When we call out to deem a patient difficult regarding access-airway-anesthesia, we do not consider the procedure, provider, proceduralist, place, phase, payer, or player as difficult. Does this mean that only patient conditions make it difficult, with conditions surrounding the procedure, provider, proceduralist, place, phase, payer, or player never coming into play? Aren’t we putting the onus solely on the patient when we document all such experiences of difficulty only in the patient’s records, thus stereotyping the patient’s future health care, even when the procedure, provider, proceduralist, place, phase, payer, or player may have changed in future encounters?
When drug use flourished, the timely development of personal use ultrasound came in handy to access seemingly impossible veins. When obesity became prevalent, the timely development of video-laryngoscopy helped manage difficult airways. When anesthesia awareness increased, the development of consciousness level monitors helped ensure effective sedation. However, it now seems that the arrival of glucagon-like peptide 1 (GLP-1) agonists could overhaul the entire system, potentially preventing addiction or managing obesity, thereby improving anesthesia delivery.
Maybe veins won’t appear scarred anymore, glottises won’t appear invisible anymore, and brains won’t appear unpredictable anymore. The bottom line is that patients’ safety and their providers’ longevity may no longer depend solely on proficient ultrasound use to access veins or on predominant video-laryngoscopy use to access airways. These advances may make the delivery of anesthesia easier to attain and sustain.
Thus, the question becomes whether it has always been a difficult situation rather than a difficult patient with difficult access-airway-anesthesia, where the difficult situation cloaks everything, including but not limited to the difficulty created by the procedure, patient, provider, proceduralist, place, phase, payer, or player. Therefore, rather than stereotyping the patient, it would be better to deem and document the experiences themselves as difficult situations where multiple interplaying factors come into play, with neither the failures in prior situations deeming anyone dumber nor the successes in future situations deeming anyone wiser.
Interestingly, do evolving artificially intelligent support systems ensure safety that is easier to attain and sustain through collective team efforts, thus possibly reducing the expectation of superlative excellence from individuals themselves? Does this inadvertently lowered expectation of the individual in the Swiss cheese model of safety allow individuals to become dumber and weaker while the systems themselves become smarter and stronger, based on parts working collectively in rhythmic tandem? With systems becoming the smartest and strongest, would conflicts arise when they are faced with superlatively excellent individuals who may destabilize the well-functioning systems guided by their collectively evolving smartness and strength, potentially superseding and even rendering individual smartness and strength moot?
Essentially, the situation, not the individual, has always been and will always be difficult to manage, whether considering the procedure, patient, provider, proceduralist, place, phase, payer, or player.
Deepak Gupta is an anesthesiologist.
