PGA 2011 – Elizabeth Frost

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Dr. Eric Fishman, CEO EHRtv, and Dr. Howard Rollins, EHRtv AIMS specialist and medical consultant, speaks with Elizabeth Frost, Professor of Anesthesiology.

Category: AIMS, Uncategorized
Date: January 18, 2012
Views:5,137 views

Dr. Howard Rollins: This is Dr. Howard Rowlands with EHRTV and I have with me Eric Fishman with EHRTV and the esteemed Dr. Elizabeth Frost, Professor at Mount Sinai School of Medicine. Dr. Frost we are very proud to be in your presence and we know you have a lot of wonderful stories to tell you and you have had an amazing career as anesthesiology. Tell us the most interesting thing that has ever happened to you in this field.

Dr. Elizabeth Frost: Well there has been a lot of interesting things and first of all it is nice to say you’re happy to be with me, I would like my sons to hear that for a start, they could never imagine why anybody wanted to ever hear anything from me. When I said to them once that not only do people get up early in the morning to listen to me talk they sometimes even pay for it, and they were certain that was absolutely nonsense. Well I don’t know what has really happened that has been standing out as more exciting and more wonderful than anything else. Many, many things the residents I have been involved with, the teaching I have done, being admitted to the Association of University Anesthesiologist, becoming a professor in anesthesia at time when there were very, very few with any women in it in the United States who were given that honor. All of this has been very exciting and has been building on many things throughout my career.

Dr. Howard Rollins: I asked you earlier who do you think is the most famous anesthesiologist is and I know there are many but let’s talk about that a little.

Dr. Elizabeth Frost: From a female point of view? I would say that probably Virginia Apgar. I met Virginia Apgar a very, very long time ago. I actually had come to this country because I had applied for a job in the United Kingdom, right after I had graduated. My credentials were much better as I saw it than the other man who was applying for the position in London a health officer job but of course he was given the position because as the board explained to me, you understand that we have to keep everything just the way it is, to which I am looking at a whole room full of men. I said I don’t understand, explain it to me, to which they said well the trouble is you don’t understand. With that left I left the country and came to the United States because I found a hospital in New Jersey that was prepared to pay my passage if I was in the to 10% of my graduating class so I came to Englewood, New Jersey and this is a little bit a long explanation but that is where I met Virginia Apgar. She was part of a quartet that played the cello and I would go on once a week with Dr. Driggs who was an internist, who was my mentor at Englewood Hospital and I met with her and actually played the piano with her sometimes and she told me about anesthesia and how great it was to do that. Now at that point I realized that the public expects the doctor to do 2 things, to deliver the baby and take away the pain. Well I was already a diplomat of the Royal College of Obstetricians in London, I was already an obstetrician, I didn’t like it. And then I decided what else is there to do in medicine, I better become an anesthesiologist so after I had got through my time in Englewood, I went to New York Hospital and I became an anesthesiologist and never forget the wonderful times I had with Virginia Apgar.

Dr. Howard Rollins: That is a fantastic story, it really is, Dr. Fishman?

Eric Fishman: And so continuing along with New York I understand that we both spend some time at Albert Einstein, you possibly a bit more than I did and if you could tell us some stories about Albert Einstein College of Medicine I would love that.

Dr. Elizabeth Frost: Oh yes I was at Einstein for a long time and for many years I was in charge actually of the medical student teaching, I would have them for a week or 2 weeks, they would come to the department of anesthesia. Well we had a great time because at that time things were a little different from right now. So I would have them all breathing nitros oxide and then they would draw things on each other’s arms and I remember one medical student drew on somebody else arm under the influence of anesthesia. He put a heart shape and put arrows through it and put somebody elses initials and not the initials of that medical student’s wife, so that was a little bit difficult. But we had a lot of fun with medical students in fact I remember one group of medical students actually took me out for lunch because they thought I was the coolest teacher that they had because I gave them the drugs too …

