ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

Perioperativeand pain medicineProf Michael Cousins AM“A crucial aspect of enhancedknowledge of pain is the verydistinct possibility that we will beable to identify ‘at risk’ patientswho are likely to progress fromthe acute pain situation topersistent pain.”BackgroundDuring the last 10-15 years I have had anopportunity to have broad ranging contactwith Government and non Governmentorganisations outside of ANZCA as a resultof my appointment to a number of positionssuch as: NHMRC Councillor, Dean of theFaculty of Pain Medicine, Vice-Presidentand President of the College, Chair ofthe Committee of Presidents of MedicalColleges and Councillor, The AustralianMedical Council. Fellows will be pleasedto hear that without exception I receivedstrong feedback that ANZCA was viewed inan extremely positive light. This image hadarisen from outside perceptions of our verystrong training and examination process,our development of professional documentsand other professional activities. Over thelast decade ANZCA has attained statusof equivalent level to the major collegessuch as RACP and RACS. However we areabout to have perhaps the greatest changein healthcare in our lifetime as a result ofwork by the Health Reform Commissionand related bodies. Several MedicalColleges are moving rapidly to positionthemselves for these changes and ANZCAwill need to do the same if it wishes tomaintain or indeed enhance its key role inhealthcare. I believe that there are somevery major opportunities and even threatsfor ANZCA and my purpose in this briefarticle is to comment on a few of these.Perioperative medicineFast tracking of surgical patients continuesto evolve at a rapid pace, that in somerespects has outstripped the scienceand practicalities of this approach.Undoubtedly anaesthetists have a greatdeal to offer in the field of perioperativecare and this is why I appointed thetaskforce on this area during myPresidency which evolved into an ANZCACommittee. However, physicians have animportant and obvious role to play and itis my view that ANZCA should collaboratewith RACP in the development of thescience and practice of perioperativemedicine. From time to time I talk to myfriend and colleague Ron Miller in theUSA about developments in America inthis field and it is clear that perioperativemedicine is evolving rapidly with manyanaesthesiologists taking leadershiproles. The ANZCA curriculum will need toevolve to include the key knowledge baseof perioperative medicine and ANZCAresearch should encompass the effectsand management of various disease statesin the perioperative setting. Whether welike it or not, the perioperative medicinespecialist will be in an unparalleledposition to project a clear image of theknowledge and expertise of thespecialist anaesthetist.Pain medicinePain medicine is now an independentmedical specialty, bringing the knowledgeand expertise of five separate medicalspecialty bodies together. This is a uniqueprofessional body in the world at presentand represents a very major asset toANZCA in collaboration with RACP, RACS,RANZCP and AFRM. All ANZCA Fellowsand Trainees should benefit from enhancedknowledge of the mechanisms andtreatment of pain. Indeed this knowledgeshould be applied to the management ofmany patients in the perioperative phase.A crucial aspect of enhanced knowledgeof pain is the very distinct possibilitythat we will be able to identify ‘at risk’patients who are likely to progress fromthe acute pain situation to persistent pain.The implications of this will be that specialtechniques of acute pain management willbe applied to provide a very cost effectiveintervention because of the reduction inthe large disease burden that is currentlyrepresented by persistent (chronic) pain.Thus, there will need to be timely updatingof the knowledge base of all anaesthetistswith respect to pain mechanisms andtreatment. It seems so simple, howevercross fertilisation from one specialty bodyto another, even in the same college, hasoften been found to be lacking. A startingpoint may well be to ensure that theFaculty’s role in the College is appropriate.The name of the CollegeAnother taskforce that I appointedduring my Presidency was ‘The Nameof the Specialty”. In retrospect this wasnot an optimum choice of title since thereal issue for ANZCA is the name of theCollege. In my many interactions withpeople outside the College, I have rarelymet an individual who could pronounce‘anaesthetists’. Certainly the mediaalso have enormous problems with thisword. This is not a good starting point fora College that is already in difficulty inprojecting to the general community whatit actually does. As noted above, it is mucheasier to project perioperative medicine,pain medicine and dare I say it intensivecare medicine! In any case it is imperativethat the word ‘Medicine’ appears in thename of the College, in my view. Thuskeeping it simple, I would suggest that theCollege’s name be changed to “Anaesthesia& Pain Medicine”. At least anaesthesiais a term to describe the practice of ourspecialty and this matches the word painmedicine. Another advantage is that“Anaesthesia & Pain Medicine” appears tobe a shorthand for Anaesthesia Medicineand Pain Medicine. I would much preferanaesthesiology in the title since there aremany medical specialties that are ‘ologies’.The Australian Society of Anaesthetistscould retain ‘Anaesthetists’ which I knowis dear to the ASA. From the point of viewof the Faculty of Pain Medicine, I think it isonly fair that its role within the College berecognised by including pain medicine inthe name of the College. ANZCA has to bevery careful that a train of events similar tothat surrounding the Faculty of IntensiveCare Medicine, does not occur in the caseof pain medicine.Election of College CouncilMuch has been done within ANZCA toensure that the College Council, andindividual Councillors, act in accordancewith the requirements of regulatory bodies.Councillors all now recognise that theyare members of the Board of a mediumsized company. However, the process of26The ANZCA Bulletin June 2009