Personas Part 3

Part
01
of fourteen
Part
01

OB/GYN Surgeon Persona: Pain and Caregivers

After an extensive search through medical databases, forums, and research firm directories, details about the relationship between a patient's caregiver and OB/GYN surgeons concerning pain management or prevention do not appear to be available in the public domain. However, the research team was able to gather valuable insights into opioid prescriptions for OB/GYN patients, patient safety, and patient concerns about pain management.

HELPFUL FINDINGS


RESEARCH STRATEGY:

We began our research by looking into specialized research repositories for any relevant studies to track data points about OB/GYN surgeons and their communication with patient caregivers concerning pain management. However, we couldn't find any such research requests. The only research we found focused on OB/GYN general surveys about the difficulty of pain management and the importance of patient consent in surgery.

Next, we looked into specialized medical databases and organizations, directly or indirectly related to OB/GYN surgery. We hoped to find reports or studies related to patient caregivers and OB/GYN surgeons' communication regarding pain management. Even after thoroughly scanning World Health Organization (WHO), American Surgical Association (ASA), Association of Academic Surgery (AAS), American College of Surgeons (ACS), American College of Obstetricians and Gynecologists (ACOG), Institute for Healthcare Improvement, Society of University Surgeons (SUS), and the Consortium Pain Task Force, we couldn't find any data either directly or indirectly related to our topic.

We then looked through medical research databases to find any evidence that OB/GYN surgeons' pain management is affected by patient caregivers in any way. Information found here was mostly related to pre-OB/GYN appointment suggestions and general opinions on how to avoid pain related to OB/GYN surgery.

We also tried to collect general opinions of OB/GYN surgeons on whether patient caregivers' opinions or communication changes/modifies their pain management strategies, searching through surgery-oriented forums. However, there were no relevant threads that provided any insights into patient caregivers and their effect on OB/GYN surgeons' pain management strategies and methods.

Since the data required for our purpose was qualitative and research-based in nature, we couldn't utilize triangulation or extrapolation approaches. Nor could we identify any paywalled research or studies on patients' caregivers and their effect on OB/GYN surgeons' pain mitigation procedures. Also, due to the data being related to medical science, using arbitrary approximate approaches like combined analyses and logical inference would require some definite amount of background data on the subject, which was not found during our research.

Lastly, we expanded the scope of applicable research to sources older than two years and relating to the entirety of North America, rather than just the US. However, even this failed to produce any relevant sources that provided us information on patient caregivers and their impact on OB/GYN surgeons' pain mitigation strategies. We only found a few sources that provided guidelines for surgeons on informing the patient caregivers about pain mitigation strategies.
Part
02
of fourteen
Part
02

Anesthesiologist Persona: Pain and Caregivers

The caregiver has an important role in the pain management of the patient due to their ability to influence the mental and physical relaxation of each patient, which ultimately affects how well patients manage the pain. They are involved in conversations to provide information on the patients' previous medical history, which influence the physicians' decisions on how to proceed with the anesthetic procedure, hence deciding whether it is paramount to try a new product or not for each specific case.

Role of Caregivers in the Pain Management of the Patients

  • Caregivers play an important role relating to the complete timeline an anesthesiology patient goes through, from the preoperative stage to the postoperative stages due to the positive influence their participation has on improvements in the allocation of health care resources, patient and family satisfaction, chronic disease self-management, morbidity, and mortality."
  • According to the Association of American Medical Colleges MedEd portal report, caregivers influence physicians' decisions on how to proceed with the anesthetic procedure.
  • Caregivers have the important role of calming the patient, explaining what the procedures are and ensuring the smooth running of the operation. They are vital due to the patient\physician relationship being new, which makes it difficult for patients to feel comfortable or trust physicians during the preoperative stage.

Influence on Physicians Decisions around Pain Management

  • According to a study from a pediatric surgical program on the patient and family-centered care defends the positive impact of caregivers involved in the patients' pain management mainly due to the reduction of anxiety — therefore reducing the quantity of sedative medicine administered — this study included the comparison of preoperative Midazolam administration, preoperative time and induction time.
  • According to the Canadian Institute of Health and Research's information bank, Midazolam is a short-acting hypnotic-sedative drug with an anxiolytic, muscle relaxant, anticonvulsant, sedative, hypnotic, and amnesic properties.
  • The quantity of the preoperative use of Midazolam uses reduced from 41% (392/964) to 13% (16/118) — the program received a rating of 99.2% efficiency by caregivers and 77.5% efficiency by the medical staff.
  • The caregivers defended that their presence during the preoperative process greatly reduced anxiety for them by 87.1% and their child by 93.2%
  • It is a physician obligation to honor respect and oblige to the patients' families/caregivers choices, automatically, this would ultimately influence the physicians' decisions revolving the correct manner in which to proceed with the care and medicine administration of the patient.
  • Caregivers may influence physicians to try new products if previous records show that the standardized products administered have a bad reaction or are ineffective on the patient.
  • Furthermore, physicians are the party with medical expertise, giving them the ultimate power to decide whether a new product is suitable for the patient at hand.

RESEARCH STRATEGY

To locate information regarding the role of a caregiver in the pain management of an anesthesiology patient, we began by combing through the United States National Library of Medicine and the National Institutes of Health Research on the benefits of a family-centered approach to pediatric induction of anesthesia. We analyze medical findings on the physician and caregiver relationships revolving around how it influences the procedure and outcomes of the patients’ surgical journey.

Quantitative information was used to support the claim that caregiver involvement positively affects the outcomes of pain management in the surgical environment — the amount of involvement and influence caregivers have on the physicians' decisions were obtained by researching information on family-centered operational methods.

The lack of information or vague statements revolving the caregivers' direct decision-making on the administration of new medicine led us to assume that these decisions are influenced by more detailed factors belonging in the conversations between medicinal experts through thorough research rather than the majority of uninformed suggestions from caregivers.
Part
03
of fourteen
Part
03

OB/GYN Surgeons Persona: Pain Perceptions

Most often OB/GYN surgeons suggest regional anesthesia during planned C-section whereas surgeons use general anesthesia when the mother strongly prefers it due to her perception of pain. Below is an overview of the findings.

PATIENT PERCEPTIONS OF OB/GYN PROCEDURES

Planned C-sections


Mastectomy

  • As per a case study by the University of South Florida, patients who underwent mastectomy experienced a pain level of 0.4 to 2.5 out of 10, which lasted for one day.

INFLUENCES AND PREVENTION TECHNIQUES OF OB/GYN SURGEONS

Planned C-sections

  • For patients who opt for C-sections, OB/GYN surgeons suggest various types of sedation for pain management such as regional anesthesia and general anesthesia. The types of regional anesthesia used are spinal anesthesia and epidural anesthesia.
  • Most often OB/GYN surgeons suggest regional anesthesia which makes the mother aware of the baby’s first cry. Surgeons use general anesthesia when the mother strongly prefers it due to her perception of pain or in case of surgical emergencies.
  • Though general anesthesia is safe, it is not the preferred choice of surgeons and it is only used when it is a patient’s strong preference.
  • Medication is altered even after the surgery based on the patient’s pain perception.
  • Ibuprofen and acetaminophen are the drugs given after a C-section based on a patient’s pain perception. Opioids are prescribed based on the patient’s need.

Mastectomy

  • To avoid or reduce the fear of pain before a mastectomy, OB/GYN surgeons suggest using Tylenol before the surgery and avoid using vitamin E supplements and aspirin.
  • Surgeons also suggest listening to music and focusing on reading.
  • General anesthesia is the first choice for mastectomy sedation, however, patients can choose the type of sedation after discussing this with the surgeon.
  • Surgeons alter a wide variety of medication to induce anesthesia based on the patient’s preference for the surgery.
  • OB/GYN surgeons give the best possible dosage regimen to patients with chronic postoperative pain after a mastectomy by collaborating with anesthesiologists.
  • OB/GYN surgeons prescribe narcotics if there is intense pain whereas, for moderate pain medications such as Vicodin, Ibuprofen or Tylenol are prescribed.