When I was at Einstein starting out at Einstein I was very interested in neuro-anesthesia right away. We were still getting out of the age of having drugs that actually blew up, like ether and cyclic propane and the surgeons wanted to use cautery. Now that is not a good idea. So you had to sort of put a lot of wet blankets around everything. I remember one interesting time too when the resident in nuero-surgery he was using a hole air drill to drill a hole in somebody’s scalp, now I am sure you remember that time we re-sterilized everything and the whole air drill, all that rubber around it was all gummy and sticky, so as he applied the pressure on the drill, he wasn’t getting much air out because behind him the rubber was blowing up and it exploded with an enormous bang and to which the poor guy fell down on the floor and screamed I have been shot! But this was the day of the mafia and everything else at Einstein a lot of at Jacobi. Like the time when somebody had been shot but not quite killed and was in the recovery room at Jacobi and the mafia guys came up to finish it off. So they came to the door of the recovery room and I just said that is it everyone out of here, you can have your patient. Or the other time when somebody had I was with … I don’t know if you remember Dr. Thailor, he was an ENT surgeon and this patient had come in with every bone in his face was broken and there was a lot his thugs along with him and Thailor said something to the effect that we may to do a tracheotomy to which these thugs got Thailor by the shirt collar and pushed him up against the wall and said you cut his throat and we cut yours! And Thailor looked at me and said if you’ve never got an endotracheal tube in before make sure you get this one in. I said whoops! So I called down to security and I said can you come up and help us, we were in Van Etten and they said are you kidding? Those guys have got real guns we are not coming. That was Jacobi and Van Etten and then I was there of course when Einstein opened. That had its problems too I was in the elevator one night and this woman got on the elevator and she came up and I had my mask on my next and she began to twist and just staring at me and I thought she was going to choke me and so I turned around quickly kicked her right against the wall, got out of the elevator and the guards said oh that is Betsy she does that every night don’t worry about it. So it was fun.

Eric Fishman: On a more serious note, I think we can all agree that medical care in this country is in a transition phase, what do you see happening especially in our specialty in anesthesiology and medical care in general?

Dr. Elizabeth Frost: It is a very difficult time, I would like to see a higher rise in anesthesia assistants, I would really, really love to see us work in a more collaborative fashion with the CRNAs rather than the adversarial situation we have right now. I mean I lectured at the CRNA conference this year well received and I had a very good time, we had a lot of CRNAs with us and we enjoy working together in a truly collaborative system with an understanding that we are physicians when things really go wrong they like us to be there. And I think that is very important, I think that we should take a lot more charge as perioperative physicians and this is extremely difficult. One of which I’m dealing with right now is to try and decrease the amount of pre-operative testing that we are doing. Another healthy say 50 year old who might be having a knee replaced or even a hip replaced, if they got they got their knee done because they’re running marathons all the time, they don’t need a nuclear stress test for $2300. We don’t need all that it is not going to change the anesthetic. I mean I feel that something like less than probably 0.2% of the tests we do actually impact our anesthetic or surgical management. And we are spending something like $60 billion a year on unnecessary testing?

Eric Fishman: Why do you thing we are doing these many tests?

Dr. Elizabeth Frost: Because it is a bit of a back scratching situation, I think that many internists depend on surgeons for referrals back for all sorts of testing, I think that hospitals do a lot of unnecessary testing because it keeps the labs in business. I think that radiologist, cardiologists can read normal tests. I think it is just a complicated system, so many people involved, so much money involve.

Eric Fishman: What do you think about this improvement in technology, that we see happening around us, these anesthesia information management systems, the electronic health records if you will, they are touted to improve patient safety there is clinical support built into them they have lots of alerts when the wrong drug is being given, they help with skip protocol adoption, do you think that the future is bright for that technology?

Dr. Elizabeth Frost: Absolutely

Eric Fishman: Are you excited about it?

