THE ANESTHESIA TURF WAR
In your article "Nurse 'gassers' sink standards: MDs" (April 15, 2007, Vol. 4, No 7, page 3), I was surprised to read that Dr Shane Sheppard, president of the Canadian Anesthesiology Society (CAS), has such a narrow view of the role RNs can play in anesthesia. I have news for him. In some countries, nurses have been doing anesthesia at least as long as doctors. American nursing anesthesia schools were responsible for much of the training given to those who paved the way for anesthesiologists like Dr Sheppard. What makes him think anesthesia is more complex here than in the States?

Let's not underestimate what RNs are capable of. In the US, nurse anesthetists currently provide the majority of anesthesia to patients in the community, the hospital and on the battlefield, including full anesthesia in the OR, in collaboration with an anesthesiologist. The reason is simple. They are proficient and have demonstrated expertise in critical care. Can a new graduate from a medical program entering residency say the same? I challenge Dr Sheppard to provide credible information to suggest that nurses do not deliver safe anesthesia in an OR setting or otherwise.

He can fear for his job, stamp his feet and fight it all the way, but nurses won't stop. As for his mum, he can rest assured that the nurse putting her under has the backing of 125 years of research, practice and caring to ensure it's done compassionately, with knowledge and with experience. Like it or not, NPs - Anesthesia are coming to Canada.

Jason Lea, RN, BScN (hon), Fonthill, Ontario

Dr. Sheppard Responds: I'm not surprised to see this topic generating controversy and passionate responses from all members of the healthcare team. Nurses play an integral role in the highly collaborative areas where I work, the OR and the ICU. Patient care requires teamwork involving many doctors, nurses, physiotherapists, technicians and others.

The CAS welcomes expanded roles for nurses in patient care. We need more nurses in Critical Care areas as their shortage affects access to these specialized units. Across Canada they play an expanded role in pre-op patient assessment. Other roles are emerging in post-op pain control and facilitating access to specialized care at home as earlier discharges become the norm.

Unlike in many countries, anesthesiology in Canada has always been taught and practised by physicians. Our model of physician-driven anesthesia is incredibly safe. My malpractice insurance has dropped virtually every year for the past 15 while other specialties have not been so fortunate — nor have our anesthesiologist colleagues to the south.

Dr Shane Sheppard, MD, FRCPC, President,
Canadian Anesthesiologists' Society

SPAM SLAM
Regarding your article "Doc's RateMDs battle turns ugly" (May 15, Vol 4, No 9, page 14), it's funny how Dr Keith Thompson thinks he can spam the RateMDs website with no consequences, just because he's a doctor. What happened to free speech? I guess it's free as long as we exclude truthful complaints about doctors' poor procedures, poor manners and unfair practices.

Sherry Sanderman, Address withheld