RESEARCH STRATEGY

Initially, we searched for information on patient perceptions of pain and how it influences the pain management/prevention techniques of OB/GYN surgeons in various medical journals and medical research surveys (such as Remedy Publications, WebMed Central, NJCP Online, Researchgate, Cochrane Library, Komen, JNSBM, and others). We were not able to find specific information for all gynecology procedures but were able to collect some insights on planned C-sections, mastectomy, and other procedures.

As there was no readily available related information on pain perceptions for the whole field of gynecology in the U.S., we tried locating information on various gynecology procedures such as planned C-sections, mastectomy, and other procedures but there was very limited statistical information as most of the sources had subjective insights.

Last, we searched for information on what an OB/GYN surgeon does during, before, and after surgery on the websites of various OB/GYN surgeon associations and hospital websites (such as Yale Medicine, WebMD, UCSF Health, Mayo Clinic, and others) and found that surgeons alter their treatment plan based on the patient's pain perception during, before, and after surgery.

As the scope of the request is very niche, we could find only a limited amount of subjective insights to address the patient perceptions of pain and its influence the pain management/prevention techniques of OB/GYN surgeons.



Part
04
of fourteen
Part
04

Anesthesiologists Persona: Pain Perceptions

An exhaustive search in the public domain reveals that information on how do patient perceptions of pain influence the pain management / prevention techniques of anesthesiologists is non-existent and media mention on the topic is scarce. The most relevant media mention on the topic is; according to the patient perceptions of pain management therapy study, measuring patient satisfaction of pain has become critical in evaluating the treatment. The factors that affect patient satisfaction with pain management include the adequacy of teaching they receive and the type of therapy they receive. Below are our helpful findings and detailed methodology.

USEFUL FINDINGS:

  • According to a study on the patient perceptions and expectations about postoperative analgesia, 100% of patients believed they would receive analgesics after surgery. Out of which about 37% of patients believed they would receive Tylenol, 18% Motrin, and 77% opioids.
  • The study also reported that patients not expecting to receive opioids postoperatively, still believed opioids would be superior to non-opioid medications.
  • The study results showed that patients expected to experience pain after surgery were given analgesics.
  • The patient perceptions of pain management therapy study reported that measuring patient satisfaction of pain has become critical in evaluating the treatment. The factors that affect patient satisfaction with pain management include the adequacy of teaching they receive and the therapy they receive.
  • The study reported that nurses must understand their patients' perception to help meet analgesic goals.
  • Candice Morrissey, Assistant Professor at University of Utah School of Medicine, believes that anesthesiologists want specific patient feedback to improve upon medical care.
  • Candice Morrissey also says that getting patients feedback about treatment helps to know if patients understood us, felt their care was coordinated, and got the feeling their wishes would be observed.
  • A Chorionic Villus Sampling procedure was conducted to determine the pain perception among patients during antenatal genetic testing.

RESEARCH STRATEGIES

We began our search by looking for information on Anesthesiologists Association websites. We looked for information on sites like American Society of Anesthesiologists, AANA, among others hoping to
find articles and publications on patient perceptions of pain influencing the pain management / prevention techniques of anesthesiologists. However, we could not find any information pertaining to the research
criteria. The most relevant information we could find is about the patient perceptions and expectations about anesthesia. We had thought this strategy may work as sites like these publish educational, research, and scientific information for the medical practice of anesthesiology and would have published the required information.

Next, we looked for scholarly research papers that may published the required information on sites like NCBI, Lens, Webmd, among others. Unfortunately, this strategy did not provide the required information. We looked into these websites because they usually provide various studies/research/survey on the medical field. Here,
we could find the information on the patient perceptions of pain management therapy, among others. Further, we searched for interviews of anesthesiologists in the United States on sites like Asra, Medical News Today, Anesthesiology News, among others. This strategy wasn't fruitful, as the information presented in the sources is about the drugs used for anesthesia, techniques used to treat patients, among others. Our aim behind this strategy was to see if any anesthesiologists have reported how the patients influenced them in any pain management or preventive techniques.

Finally, we searched for information on pain perceptions for some surgery and other treatment procedure conducted in the United States, which required the use of anesthesia. We tried locating the information on sites like Yale Medicine, Mayo Clinic, among others, but we could not find any relevant information on the topic. Our aim behind this strategy was to search for information on what influences the pain management / prevention techniques of anesthesiologists pertaining to the patient perceptions of pain before and after surgery. However, we could only find information on the types of anesthesia during surgery.
NOTE: We could not triangulate the information pertaining to this research because:

  • There are no research reports, articles, and journals on how patient perceptions of pain influence the pain management / prevention techniques of anesthesiologists in the public domain.
  • This could be due to the niche nature of the request and also no organization has done research on this type of topic due to the costs involved and less demand for such type of reports.

Part
05
of fourteen
Part
05

OB/GYN Surgeon Persona: Procedure Follow Up Appointments

On a scale of 0–100, obstetricians and gynecologists have a mean patient satisfaction score of 65.1, which is higher than other specialists at 58.1; and female OB/GYNs are less likely than males to receive top patient satisfaction scores. However, even after exhaustive research, the typical post-surgery satisfaction rate for OB/GYN surgery patients specifically focused on pain management or prevention from both the patient's and physician's point of view could not be located in the public domain. Below are some helpful findings.

HELPFUL FINDINGS

  • Opioid prescribing and use is of particular relevance to obstetrics and gynecology practice. Cesarean delivery (C-section) is the most common inpatient surgical procedure performed in the United States—approximately 1.3 million women undergo this procedure each year, and virtually all are prescribed opioid medications as a result.
  • The American College of Obstetricians and Gynecologists (ACOG) recommends pharmacologic and nonpharmacologic therapies for managing postpartum pain management as pain can interfere with a woman’s ability to care for herself and her infant.
  • According to a study, the amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.
  • According to a study, female OB/GYNs are less likely than males to receive top patient satisfaction scores.
  • According to an NCBI study, a study sample comprised of 1,903 obstetricians and gynecologists and 6,035 other specialists, on a scale of 0–100, the mean satisfaction with physician score was 65.1 for obstetricians and gynecologists and 58.1 for other specialists. Patient satisfaction due to the physician’s caring and friendly attitude was 6.65 (P < 0.001) for obstetricians and gynecologists and 5.86 (P < 0.001) for other specialists.
  • Overall, patients waited a significantly shorter time for obstetrician and gynecologist visits, averaging at 26.8 minutes, compared to other specialists.

RESEARCH STRATEGY

To provide a description of the typical post-surgery satisfaction rate for OB/GYN surgery patients specifically focused on pain management and/or prevention both from the patient and physician's point of view, we first consulted industry sources, such as the American College of Obstetricians and Gynecologists, the American Journal of Obstetrics and Gynecology, and Obstetrics & Gynecology Journal, among others, in the hope of finding relevant statistical or hard data. However, we were only able to find some pilot studies about the postpartum pain management expert opinions and best practices, opioid use in pain management, and OB/GYN compensation and workforce statistics.

Next, we looked into US government health institutes databases, like Centers for Disease Control and Prevention (CDC) and the National Center for Biotechnology Information (NCBI), hoping to find existing research and survey studies that provide information about the satisfaction rate for OB/GYN surgery patients focused on pain management/prevention. However, using this strategy, we still were not able to find any research and survey studies that have the patient's or physician's satisfaction rate of pain management and prevention for OB/GYN surgery. The closest information we found was a study that provides quantitative data about patient satisfaction with obstetricians and gynecologists compared with other specialties, but not specific to pain management/prevention. We added them as helpful findings above.

Lastly, we tried to provide proxy data by checking major US-based healthcare organizations in OB/GYN surgery space, such as Cleveland Clinic, Mayo Clinic, and Massachusetts General Hospital, among others. We did this to find if they have data about the satisfaction rate of their patients related to OB/GYN surgery specifically for pain management and pain prevention. However, still, we were not able to find any information or survey that can address the requested information. The lack of information could be because surveys and statistics on the satisfaction of pain management/prevention specific to OB/GYN surgeries are not publicly available and are only used internally to improve the department/hospital/clinic and their customer satisfaction rate.
Part
06
of fourteen
Part
06

Anesthesiologists Persona: Procedure Follow Up Appointments

After an extensive search through medical websites, surveys, and medical association pages, details about the relationship between patients and anesthesiologists do not appear to be available in the public domain. However, the research team was able to gather valuable insights into this relationship from the perspective of higher-order organizations, such as medical associations and hospital networks.

