Pain is a universal experience that is unique for each person — one that’s tough to measure, with an endless list of possible causes and physical locations.
Therein lies the challenge of managing pain. Pain often is the reason people consult a physician, but how do doctors treat something that is so hard to quantify and describe?
Anesthesiology Chair Tony Jones is
responsible for a team that performs
more than 45,000 anesthetic procedures
For the UAB Department of Anesthesiology, the solution is to redefine that treatment with a two-pronged approach. While teams of specialists focus on specific types of pain, new programs take a look at the big picture, integrating multiple fields of medicine to manage pain’s physical, psychological and even social aspects.
Anesthesiologists work in UAB Hospital and UAB Highlands, The Kirklin Clinic, Callahan Eye Foundation Hospital and the Veterans Affairs Medical Center — basically anywhere there are operating and procedure rooms.
Anesthesiology Chair Keith “Tony” Jones, M.D., coordinates this sprawling service. He is responsible for a team that performs more than 45,000 anesthetic procedures each year — and on any given day those could include treatment during specialized medical procedures or preliminary medical evaluations; comprehensive management of acute, chronic and cancer pain; and full-time critical-care treatment in three intensive-care units. The patients, who could be pediatric, adult, inpatient or outpatient, are treated by anesthesia care teams that involve physicians, nurse anesthetists, laboratory technicians and anesthesia assistants, respiratory therapists, recovery-room nurses and trainees including residents, fellows and student nurse anesthetists.
With so many variables to consider, Jones says the key to blanketing UAB with high-quality anesthesia care is to cultivate the clinical skills and interests of his anesthesiologists.
“What makes people good at what they do is when they love what they’re doing,” he says. A new fellowship program is enabling anesthesiologists to acquire an extraordinary level of proficiency in one subspecialty and a very high level of proficiency in another.
“Promoting this subspecialty focus in two areas broadens their interest and they become more engaged,” Jones says. “That results in better outcomes for our patients and a sense of fulfillment for our clinicians.”
The program also creates redundancy in the anesthesia practice, allowing faculty to back each other up in certain areas. Anesthesiologists who work in the pain clinic, for example, also may practice in the operating room, spending 60 percent of their time in the pain clinic and 40 percent in the operating room. Physicians in the critical-care medicine fellowship also could specialize in neurosurgical or cardiothoracic anesthesia. Jones says the additional training strengthens the camaraderie between anesthesiologists and surgeons and promotes working relationships that raise the quality of patient care.
Expanding areas of expertise helps UAB anesthesiologists treat myriad complex medical conditions now — and also could benefit future pain sufferers. The fellowship programs “will continue to evolve in the next four to five years,” Jones says. “One reason we’re doing this is so that at some point down the road we can develop a comprehensive perioperative cardiac program with physicians trained in critical-care medicine with high degrees of proficiency in adult cardiac or neurosurgical anesthesia. We would be able to administer the anesthesia intra-operatively and help take care of post-operative patients in the critical-care units.”
Jones, who earned his medical degree from the School of Medicine at UAB in 1986, saw a similar program in action at the Mayo Clinic, where he was a professor. When he returned to UAB in 2006, he inherited a pioneering anesthesiology department — founded 50 years ago as one of the first academic units of its kind in the nation — ready to take its next big steps.
Developing a well-rounded skill set lays the foundation for future advances, suggests Jones.
“Because of the way the UAB Health System’s surgical enterprise is structured, it would be almost impossible to create isolated obstetric, cardiac, critical care, pain and neuroanesthesia divisions and sections,” he says. “There’s no way to provide every subspecialty service 24 hours a day, seven days a week, in silo fashion. It could triple the size of the department.
“The best way to do it is to create two areas of interest instead of one and have them cross-fertilize one another. That’s what we strive to accomplish.”