Dr. Elizabeth Frost: I wouldn’t want to spend a day without having our AIM system, we have had it at Sinai since 1990 something like that and what I think is in the future you got these AIM systems , you don’t have to hand out pens at these meetings anymore.

Eric Fishman: Thank you.

Dr. Howard Rollins: And yet I have been involved with electronic health record industry for a quite a number of years and as I understand it the adoption of AIMs is many years behind the adoption of health information technology in non-anesthesia areas. Do you have an explanation of why or how rapidly it will be increasing.

Dr. Elizabeth Frost: Well we have been working with this system right now at Sinai. Now I can get as much information out of it as other physicians put into it. Now if the Chinese doctor down in China Town or the Russian doctor in Brooklyn doesn’t input in to the machine, I can’t get this information back out again and I say to the Russian or I say more to the Chinese individual what operation are you going to have? Look blankly at me, what is the name of your doctor? What medications are you on? And they bring me a great big bag of Wal-Mart all written in Chinese, this isn’t too helpful. So I got to get the input from these peripheral doctors and many of them say it is too much money that system into their office yet.

Dr. Howard Rollins: What we have been hearing from a lot of AIMS vendors and anesthesiologists and I think you will agree with these, is that anesthesiologists have tended to resist bringing the automated anesthesia record into their hospitals and in the community setting for fear of increased liability that when these physicians were used to writing their anesthesia records on their own and now all of sudden a computer is doing that for them.

Dr. Elizabeth Frost: Well this obliviously is fallacious, for years we did railroad tracks anesthetic records, it is now increasingly evident that if a patient does not exhibit variation in blood pressure and pulse rate during the procedure there is something wrong with them, they are not responding the way they should and in fact the patient who has steady state blood pressure pulse is in trouble and they are not being as responsive to accommodate their bodies, their cardiovascular system cannot accommodate to the changes that are caused by the various drugs and maneuvers and stress response. So what we get out of the automated record keeper is we see really what is happening. They have analyzed quite a few medical legal cases right now and they find that in something like 70 or 80% of the cases having automated recording keeping actually helped the anesthesiologist. Sure if you have no end tidal CO2 after intubation and you do nothing about it you are liable. If you have a pulse meter going down to 50% and you have done nothing about it, and this is all recorded you are liable but for the most part there is no doubt in my mind that the automated information systems are excellent, we should have them, everybody should have them and they are here to stay.

Dr. Howard Rollins: Do you think it improves work flow because that has always been one of the fears and the resistance to it has been that I don’t want my work flow interrupted by having to learn and work with a system that might actually slow me down.

Dr. Elizabeth Frost: Well if you put in your own template to start with, what sort of anesthetic do you want to give in this case? Half your work is already done for you and the wonderful thing is it is legible afterwards, the number of the anesthetic records I have looked at from medical/ legal point of view they are just not legible. The other thing is they are definitely helpful for the SKIP project because we have a little button on our machine that says have you given the antibiotics appropriately? Until you push that button you cannot move on to the next page. So that helps you, does this patient have appropriate beta blockade , is the status being given, what does the temperature looking like, it gives us all the buttons to remind us of all the SKIP projects and all the other things that we have to do.

Dr. Howard Rollins: And you work with young residents, how do they feel about it? For them I would assume it is fairly normal because they’re starting their training with this. It’s just part of what it is.

Dr. Elizabeth Frost: Oh yes they have got their iPads, they got everything, they have got their phones and if they didn’t have this I don’t know, they couldn’t function without this, they couldn’t function with a pen and paper record anymore.

Dr. Howard Rollins: Dr. Frost I cannot tell you what an honor it sit here with you and speak with you. If somebody told me during my residency that someday I would be doing this I would have said that is only a dream. Thank you.

Dr. Elizabeth Frost: Thank you

Dr. Howard Rollins: Thank you very very much, this is Dr. Howard Rowlands and Dr. Eric Fishman with EHRTV, we have been speak to Dr. and Professor Elizabeth Frost at the New York Society of Anesthesiologists PGA 2011. Thank you.

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