HELPFUL INSIGHTS

  • Anesthesiologists' skills in regional anesthesia contribute to advances in pain management, securing them an important role in chronic pain management. Many chronic pain patients are inappropriate candidates for such treatments. Much of the confusion surrounding their treatment with nerve blocks results from anesthesiologists extrapolating from their management methods for acute and cancer pain, where pain relief is the goal, to chronic non-malignant pain where long-term pain relief is usually an unrealistic goal.
  • According to the Anesthesia Quality Institute, there is currently no standard for anesthesiology patient survey questions which makes the comparison of satisfaction results across facilities or practices very difficult.
  • Hospitals do not have mechanisms for getting feedback on patients’ anesthetic experience because anesthesiology is connected with feeling nothing, that is, a lack of experience.
  • Postoperative pain is one of the anesthesiology symptoms that can be addressed by multimodal drug regimens.
  • The Iowa Satisfaction with Anesthesia Scale (ISAS) is a self-administered written questionnaire used by some hospitals that focuses on monitored anesthesia care rather than the perioperative process.
  • According to anesthesiologist Candice Morrissey from the University of Utah, anesthesiologists are not using patient feedback enough to improve the care they provide.


RESEARCH STRATEGY:

We began our research by searching for US patient surveys that focus on their satisfaction with the anesthesiologists that care for their needs in terms of pain management and prevention, to determine if they feel their anesthesiologist is attentive to their pain management needs. We determined that no patient satisfaction surveys focus specifically on pain management satisfaction when it comes to anesthesiologists. Surveys with some relevant information were available but focused on a different country (Saudi Arabia).

We then searched through reports on such medical news websites, looking to find reports on this topic, or to at least locate mentions and relevant insights on the topic of patient satisfaction when it comes to anesthesiologists pain management. Unfortunately, this was not effective because our search determined that no reports focus on the topic. Also, no relevant insights were found because no reports focus even briefly on this topic.

We also looked through scholarly databases, looking through articles and publications to locate relevant data or an article that focuses on the topic. We were unable to find any relevant insights. The scholarly articles we found focused on irrelevant things such as improving patient satisfaction rates in anesthesiology. There was no information regarding general US patient anesthesiology pain prevention satisfaction was available.

To determine what US anesthesiologists think about patient satisfaction levels when it comes to pain management they provide, we started the search by looking through industry-specific publications. This strategy failed because no reports even briefly addressed the general anesthesiologist opinion regarding their patient pain management satisfactions, but rather focused on ways that are more effective to manage patient pain.

We also searched for interviews with anesthesiologists that focus on this topic or provide insights. Our search determined that no relevant interviews exist. One interview focused on the importance of patient satisfaction in anesthesiology but provided no relevant insights into general anesthesiologists' opinion when it comes to how satisfied patients are with the pain management level they provide.

We then decided to search scholarly publications on the topic of feedback anesthesiologists receive from their patients regarding satisfaction. No scholarly articles focused on or provided insights regarding the general feedback anesthesiologists receive. The focus was on irrelevant things such as best practices when creating patient satisfaction surveys.

Given our findings, we concluded that there is not enough information in the public domain specifically regarding these two subjects to reliably answer the query. However, we provided helpful insights into the relationship between anesthesiologists and their patients.
Part
07
of fourteen
Part
07

OB/GYN Surgeon Persona: Pain Management Confidence

Obstetrician-gynecologists or OB/GYNs, when managing pain in labor, often work in remote environments, have no other specialists around them, and are more confident in their abilities. Obstetricians and gynecologists believe that a "shared decision-making approach" (between the patient and physician) should be used to manage postpartum pain. Shared decision-making optimizes pain control and also reduce the prevalence of unused opioid tablets.

1. OB/GYN SURGEONS: PAIN MANAGEMENT CONFIDENCE LEVEL

  • Obstetrician-gynecologists, or OB/GYNs, have specialized knowledge of the female reproductive system, including sexually transmitted infections (STIs) and chronic pain.
  • OB/GYNs often handle labor pain in remote environments, have no other specialists around them, and exhibit more confidence in their abilities to succeed.
  • All OB/GYN surgeons have gone through "extensive education" and have "practical experience." A minimum of four years of college studies in pre-medicine or science prepares them for the OB/GYN profession. They follow up this training with four years of medical school training.
  • Obstetrician-gynecologists have detailed information regarding pain management (both pre and postoperative pain). The American College of Obstetricians and Gynecologists (ACOG) publication guides its members on how to manage postoperative cesarean pain. The American College of Obstetricians and Gynecologists encourages the use of standard oral and parenteral analgesic adjuvants such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), as well as opioids.
  • Obstetrician-gynecologists are also guided on how to use preoperative doses of dexamethasone to improve analgesia, decrease nausea and vomiting in patients on the first postoperative day by the website of the American College of Obstetricians and Gynecologists.
  • According to recent web traffic analysis, (screen capture available here), the website of the American College of Obstetricians and Gynecologists has about 1.24 million views every six months. About 57.25% of this traffic originates from the United States, indicating that American OB/GYNs are taking advantage of ACOG web publications. It was therefore assumed that this boost in knowledge also boosts confidence levels.

2. OB/GYN SURGEONS: VIEW ON PAIN MANAGEMENT

  • Publications in obstetrics and gynecology reveal that OB/GYN surgeons who manage pain in women believe that pain and fatigue adversely interfere with women and their ability to care for themselves and their infants. OB/GYNs also agree that untreated pain comes with the "risk of greater opioid use," causes postpartum depression, etc.
  • Publications in obstetrics and gynecology also reveal that OB/GYN surgeons believe pain management should involve both the patient and physicians. They opine that a "shared decision-making approach" to postpartum pain management and discharge opioid prescription will optimize pain control and also reduce cases of unused opioid tablets.
  • The "shared decision-making approach" (SDM) in pain management is considered by a majority of medical experts as an integral path to achieving patient-centered care in the practice of clinical medicine. This process helps clinicians inform patients on treatment options and captures patient preferences in the decision-making process to promote favorable "health outcomes."

3. OB/GYN SURGEONS: CONTINUING EDUCATION ON NEW TECHNIQUES

  • All OB/GYN physicians have gone through medical school and must spend four years learning specific skills relevant to obstetrics and gynecology in a residency program. After passing a licensing exam, some students typically continue their studies and get specialized knowledge via a Fellowship training.
  • OB/GYN physicians may opt for a general practice or choose to continue their education and become specialists. There are four fields of sub-specialty for OB/GYN which include (1) gynecologic oncology, (2) reproductive endocrinology & infertility, (3) maternal & fetal medicine, and (4) urogynecology & reconstructive pelvic surgery.
  • Obstetricians and gynecologists also attend meetings and workshops which boost their skills, knowledge, and consequently skill levels. Some training recently scheduled for attendance by obstetricians and gynecologists cover "advances in OB/GYN ultrasound," and developments in neuroelectronic interfaces, etc.
  • Institutions such as the American Institute of Ultrasound in Medicine, Orlando Health, and Wake Forest School of Medicine are known to organize some training sessions advancing ultrasound techniques in obstetrics and gynecology for physicians and technicians. Ultrasound imaging is used to manage "chronic pelvic pain in women."

RESEARCH STRATEGY

Our research team scoured through OB/GYN medical publications such as MD-Edge for insights into what OB/GYN surgeons feel about pain management. We specifically tried to understand if they think pain is something that should be self-managed by the patient or managed by the physician. Unfortunately, MD-Edge and other studied publications did not uncover the view of general OB/GYN surgeons. Insights uncovered from OB/GYN revealed the opinion of expert writers in the OB/GYN field. Experts feel the shared decision-making approach which involves patients and physicians is excellent in managing pain.

We also scoured through medical news publications such as the website of the American College of Surgeons, Medical News Today, etc., for insights into the knowledge level and training of OB/GYN physicians. We researched if they have a general understanding of pain management but feel under-educated if they learn about pain management at school. We also examined if they get continuing education on new techniques. Medical News Today revealed that OB/GYN professionals have specialized knowledge in female reproductive health, including chronic pain. The American College of Surgeons reveals that OB/GYN physicians understand how to handle several issues, including pelvic pain.

