are instrumental for implementation of standardized safety procedures, anaesthesiology is the “natural” specialty to play a key role in advancement of patient safety, which is a hot issue worldwide.
Susan: In your opinion, what are the most promising areas of research to watch?
Dr Knape: Basic research is and will be vital to further develop our understanding of the fundamental physiologic and pharmacologic principles of our specialty. But in these days, both the general public and the financial care providers, due to limited resources in many countries, have a great need to be informed about the cost/benefit aspects of the work we do. Therefore, we will have to put more and more emphasis in research activities for clinical outcome studies.
These studies will have to take into account the development of prediction factors that will assist medical specialists in decision making for difficult ethical questions. Can we afford to provide expensive medical care to one patient whose likelihood to recover to a meaningful life is less than 1% at a price that could also be spent on a potentially successful outcome for 50 other patients?
Further promising areas of research may focus on safety issues in areas which anaesthesiologists share with others such as in sedation by non-anaesthesiologists.
Susan: What do you view as the greatest challenges facing the field of anaesthesiology today?
Dr Knape: Anaesthesiology is developing from an OR-based medical specialty to a specialty with responsibilities both in and outside the operating rooms. As a result of significant changes in expectations both from the public and from the authorities; developments in medicine leading to further (sub-)specialisation; and social factors such as reduced working hours and part-time employment, the traditional role patterns between surgeons, physicians and anaesthesiologists are changing rapidly. The anaesthesiologist is now the physician to take on responsibilities as perioperative doctor and to show leadership in the control of the process that guides the surgical and emergency patient through the hospital. All this against the background of anaesthesiologists continuing to be closely involved with safety principles.
Susan: Looking down the road, how do you think the practice of anaesthesiology will differ 10 or 20 years from now?
Dr Knape: In my view, the anaesthesiologist will have taken the responsibilities to direct the perioperative process as a process manager. In many countries, a number of medical activities, now typically the domain of the doctor-anaesthesiologists, will be transferred to health care professionals with specific and limited expertise in well-defined areas, such as nurse practitioners, physician assistants, sedation practitioners, but under final responsibility of an anaesthesiology department. This will require new, non-anaesthesiology-specific skills in the field of communication, cooperation and professional behaviour, which are being incorporated now in some specialist training curricula.
Furthermore, a number of fields of expertise will have been developed where not only anaesthesiologists, but also other medical specialists will have input in a multidisciplinary context, such as pain medicine, intensive care medicine, emergency medicine and others. A main challenge for the next few years will be the capacity and ability to train sufficient residents in every European country to meet these new tasks in the future and also to try and harmonize working conditions in all countries to reduce the incentive for experts to switch to other countries due to significant differences in working conditions. With this in mind, anaesthesiology is and will be the most rewarding medical specialty today and in the future.
European Journal of Anaesthesiology
The European Journal of Anaesthesiology, the Official Journal of the European Society of Anaesthesiology, publishes original, peer-reviewed articles of a high scientific quality in the specialties of anaesthesia, intensive care and related disciplines. Preference is given to experimental work or clinical observation in humans, and to laboratory work of clinical relevance. The Journal also publishes comprehensive review articles by an authority in a field, abstracts of scientific meetings, editorials, book reviews, and news and lists future meetings. Learn more
Visit the journal website: http://www.ejanaesthesiology.com/