How a Commitment to Lifelong Learning Will Make You a Better Physician
As an MD, your continuing education is of paramount importance. By reading journal articles, networking with colleagues, and seeing how things are done at different places, your skill set widens, new knowledge gets put into practice, and as a result, you have better patient outcomes.
To illustrate the importance of lifelong learning, I’m going to discuss a few examples from my career as a cardiac anesthesiologist. Hopefully, these will help you understand that for the physician, school is never over, and your patient’s health depends upon how well you keep up with the latest discoveries and advances.
We’ll start by looking at an example of how things used to be done for major heart surgeries, to illustrate just why expertise is always something you are in pursuit of, rather than something you’ve acquired.
An Example of Old School Cardiac Anesthesia
As a cardiac anesthesiologist, I get to have a front-row seat to some incredible surgeries. The most audacious procedure involves taking all of the patient’s blood and having it sit in a reservoir bucket outside their body, stopping its flow completely, and cooling them down to 18 degrees C so their brain and organs can tolerate it.
Naturally, surgeries this large require a lot of analgesia and sedation. One time, I took over from a colleague who was practicing cardiac anesthesia from the 1980s (when he was trained), and he had given the patient 10mg of midazolam and 30mg of morphine, amounts of medications that all but guaranteed that even with a perfectly smooth surgery, the patient will not return to consciousness anytime today.
Of course, the longer a patient is intubated and sedated, the more morbidity they face. Breathing tubes beget pneumonia, sedation begets hypotension and the necessity for pressors, and pressors can beget end-organ ischemia. If only the patient could be safely extubated on the earlier side, much of this iatrogenic morbidity could be avoided.
There had to be a better way to do this.
How Lifelong Learning Saved the Day
Ahoy! ERAS (enhanced recovery after surgery) protocols burst onto the landscape and had patients from all realms of ORs shortening their lengths of stay, getting extubated sooner, and avoiding all the problems that come with staying in the hospital, like infections and delirium. With ERAS came fast-track extubations, protocols that aim to get that breathing tube out within 4-6 hours of ICU drop off.
We learned how to tailor our anesthetic to get these patients extubated quickly. We utilized different sedation protocols, fewer opioids, more adjuvant analgesics, and other advanced monitors to give a patient more precisely what they needed, and not just “a boatload of anesthesia.”
Then We Took It to the Next Level
As I entered practice as an attending, we took things one step further and started to employ peripheral nerve blocks to decrease immediate post-operative pain and get patients extubated even faster. The hot-off-the-presses pecto-intercostal fascial plane block was not a block I had ever performed before, but it was newly described in the cardiac surgery literature, showed promise in decreasing opioid requirements after surgery, and improved patient satisfaction. As more and more data came out, the results were clear that the block offered a benefit. It became a standard tool in our armamentarium.
It brought us great joy to see patients that we had dropped off at lunchtime extubated before dinner. Sure, they were groggy and often required a little bit of blood pressure support, but they were talking, and had enough mental wherewithal to not only remember us as their anesthesiologists, but give us a “Thanks, Doc” as well.
How Lifelong Learning Saved a Patient
A time when this really came to fruition was when a young male patient, who had recently recovered from opioid addiction, needed cardiac surgery and requested an opioid-free anesthetic. He naturally wanted to minimize his chances of relapse, which brings with it enormous risk of mortality.
Clearly, this was not the patient to prescribe various opioids and benzos, as would have been done in years past. By utilizing a novel and effective nerve block and catheter technique, along with numerous adjuvant analgesics, the anesthesia and ICU teams were successfully able to navigate the patient through, and give him a substantially improved chance at long-term survival. Every measure was taken to prevent this patient’s relapse into opioid addiction. The paradigm shifted, and we didn’t execute the usual plan. (You can read about it here, as it was case reportable.)
As the previous examples demonstrate, medicine is an evolving science, and learning new protocols, keeping up with the literature, and using new knowledge to tailor treatments is key to being an effective practitioner. Being a lifelong learner isn’t just a good thing for a physician to do—it’s absolutely essential to the practice of medicine.
We must never give up on keeping abreast of the literature. Otherwise, we become dinosaurs. Technology keeps moving forward, and we must too. Sure, it’s one more thing to do, but don’t we want to be the best possible doctors we can be? Don’t lose touch with the ever-advancing cutting edge of medicine. Remember, even though you are a doctor, you still have a lot to learn!
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