We studied publications of the Association of American Medical Colleges. We researched the confidence level of OB/GYN surgeons in handling various pains, such as those during labor, surgeries, etc. The publication revealed that OB/GYN surgeons are often required to work without other specialists around them when treating pains associated with labor and are more confident. We also researched the "career duties & responsibilities" of obstetricians published by Chron. We researched what specialized training OB/GYN surgeons go through to further refine their skills after completing their licensing exam. This strategy revealed that some continue in Fellowships to gain more specialized knowledge.

We also scoured through the website of the American College of Obstetricians and Gynecologists. We tried to gain insight into how obstetricians and gynecologists update their knowledge on pain management. The American College of Obstetricians and Gynecologists publishes articles on pain management which surgeons read to update their skills. The professional (ACOG) website has 57.25% of its traffic originating from the United States, indicating that OB/GYNs are taking advantage of ACOG web publications. Therefore, we have assumed that reading these publications provides a boost in knowledge and consequently, confidence level.

Part
08
of fourteen
Part
08

Anesthesiologists Persona: Pain Management Confidence

Anesthesiologists are critical professionals in the medical field when it comes to pain management in the human body and patients should learn to work with the right professionals as regards their health.

CONFIDENCE LEVEL OF ANESTHESIOLOGISTS IN PAIN MANAGEMENT


HOW DO ANESTHESIOLOGISTS VIEW PAIN MANAGEMENT?


The Roles of Patients

The Roles of the Physician Anesthesiologist


Part
09
of fourteen
Part
09

OB/GYN Surgeon Persona: Pain Management Opinions

Surgeons try to replace expensive pain medication with others that are equally effective but less pricey, thereby eliminating the use of expensive medication. OB/GYN surgeons opt for preoperative to postoperative pain medication and management to help patients get discharged faster.


OB/GYN SURGEONS’ OPINIONS AROUND PAIN AS IT RELATES TO COSTS

  • OB/GYN surgeons consider drugs they prescribe based on cost.
  • The surgeons try other pain medication and management that are equally (or almost equally) effective but less pricey and so they try to eliminate the use of expensive medication.
  • In light of this, the surgeons try to implement high-value care projects on performance improvement.
  • After experts at Greenville Health discovered the effectiveness of less expensive pain medication over Epifoam, Epifoam orders dropped by 90% from 2,287 to 228 times annually. The removal of Epifoam by this hospital saved it $92,655, not to mention the cost saved by the patients.
  • Another expensive drug, Cervidil, was first highlighted and its use dropped from 384 to 194 cases saving $66,500 and then it was completely ruled out.
  • Nevertheless, their prescriptions may not always be influenced by cost, considering that OB/GYN surgeons have been accused of overprescribing opioids after all kinds of surgeries and therefore prescribe these kinds of products more than others.
  • The number of drugs prescribed by surgeons does not consider the associated costs because, at the 46th AAGL Congress, it was discovered that out of an average of 29.6 opioid tablets, 19.1 were leftover (or wasted) regardless of the type of surgery.
  • Surgeons believe that patients should thoroughly discuss their postsurgical pain medication and management before surgery.

OB/GYN SURGEONS’ OPINIONS AROUND PAIN RELATING TO PATIENTS GETTING DISCHARGED

  • OB/GYN surgeons opt for preoperative to postoperative pain medication and management to help patients get discharged faster.
  • In addition, multimodal pain management strategies covering intraoperative, preoperative and postoperative pain management and medication are discussed with the patient which can reduce patient's stay in the hospital.
  • The surgeons are more likely to prescribe an opioid alongside another analgesic for discharged patients to take at home.
  • OB/GYN surgeons are concerned about the leftover pain medication for discharged patients and therefore might tend more to delaying discharge until the amount of leftover medication is considered minimal.


RESEARCH STRATEGY:

We tried to find or triangulate the opinions of OB/GYN surgeons on pain medication and management relating to costs and the discharging of patients hospitals. Nevertheless, we were not able to find a lot of information on the opinions of the surgeons on pain related to cost or discharge. In addition, we didn't find any information pointing out a difference in the pain medication and management prescribed to patients with insurance as opposed to those for patients without. Although the information available was mostly related to opioids, we were able to determine surgeons’ opinions through surveys, articles, and publications on the practices of the surgeons related to patient’s discharge and pain medication costs (as opposed to actual surgeons’ opinions) that satisfied the criteria.

We searched for articles, reports, press releases, publications, and other sources of opinions of OB/GYN surgeons pain medication and management costs and patients’ discharge. For this, we leveraged reputable industry databases and scholarly/academic platforms. We didn't find any information that could satisfactorily or directly answer the client's question. Most of the information available was on opioids for pain medication, analyses of costs for alternative (non-opioid) medications and surgeries that didn't contain information on the opinions of the surgeons on either of the research criteria.

We then decided to look for new pain medication and management products in OB/GYN and the costs for customers with insurance. We hoped to find information regarding the preference of one product over another due to cost considerations and possible recommendations of more costly and probably better drugs to patients with insurance by comparing the average cost of pain medication mostly prescribed to patients with insurance and those without. We utilized several trusted industry and relevant databases and websites. However, we could not find sufficient information to be able to compare the costs to those with insurance and those without. This is probably either because several patients have insurance or there's no substantial difference in the costing for either category of patients.

Thirdly, we looked for the most-prescribed pain medication products and management systems used by OB/GYN and examined the reasons for their preference. We intended to use any mentions of cost as a reason for preferring one method or another as a means to triangulate the information on surgeons' opinions. Then we looked for preferred types of pain medication and management outside hospitals and the best time to discharge patients. Our intention was to use any reference to any particular time being ideal due to pain considerations. This was implemented using reputable medical sites and industry databases. This proved to be very successful and we located several pieces of useful information from this strategy. However, the information found was not necessarily directly related to the opinions of the surgeons as it was to opioid alternatives. This was probably because opioids are a norm in the industry.

We then turned to OB/GYN and medical forums to compare experts' and practitioners' opinions available on such platforms based on the frequency of the opinion and the expertise of its supporters. Nonetheless, some of these platforms demanded registration, requiring several verifications from qualifications and the sources that did not have these restrictions were not only difficult to navigate due to the specific nature of the filters. Nevertheless, they did not contain sufficient information from which we could conclude on the opinions. We hoped to find a discussion on the decisions on pain medication and management due to cost and recovery consideration and examine the responses, comments or the like but we couldn't find such discussions or posts. Advice to OB/GYN surgeons on alternatives to opioids composed the majority of our findings, so we deduced that this was because opioids were being so overprescribed that few surgeons considered having opinions of other medications (as we had discovered earlier).

Then we looked for the effect of pain medication and management on patients stay and discharge. This was a very useful strategy from which found articles that explain why surgeons advise preoperative pain medication for faster checkouts. From there, we were also able to find other advice and choices from surgeons that shed light on their opinions on pain as it relates to patient discharge.

From all the information found, we were able to determine surgeons’ opinions through the practices of the surgeons related to patient’s discharge and pain medication costs (as opposed to actual surgeons’ opinions) that satisfied the criteria.
Part
10
of fourteen
Part
10

OB/GYN Surgeon Persona: Technology Adoption

Obstetrics and gynecology surgeons embrace new technology by increasing the efficiency and accessibility to the utilization of technology to carry out minimally invasive surgery. Also, robot technology is applied widely in gynecology for hysterectomy, sacrocolpopexy, myomectomy, adnexal surgery, and malignancy staging.

