A Recollection of My Visit to the U.S.A., October 14 November 3, 1990:
First of all, let me offer apology for delay in writing to you. I have visited your country nearly half a year ago and have started to write a report immediately, bid could never quite finish it because of more and more thoughts and alterations. After the personal letter from Jeep Pierce in April, I have realized it is not necessary to wait until my style will reach the level of perfection and I send the report as you read it now.
As a Visiting Professor invited by APSF, I have had a chance to come from the U.S.S.R. and spend three weeks in the U.S.A. and to observe the work of several departments of anesthesiology: in Boston, San Diego, Los Angeles, Gainesville, Baltimore and New York. A great experience was the ASA Annual Meeting in Las Vegas. My itinerary was rather tight, but everything ran so precisely that I was able to follow an extremely interesting program, and, in the end, survived my stay in your country. Even my 12 takeoffs and landings were excellent and I was transported exactly according to the timetable. Ut was my second visit, the first one being the 9th World Congress in Washington.
I wish I had better literary ability to explain my many feelings concerning your medicine, surgery, anesthesiology, and life.
First, I shall try to outline some similarities and differences in our practice. I would say that your medicine is much more business-like. You spend much more money, you count the costs precisely, you earn much more and you work much more intensively. It seems that the slow and clumsy are hardly surviving in your anesthesiology or surgery, at least I have not met those during my visit. The number of surgical interventions and anesthetics in your big hospitals differs from ours by as much as 3: 1 or even 5: 1.
Our patients mostly spend in hospitals much longer times. The main reasons are: no reliable prehospital diagnostics and unreliable postoperative care at home. The percentage of outpatients in your OR schedules is much higher. Day-surgery is highly valued and recommended in your country and could be important in our country, but still is underutilized in many regions. I was very impressed by the administrative parts of the departments of anesthesiology. It is rather astonishing the number of personnel working in the offices in each department! Probably we shall need the same after introducing the Health Insurance System and changing the financial support for medicine.
Methods of anesthesia in American hospitals are more or less similar to those used in our country but the assortment of available drugs makes a great difference. At present time, we can only envy your ability to choose individual medication for every patient. Many of us have to give our patients the drugs available at the moment, which are not always among the best choices. For example: we would rather have preferred to use enflurane and isoflurane instead of halothane. We still have no experience with many widely used drugs (examples: long-acting local analgetics, a new generation of narcotics and muscle relaxants, Diprivan, and many others) and are interested to have them in our practice. Probably there are still many places in the world where either the economics or inadequacy of the pharmaceutical industry dictate the choice of anesthesia and therapy. We happened to have both.
Professor Elena Damir (top center), president of the equivalent of the ASA in the U.S.S.R. and the first APSF Visiting Professor, was greeted at a large reception at the ASA annual Meeting last October. Top photo, from left: Mr. Burton A. Dole, Jr., APSF Treasurer; Jeffrey B. Cooper, Ph.D., APSF Executive Committee; Dr. Damir; Ellison C. Pierce, Jr., M.D., APSF President; J.S. Gravenstein, M.D., APSF Executive Committee. Lower left: John H. Eichhorn, M.D., APSF Newsletter Editor explains a point to Dr. Damir. Lower right: G.W.N. Eggers, Jr., M.D., ASA President-Elect, discusses comparisons of U.S. and Soviet anesthesiology practice.
The great impression I have had from the anesthesiology in U.S.A. was technology and monitoring. I have seen this in every operation room of all the University and Veteran Hospitals I have had the chance to visit. Most of us in the U.S.S.R. live and work in quite different technological conditions. This might be partly the reason why many of us believe that the only possibility to diminish the risk of anesthesia is with monitoring systems and other modern technical devices. We know another point of view, explaining any better outcome of anesthetics by improved skills, methods, and techniques. Observing the work of anesthesiologists in your country, I cannot say there is great difference in professional skills or clinical thinking abilities. Statistics show the favorable result of your high technological anesthesiology: the anesthesia mortality and morbidity are noticeably lower in your country. I do believe that your system can increase patients’ safety during anesthesia and operation. In the same time, it is obvious that your system is much more expensive and not every country can afford it.
Unforgettable was my first experience of participation in ASA Meeting in Las Vegas. I have spent most of my time in Refresher Course lectures and the very impressive exhibition. I could never imagine any meeting with more than 10,000 participants, and in Las Vegas there were more than 13,000 anesthesiologists! Very interesting and educational for me was to observe some special activities and committees: Educational, Board Examination, Patient Safety, Election of the President and Officers. It was a little bit astonishing to learn that the Presidentship term is so short, only one year. I wish I could learn more about the system of the ASA organization, activity, and its relations with the Societies of the different states. The position of AU-Union Societies in our country is actively discussed now and your experience could be real help in the period of Republic sovereignty and all those political changings, national problems, and permanently arising difficulties. I am most grateful to those who made possible my participation in the meeting. The hospitality of the officers and committees was tremendous.
Very interesting were discussions with residents and observing the training system. The hard work of residents could be called probably slave-like. Compared to our two-year residents, it seems unbelievable. The high professional skills of the senior residents proves the Russian saying: “hard in training easy in battle:” Very important in early training could be the simulator for diagnostics and tactics of dealing with complications and incorrect functioning of monitors. I have seen the simulator in the process of construction and trial in Gainesville.
How shall I finish my short and never completed report? I have not mentioned the names of my hosts, of all the anesthesiologists who helped to organize my stay in many places. Please believe I am deeply grateful to all of you. My address file includes about 100 new names. I remember all of you and I hope many of you will visit me in the future with your families.
Thank you all!
Professor Elena Damir is President of the All-Union Society of Anesthesia and Reanimation, U.S.S.R., and in the Fall of 1990 was the first APSF Visiting Professor.