DOI: 10.1097/PEC.0000000000000115
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PMID: 24694890
Issn Print: 0749-5161
Publication Date: 2014/04/01
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Excerpt
First, nonanesthesiologists is grammatically imprecise and contextually inaccurate. Adding “non” before any word implicitly denotes opposition, as is appropriate for antithetical concepts such as nonfiction, noncitizen, and nonsense. When the subject at hand lacks underlying dichotomy, however, such phrasing becomes vague and confusing. Procedural sedation skills across the various specialties are not simply dichotomous, that is, present or absent, but rather demonstrate a rich and well-documented continuum.5,10
Second, many anesthesiologists may not appreciate that this artificial dichotomization is perceived by other specialists as intentional and thus pejorative. Implicit is the notion that anesthesiologists possess safe sedation skills and nonanesthesiologists do not. Emergency physicians are one of the multiple specialties who can rightly object to this implication because their residency and fellowship core curricula amply cover procedural sedation’s requisite skills including advanced airway management, rescue, resuscitation, monitoring, and pertinent pharmacology.5,10 In 2011, the United States Centers for Medicare and Medicaid Services affirmed that emergency physicians “are uniquely qualified to provide all levels of analgesia/sedation and anesthesia (moderate to deep to general).”11 It is no longer constructive or professionally acceptable to take 1 set of practitioners with proven advanced sedation skills and categorically lump them together with other groups who are lacking such skills. Imagine how anesthesiologists might react if organized emergency medicine issued for them and others a “statement on granting resuscitation privileges to non–emergency physicians.”
Finally, policies directed at just nonanesthesiologists imply that anesthesiologists themselves are somehow exempted. If one specialty wishes to define its “best practice” vision for a multidisciplinary field, should they not then be expected to follow their own recommendations? Should not prudent safeguards for procedural sedation be equally applicable to everyone? When anesthesiologists administer deep sedation, should they be uniquely exempted from the precautions that they believe are appropriate for this setting?
Sedation is and always has been a multidisciplinary field, and optimal interspecialty spirit and collaboration are best fostered through terminology that is both accurate and respectful. If a sedation policy or guideline is intended for a set of practitioners with or without a certain set of sedation skills, then why not specifically detail the skill set in question? For example, one guideline might apply equally to everyone. Another guideline might be focused on those new to moderate sedation. A third might be directed for those lacking preexisting skills in advanced airway management. Such an approach is far more specific and helpful than the oversimplification of nonanesthesiologists or an equally unhelpful paraphrase such as “practitioners who are not anesthesia professionals.”7
More than a decade ago, Peter Bailey appealed to other anesthesiologists to rethink their paradigm of other specialists and to “stop calling them nonanesthesiologists.”1 The implementation of this corrective and progressive action is long overdue. More than a decade ago, we abandoned the term conscious sedation as more trouble than it was worth, and now, the equally problematic word nonanesthesiologists deserves the same fate.