OB/GYN Surgeon Persona: Technology Adoption

  • Obstetrics and gynecology surgeons embrace new technology by increasing the efficiency and accessibility to the utilization of technology to carry out minimally invasive surgery.
  • Michelle D. Edwards, Director, MedTech says that women in the United States have suffered from benign uterine tumors. As a result, new technology was adopted to treat uterine fibroids noninvasively.
  • However, no such technology existed for so long but with the new therapy alone, women can be prevented from living with severe pain and/or heavy menstruation when undergoing a hysterectomy. Thus, the new technology was well-positioned to become the standard of care for treatable patients.
  • Expanded use of new technology has been suggested as a possible strategy for mitigating demand for delay for obstetric–gynecologic surgery.
  • Gynecology surgeons show distinct needs and barriers when it comes to adopting new technologies.
  • Virtual/augmented reality helps to reshape medical training by allowing doctors to overlay information or images in the world right in front of them. Nearly three-quarters of Obstetrics/Gynecology specialists indicate they are likely to use Virtual/augmented reality within the next five years (2023).
  • Robot technology is applied widely in gynecology for hysterectomy, sacrocolpopexy, myomectomy, adnexal surgery, and malignancy staging. Thus, the field of robotic surgery has developed rapidly, and its use for gynecologic conditions has grown exponentially.
  • OB/GYN Surgeons generally perform up to 90% of all GYN surgeries in the United States.
  • The new techniques and procedures, or new procedural technology developed by CIGC prove that there is a better way to perform GYN surgery from a both clinical and financial standpoint.
Thus, we can conclude that OB/GYN Surgeons "generally" accept new technology.

Correlation — Adoption Rate and Using New Products in Medical Practice

  • As per the American Congress of Obstetricians and Gynecologists, there has been an increase in the number of female physicians in training and practice for surgical specialties. In a period of the rapid growth of medical knowledge, advancement in technology, and emphasis on health care provider competencies, subspecialization appears to be desirable for patients.
  • Dr. John M. Garofalo, M.D., the first gynecologist in Fairfield County says he has been regularly adopting new technologies during his surgical experience.
  • DualPortGYN hysterectomy and LAAM procedures are safer, faster, and cheaper to perform in the outpatient ASC setting, and have higher patient satisfaction rates than any other type of hysterectomy or myomectomy nationally or internationally.

RESEARCH STRATEGY

Despite an extensive search, we were unable to locate statistics concerning the correlation between the adoption rate of new technology and the likelihood to use new products in medical practice among OB/GYN surgeons in the US. Most of the data available in the public domain were qualitative in nature and dealt with the prevalence of digital technology among OB/GYN surgeons. This is due to the fact that there has been an increase in the number of female physicians in training and practice for surgical specialties.
We started our search by looking for market reports specific to OB/GYN surgeons in sources such as Navigant, Grandview Research, and Market&Market. The idea was to check the information on the latest technology used in planned c-sections/hysterectomy & fibroid/breast reconstruction/mastectomy surgery. The sources enumerated the information that women in the United States suffering from benign uterine tumors usually face two choices -cope with severe pain and heavy menstruation or undergo major surgery. Nevertheless, there was no statistical information available for the same. Following this, we checked information in sources such as Thrive Global, US news, and Medical News Today. The sources mentioned that the high volumes of laparoscopic procedures performed in the U.S exacerbate the financial impact of a more expensive robotic option being used by OB/GYN surgeons. But, there was no hard data available to support that information.

Subsequently, we examined healthcare forums and industry experts' opinions in sources such as the American Medical Association ad American Congress of Obstetricians and Gynecologists. The idea was to look for interviews and opinions of healthcare experts to get quantitative information on the number of technology savvy OB/GYN surgeons. The sources mentioned technology is the application of scientific knowledge for practical purposes which have always been a core component of c-sections. But, there was no specific information available that concluded the correlation between adoption rate and their use in medical practice.

Further, we checked the persona of OB/GYN surgeons in sources such as Kem.edu and data.gov.in. The idea was to check if OB/GYN surgeons quickly adapt to new technology in their medical practice. The sources mentioned that the OB/GYN surgeons perform up to 90% of all GYN surgeries in the United States. However, the hard data was behind a pay wall and the likelihood to use new products in their medical practice could not be correlated. The link to the paywalled report is here.

As our last resort, we decided to broaden the scope and focused our research on the entire North America. We looked into sources such as North American Healthcare Forum, Businessresearchcompany, Reuters, and Futureinsightsmarket. But, all the reports found in these sources covers global information and are locked behind a paywall.
Part
11
of fourteen
Part
11

Anesthesiologists Persona: Technology Adoption

Anesthesiologists are early adopters of new technology, for reasons such as improving patient care, satisfying patients who already use technologies to manage their health, simplifying work processes, and delivering healthcare in the perioperative surgical home. These reasons and the continual advancement and application of medical technology are evidence of the likelihood that anesthesiologists will use new products in their medical practice.

ANESTHESIOLOGISTS ADOPTION OF NEW TECHNOLOGY IN THE U.S.

  • According to a publication by the National Library of Medical Science, anesthesiologists in the United States are early adopters of new technology in their field and are encouraged to continue this trend which means that it is likely that they will use new products.
  • The publication also states that anesthesiologists "tend to be comfortable incorporating technological solutions to improve patient care." This further supports the likelihood that they will use new products.
  • Between January and August 2019, 22 new technological inventions and innovations in the field of anesthesiology (some of which have already gone through a trial) have been published by Medgadget (a credible medical technology news site) as cleared by the FDA (the Food and Drug Administration of the United States of America). Following the trend, there is a likelihood that anesthesiologists will continue to use new products in their medical practice, as long as it is has gone through the necessary trials and been approved.
  • The field of anesthesiology has the Society for Technology in Anesthesia (STA) and even though it is an international organization it has its headquarters in Milwaukee, U.S. Its mission is "to improve the quality of patient care by improving technology and its application." This is another proof that anesthesiologists are interested in technological improvements and applications in their field and could use new products.
  • Anesthesiologists typically adopt new technologies and they must continue to do so for crucial reasons like satisfying patients who "use technology to manage their well-being", also called "digital patients". There are other important reasons like "simplifying work processes, providing solutions for clinical decision-making and the delivery of healthcare in the Perioperative Surgical Home (PSH)". These reasons and the need for continual improvement show that there is a likelihood that anesthesiologists will use new products.
  • This field of medicine is being re-defined by the emergence of new technologies, so the present-day anesthesiologist is left with no choice but to become tech-savvy and beyond that "understand healthcare technologies and how to best leverage them to improve patient care and outcomes". Since there will be continual advancement and application of medical technology, it is only logical to conclude that anesthesiologists will not refuse to use newer innovations or products in their field.
Part
12
of fourteen
Part
12

OB/GYN Surgeon Persona: Pain Management Options

Pharmaceuticals market their products to physicians via free drug samples, meeting with sales representatives, using social media, medical conferences, and medical journals.

Free Drug Samples

  • Pharmaceutical companies spend billions annually, distributing free drug samples to physicians.
  • Physicians are likely to prescribe newer expensive drugs even when there are cheaper alternatives in the market.
  • Physicians who receive free samples use them on their patients with limited risk.

Meeting with Sales Representatives

  • Sales representatives from pharmaceutical companies inform physicians of new drug launches and their benefits.
  • Physicians are more likely to purchase drugs if they have an interpersonal relationship with sales representatives from the company.
  • Pharma companies need to build good relationships with physicians to increase their sales.

Using Social Media

  • Pharma companies target online social platforms that have numerous subscribers to market their new products. An example is Physicians Interactive (PI) which has an online and mobile network of over 875,000 medical specialists, nurses, and physicians.
  • Another online platform is Sermo. It is an MD-only platform with over 115,000 members and provides an opportunity for pharma companies to interact and market their new products to physicians.
  • Drug companies are also using social media to promote their products.
  • Physicians are more into medical apps that other digital and print publications.

Medical Conferences

  • These conferences provide an opportunity for pharma companies to interact with physicians and get feedback on their products.
  • Some of the medical conferences that have been held/are scheduled to be held in 2019 in the US include DCAT 2019, PCC 2019, CPhl North America, ASCPT 2019 Annual Meeting, and ASCO 2019. These conferences allow physicians to learn about new trends and drugs in the industry.

Medical Journals

  • Medical journals provide an opportunity for pharma companies to precisely target different physicians with their new products.
  • Some of the most popular medical journals among physicians include Medscape (40%), Journal of the American Medical Association (28%), Medical Economies (22%), and Mayo Clinic Proceedings (12%).
  • The top OB/GYN journals include Human Reproduction Update, Human Reproduction, Obstetrics and Gynecology, Ultrasound in Obstetrics and Gynecology and Gynecologic Oncology.

RESEARCH STRATEGY

Our first strategy was to find data on how pharmaceuticals market new options for mitigating patient pain to OB/GYN Surgeons in credible publications such as Medscape, The Lancet, Harvard Medical, Human Reproduction, Gynecologic Oncology, and Obstetrics & Gynecology. Our objective was to check for articles on the links between pharma companies and physicians and how pharmaceuticals reach out to various categories of surgeons to market their new products in the US. However, while these platforms contained information on the latest research and medical trends relating to the OB/GYN industry, there were no specific details on how various pharma companies market their pain medication to surgeons in the sector.

Next, we attempted to triangulate with available data to find how OB/GYN surgeons learn about new products. In this case, we looked for a pharmaceutical company that most recently launched a pain medication. We identified Galt Pharmaceuticals which recently launched a new product approved by the FDA. We then looked into the company website to find out how the company is intending to market this product to OB/GYN surgeons. However, on the website, it states that the company uses a franchise model whereby locals own their own franchises and market their products to physicians in their respective localities. Following this, we shifted our focus to another pharmaceutical, InvaGen Pharmaceuticals whose generic version of Lyrica was recently approved by the FDA. But, nothing significant was found here.

Subsequently, we checked credible research platforms like Pew Research and IBIS World. Our objective was to check for reports relating to how OB/GYN surgeons learn about new pain medications and the relationship between pharma companies and surgeons. However, while the required information could not be found, IBIS World contained a detailed report on the OB/GYN industry in the US, which included details on the key products and services and the pharmaceutical manufacturing companies that provide drugs for this segment. However, most of the information was locked behind a paywall and apart from general highlights, most of the detailed information could not be seen.

As our last resort, we decided to broaden the scope of our search and looked for the ways pharma companies market their products to physicians in general on online platforms such as Merritt Hawkins, The Balance, and Healthcare Weekly. Based on this approach, we managed to get information on how pharmaceuticals market to physicians.
Part
13
of fourteen
Part
13

Anesthesiologists Persona: Pain Management Options

UpToDate is one of the medical educational support resource associated with improved outcomes and provides the most recent medical information. Owning to lack of publicly available information, we couldn't find information on top methods used by Anesthesiologists to find out about or learn about new options for mitigating patient pain

USEFUL FINDINGS

  • In 2019, the American Society of Anesthesiologists (ASA) launched a new Opioid Analgesic Risk Evaluation and Mitigation Strategies (REMS) continuing medical education (CME) course available for Anesthesiologists.
  • The ASA course was aimed at helping Anesthesiologists mitigate the opioid crisis through education on appropriate prescription, best practices for managing pain and opioid alternatives.
  • In 2018, NCBI published an article on recent advances in intravenous anesthesia and anesthetics which mentioned some innovations in drug development.
  • Drugs.com is an online pharmaceutical encyclopedia which provides drug information for healthcare professionals.
  • UpToDate is one of the medical educational support resource associated with improved outcomes and provides the most recent medical information. The website also gives the latest updates in Anesthesiology.
  • The Pain Management division of Department of Anesthesiology of Cornell.edu offers a full spectrum of treatment options for Anesthesiologists for preventing and treating both acute and chronic pain.

Research Strategy

We couldn't find information on top methods used by Anesthesiologists to find out about or learn about new options for mitigating patient pain. Our first strategy was to look for information on Anesthesiologists association websites. We searched for the information on sites such as; American Society of Anesthesiologists, American Society of Anesthesiologists, AANA, among others. We looked for articles, publications by the sites on methods or sources used by Anesthesiologists to find out about or learn about new options for mitigating patient pain. However, this strategy did not work as the information found was about the courses of Anesthesiologists, medicine for anesthesia, etc.

Next, we searched for scholarly research papers that may have been published on these topics on sites such as NCBI, Lens.org, WebMD etc. Unfortunately, this strategy did not provide the required information. We had hoped to find the requested information through this strategy as the above-mentioned sources, provide various studies that also includes a survey of a sample population. Instead, we found information about advances in anesthetics, medicines used for anesthetic treatment.

Our next step was to search for the information on Pharma/drug database such as drugs.com, Drugbank, etc. This strategy wasn't fruitful, as the information presented in the sources are about the drugs used for anesthesia, its purpose, etc. We also combed through medical news publications on sites like medicalnewstoday, ScienceDaily, HealthLine, among others. This strategy did not work, as the information found was about drugs used by Anesthesiologists, types of drugs used, etc. Since the mentioned sources publish information on medical and health news, we thought they would have published information about how Anesthesiologists learn about new options for mitigating patient pain.
Part
14
of fourteen
Part
14

Anesthesiologists Persona: Pain Management Opinions (r)

Anesthesiologists consider low-cost local anesthesia (neuraxial anesthesia) to reduce the operational cost of surgeries like knee or hip replacements which reduce 17-19% of hospitalization cost. Most of the anesthesiologists in the US are practicing ambulatory anesthesia method for early discharge after surgery.

ANESTHESIOLOGISTS- OPINIONS AROUND PAIN AS IT RELATES TO COST

  • Anesthesiologists are interested in reducing surgical costs by inducing patients with local anesthesia.
  • Anesthesiologists consider low-cost local anesthesia (neuraxial anesthesia) to reduce the operational costs of surgeries like knee or hip replacements which reduce 17-19% of hospitalization costs.
  • They consider insurance coverage of patients while prescribing an anesthesia plan. For instance, they prescribe home-going catheter for pain management based on patient’s insurance coverage.

ANESTHESIOLOGISTS- OPINIONS AROUND PAIN RELATING TO PATIENTS GETTING DISCHARGED

  • Anesthesiologists suggest discharge after evaluating control over pain by prescribing the pain medication. They prescribe pain medication based on individual patient condition.
  • Most of the anesthesiologists in the US are practicing ambulatory anesthesia method based on which patients can be discharged early after surgery.
  • Ambulatory anesthesia is considered beneficial because it helps to reduce the cost of patients hospitalization cost.
  • Additionally, anesthesiologists also prescribe some non-opioids such as ibuprofen, acetaminophen, and aspirin as well as suggest other pain management methods such as acupuncture for outside of the hospital setting treatments to take at home.

Research Strategy

We conducted thorough research to determine or triangulate the opinions of anesthesiologists on pain medication and management relating to costs and the discharging of patients hospitals. Nevertheless, we were not able to find a lot of information on the opinions of anesthesiologists around pain as it relates to patient getting discharged from a hospital setting. Additionally, we didn't find any information related to the decision to try new products and insights on delayed discharge.

Although the information available was mostly related to the usage of local anesthetic, the opioid crisis, and non-opioids, we were able to triangulate the anesthesiologists opinions through surveys, articles, publications on the practices of anesthesiologists related to patient’s discharge and pain medication.

In order to determine the opinions of anesthesiologists around pain as it relates to patient getting discharged from a hospital setting, we commenced our research by scanning through survey reports, medical journals, publications, and scientific studies related to the opinions of anesthesiologists on pain medication and management costs and patients’ discharge. For this, we leveraged reputable industry, research and academic platforms including ResearchGate, Academia, Journals.com and among others. Unfortunately, we were not able to find any authoritative information that that addressed the subject under investigation. Most of the information available related to opioids used for pain medication.

Next, we decided to search for any new pain medication and management products used anesthesia as well as the costs for customers with insurance through various anesthesiologists associations in the United States such as ASRA, TSA, NCBI, USAP, etc. We were able to determine that most anesthesiologists in the US were practicing ambulatory anesthesia method based on which patients can be discharged early after surgery. Unfortunately, we were not able to obtain any information specific to the decision by anesthesiologists to try new products or any insights on delayed discharge.

As a last resort, we decided to search for experts' and practitioners opinions from various case studies and interviews across both medical forums and anesthesia-related insurance cases in medical forums like Student Doctor, American Medical Association, Dräger's, ASDA, AAPC, ASAHQ, and others. Most of the information that we were able to find using this strategy was specific to new advancements in anesthesia medication but nothing was found related opinions of anesthesiologists around pain as it relates to patient getting discharged from a hospital setting.

Sources
Sources

From Part 03
Quotes
  • "One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased."
Quotes
  • "Even though a cesarean birth is planned, women may experience physical and psychological difficulties. "
  • "One woman shared, “I didn’t feel like there was anything I couldn’t do because of the cesarean.” In contrast, three of the women described long painful recoveries. One woman explained,"
  • "“I still remember feeling like I was floating in the air. No pain. Pure joy and excitement!”"
Quotes
  • "Patients typically reported very little pain during and after the procedure, with an average of 0.4 to 2.5 pain experienced out of 10. "
  • "Furthermore, the most widely used and most helpful pain medication was ibuprofen. "
Quotes
  • "New mothers often have pain and soreness after a C-section and while healing. “We give enough pain medicine in the spinal or epidural, so they’re comfortable for the first eight to 20 hours post-partum with just a pill,” Dr. Braveman says. “They can bond with the baby, have visitors and still be more comfortable.”"
  • "“If they do feel discomfort, we either give them more medicine or proceed to a general anesthetic. We don’t leave patients uncomfortable.” Of course, a patient who undergoes general anesthesia won’t feel anything and is not aware of the surgery or the arrival of her baby."
Quotes
  • ""We can control pain effectively with ibuprofen and acetaminophen. For those who do need opioids, we don't need to give out as much," Dinis said."
Quotes
  • "For mastectomy (removal of one or both breasts), lymph node dissection (removal of lymph nodes under your arm) and breast reconstruction, general anesthesia is required. It is administered through an I.V. line and a breathing tube and the anesthesiologist continuously monitors vital signs."
  • ""There is not one single medication that puts all patients to sleep for surgery," Dr. Kurup says. “There is such a wide variety of medications available, and certain ones are better for patients with conditions such as heart disease, asthma or liver disease.” "
  • "One particular challenge with breast surgery is that patients often suffer chronic postoperative pain, Dr. Kurup says. Anesthesiologists at Yale Medicine are working with surgeons to investigate the use of different medications that may decrease the number of patients dealing with chronic pain. "It is something we feel is very important, and we are keen to offer patients solutions,” she says."
From Part 06
Quotes
  • "Anesthesiologists' skills in regional anesthesia contributed to advances in management and secured for them an important role in chronic pain management. Unfortunately, many chronic pain patients are inappropriate candidates for such treatments. Much of the confusion surrounding their treatment with nerve blocks results from anesthesiologists extrapolating from their management methods for acute and cancer pain, where pain relief is the goal, to chronic non-malignant pain where long-term pain relief is usually an unrealistic goal. [10–14 ] Anesthesiologists for many years have recognized that nerve blocks are contraindicated in the two large subgroups of patients most debilitated by chronic pain: patients with no identifiable organic abnormality and patients whose disability appears to be grossly excessive given the known physical problems. [1,15–17 ] Many patients not appropriate for nerve blocks and who require chronic pain treatment have no access to multidisciplinary pain centers because of their geographic location, financial factors, and the application of stringent selection criteria. [18 ] Consequently, they represent a population with an unmet need. Therefore, their contributions notwithstanding, anesthesiologists could expand their horizons beyond nerve blocks."
Quotes
  • "For example, the majority of free-standing surgical facilities assess patient satisfaction, and many of these assessment instruments include questions that pertain to the patient’s perception of anesthetic care. At this time, no standard for anesthesia related questions exist, and this makes comparison of satisfaction results across facilities or practices very difficult."
Quotes
  • "The overall satisfaction level was moderate (56.5%) with nearly half of the patients dissatisfied with their anesthetic care due to different reasons. Nausea and vomiting control was the most common postoperative reasons for dissatisfaction followed by pain control with 35.6% and 31.7%, respectively."
Quotes
  • "A total of 200 patients were operated upon under anaesthesia during the study period. Of these, a total of 156 patients were included in this study with a response rate of 78 %. The overall proportion of patients who said they were satisfied with anaesthesia services was 90.4 %. Factors that affected patient satisfaction negatively (dissatisfaction level and p value) were general anaesthesia (12.6 %, P = 0.046), intraoperative awareness (50 %, P = <0.001), pain during operation (61.1 %, P = <0.001), and pain immediately after operation (25 %, P = <0.001) respectively."
Quotes
  • "Many would say that the anesthesiologist’s job is to give the patient no experience; that is what anesthesia is — amnesia, hypnosis, lack of feeling, thus, a lack of experience. This notion is so pervasive that hospitals do not require or even have a formal mechanism for getting feedback on patients’ anesthetic experience. In most hospitals, there is no postoperative inquiry of patient satisfaction on anesthesiologists."
  • "Patient feedback is an important contribution to ensuring great medical care. Wrapped up in patients’ feedback is the question of whether your patients understood you, felt their care was coordinated, and got the feeling their wishes would be observed. Let’s not leave anesthesiologists out of this revolution. Let’s learn what matters to our patients and find out if we are serving their needs. In the end, we cannot measure the importance of a doctor-patient relationship by its duration — only by what the patient takes away from it."
Quotes
  • "Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens."
From Part 07
Quotes
  • "OB/GYNs typically evaluate infertility, abnormal uterine bleeding, leiomyomato, pelvic masses, pelvic organ prolapse, abnormal Pap smears, pelvic pain, endometriosis, breast disorders, and urinary incontinence."
Quotes
  • "An obstetrician-gynecologist, or OB-GYN, is a healthcare professional that specializes in female reproductive health. People trained as OB-GYNs specialize in both obstetrics and gynecology: obstetrics involves working with pregnant women, including delivering babies gynecology involves the female reproductive system, treating a wide range of conditions, including sexually transmitted infections (STIs) and chronic pain"
  • "AN OB-GYN is a doctor who has broad and specific training in obstetrics and gynecology. OB-GYNs provide a wide range of preventive care services, including pap smears, STI testing, pelvic exams, ultrasounds, and blood work. They can answer a person's questions about pregnancy, sex, reproductive health, infertility, and numerous other topics."
  • "People should see their OB-GYN if they think they might be pregnant or for any reproductive system issues, including: STD testing suspected pregnancy or miscarriage pregnancy complications pain during sex pain or other symptoms associated with urination"
Quotes
  • "The program strives in part to boost residents’ comfort working in remote settings, explains Jody Silva, rural residency coordinator. “You don't have all the specialists around you, so you have to be more confident in your abilities,” she says. “By having part of your training at a rural hospital you’ll be more comfortable taking a job at a rural hospital.” "
Quotes
  • "It’s common for an OBGYN to receive patient referrals from other physicians or to work as a team on a complex treatment plan for current patients."
  • "Serve as a Researcher Some gynecologist responsibilities include researching groundbreaking treatments for illness and injury. Serving in a research lab or educational institution, a gynecologist will test medications and learn about new techniques to improve patient outcomes. A gynecologist may even serve in a dual role as an educator of future physicians and a healthcare professional."
  • "An OBGYN career isn’t possible without extensive education and practical experience. Four years of college in pre-medicine or science is the first step of preparation for an OBGYN. This is followed by four years of medical school. You’ll take classes like: Anatomy and physiology. Biochemistry. Medicine and society. Pharmacology. Immunology. Medical cell biology. Introduction to clinical medicine."
  • "After medical school, you’ll spend four years in a residency program to learn specific skills related to obstetrics and gynecology. In addition to a licensing exam, some students continue in a Fellowship to further specialize."
  • "OBGYN Career Specialization An OBGYN may choose to have a general practice or become a specialist. The four subspecialties in this field include: Gynecologic oncology. Reproductive endocrinology and infertility. Maternal and fetal medicine. Urogynecology and reconstructive pelvic surgery. Each specialization required additional training and education as well as certification exams. You can become certified in more than one specialty area."
Quotes
  • "Because pain and fatigue can interfere with a women’s ability to care for herself and her infant and untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain, postpartum pain management is crucial during this period. The American College of Obstetricians and Gynecologists (ACOG) make the following recommendations regarding postpartum pain management"
  • "Because of the variation in types and intensity of pain women experience during the early postpartum period, as well as the concern that 1 in 300 opioid-naive patients exposed to opioids after cesarean birth will become persistent users of opioids, a stepwise approach using a multimodal combination of agents can enable obstetrician–gynecologists and other obstetric care providers to effectively individualize pain management for women in the postpartum period."
  • "Parenteral or oral opioids should be reserved for treating breakthrough pain when analgesia from the combination of neuraxial opioids and nonopioid adjuncts becomes inadequate. A shared decision-making approach to postpartum discharge opioid prescription can optimize pain control while reducing the number of unused opioid tablets."
From Part 08
Quotes
  • "From the clinical work of chronic pain management to being in the labor and delivery room to care for mothers and neonates, we can do it all."
Quotes
  • "it requires a physician who has the extensive medical education (up to 14 years) and clinical training (12,000-16,000 hours) to evaluate your medical condition, recommend an appropriate anesthesia plan, diagnose and treat problems that might surface during a procedure, and make critical, split-second decisions that can save your life"
From Part 09
Quotes
  • "From a pain management perspective, the clinician can take some time during preoperative counseling to inform the patient about the pain to be expected from surgery, the ways the pain will be managed intraoperatively and postoperatively, and the multimodal strategies that will be used throughout the patient’s stay2 and that may allow for early discharge. "
From Part 10
Quotes
  • "Shifting toward a society that is inbred with advancements and technology and utilizing them for the betterment of our patients. From using electronic medical records to increase efficiency and accessibility to the utilization of technology to carry out minimally invasive surgery, we are moving medicine forward"
Quotes
  • "Women in the United States suffering from benign uterine tumors usually face two choices: cope with severe pain and heavy menstruation or undergo major surgery — typically a hysterectomy to remove the entire uterus"
  • "a women’s health startup recently developed a breakthrough technology to treat uterine fibroids noninvasively."
  • "Because no such technology existed in the United States, and this new therapy alone could prevent women from living with severe pain and/or heavy menstruation or undergoing a hysterectomy, the new technology was well-positioned to become the standard of care for treatable patients."
Quotes
  • "Of all surgeons, ob-gyns continue to constitute the highest number of female physicians in training and practice"
  • "Continued advances in minimally invasive gynecologic surgery and robotic gynecologic surgery have benefitted all surgical specialties. The widespread availability of long-acting reversible contraception, intrauterine devices, endometrial ablation techniques, and outpatient tubal occlusion has reduced the numbers of unintended pregnancies and inpatient hysterectomies "
  • "Expanded use of new technology has been suggested as a possible strategy for mitigating demand or delay for obstetric–gynecologic services. "
Quotes
  • "Doctors have distinct needs and barriers when it comes to adopting new technologies."
  • "Virtual/augmented reality (for training) – is reshaping medical training by allowing doctors to overlay information or images in the world right in front of them. Nearly three quarters of Obstetrics/Gynecology specialists indicate they are likely to use it within next five years."
Quotes
  • "The field of robotic surgery has developed rapidly, and its use for gynecologic conditions has grown exponentially "
  • "robot technology is applied widely in gynecology for hysterectomy, sacrocolpopexy, myomectomy, adnexal surgery, and malignancy staging"
Quotes
  • "Dr. Garofalo has more than 20 years of practice and surgical experience and a long history of early adoption of new but proven technologies. He is Director of Minimally Invasive Gynecology at Norwalk Hospital."
  • "Dr. Garofalo is one of the first gynecologist in Fairfield County to be certified on the da Vinci® Surgical System one of the most effective, least invasive treatment options for a range of uterine conditions."
Quotes
  • "To summarize, new techniques and procedures, or new procedural technology developed by CIGC proves that there is a better way to perform GYN surgery from both the clinical standpoint, as well as financial. DualPortGYN hysterectomy and LAAM procedures are safer, faster, and cheaper to perform in the outpatient ASC setting, and have higher patient satisfaction rates than any other type of hysterectomy or myomectomy nationally or internationally."
  • "The problem is clearly understandable, as described above, in that the OBGYN generalist performs up to 90% of all GYN surgeries in the U.S., and their surgical training is such that a robot is needed to accomplish procedures in place of cheaper and more effective non robotic laparoscopic approaches that can accomplish the same result."
  • " The high volumes of laparoscopic procedures performed in the U.S. further exacerbates the financial impact of a more expensive robotic option being used for that surgical care"
From Part 11
Quotes
  • "As a specialty, anesthesiologists have tended to be early adopters of technology, and we tend to be comfortable incorporating technological solutions to improve patient care. We should continue this trend and not only stay abreast of advances in AI, but make concerted efforts to integrate them into our practice now so that we can be the authors of our own future: improving provider productivity and each patient's outcome by building and working in concert with narrow AI learning systems that create truly individualized, evidence-based clinical guidelines built in real time based on analysis of the entirety of medical literature and pooled patient data from electronic medical records."
Quotes
  • "The Society for Technology in Anesthesia (STA), founded in 1988, is an international organization of physicians, engineers, students and others with an interest in anesthesia-related technologies."
Quotes
  • "When it comes to adopting new technologies, the anesthesiologist is a natural. The tools in his or her practice - from anesthesia equipment to automation of clinical data - are going digital, and they’re adapting with to this."
From Part 12
Quotes
  • "Critics of the practice say drug samples steer physicians to prescribe new, higher cost medications when generics or lower-priced brand drugs are available"
Quotes
  • "The reason is that physicians want to prescribe pharmaceutical products from sales reps that they know and trust. Physicians feel a sense of responsibility to their patients."
Quotes
  • "That being said, doctors hold the key to consumer sales and establishing a relationship with these professionals is a good way to communicate with a much wider audience."
Quotes
  • "They largely do so by sending sales representatives to doctors’ offices for face-to-face visits, providing free drug samples and other swag, offering payments for speeches, food and beverages, travel, and hosting disease “education.”"
Quotes
  • "Conferences are great avenues for bioscience professionals to connect, find business leads and stay informed with the key developments of the industry"
Quotes
  • "Advertisements enable pharmaceutical manufacturers to target physicians precisely and try to sway prescribing practices in favor of the product being advertised, regardless of whether it is the most efficacious or cost-effective option for a patient. "
Quotes
  • "News sites like Medscape offer breaking medical news and content such as drug releases, clinical trials, and healthcare policy updates, as well as articles designed to help physicians grow their practices"
Quotes
  • "The following lists highlight some of best medical journals across specialties, based on impact factor, citations and other measurements of influence."
Quotes
  • "According to the company, its Supplemental Abbreviated New Drug Application for the orphenadrine citrate, aspirin and caffeine combination (Orphengesic Forte), a muscle relaxant pain reliever, was given an August 2019 goal for approval."
Quotes
  • "Galt's unique model is based on continuously pursuing a better way to enhance the life of patients with products that meet their therapeutic needs."
Quotes
  • "While many healthcare industries have experienced strong growth over the past five years, the Gynecologists and Obstetricians industry has grown at a more muted pace. While demand for most healthcare services is based mainly on access to health insurance, obstetrician-gynecologist (OB-GYN) services have such a necessary place in women's health that demand is steady for this industry. "
Quotes
  • "The drug is approved for use for management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, adjunctive therapy for partial-onset seizures in patients 17 years of age and older, fibromyalgia, and neuropathic pain associated with spinal cord injury."
From Part 14
Quotes
  • "First, your anesthesia provider will check with your insurance company whether they cover the costs of the home going catheter and the nursing visits required for its care"
Quotes
  • "Moreover, compared with hospitals with the lowest neuraxial anesthesia use, hospitals with the highest volume were associated with decreased hospitalization costs: -19 percent and -17 percent in total knee and hip replacements, respectively."
Quotes
  • "Anesthesiologists are responsible for ensuring that a patient’s pain is under control before they are discharged from the PACU. An anesthesiologist may prescribe specific pain medications or perform specialized procedures to maximize patient comfort, which helps to minimize stress on the patient’s heart and blood pressure. The techniques that are best suited for each individual patient are chosen to allow for proper rest and healing."
Quotes
  • "The rate of ambulatory surgery use has increased steadily due to continued improvements in anesthesia techniques, such as regional anesthesia, and the availability of ultrashort-acting anesthetics with reduced side effects. "
  • "Ambulatory anesthesia allows quick recovery from anesthesia, leading to an early discharge and rapid resumption of daily activities, which can be of great benefit to patients, healthcare providers, third-party payers, and hospitals."
Quotes
  • "There are many non-opioid pain medications that are available over-the-counter or by prescription, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer) and steroids, and some patients find that these are all they need. "