Professor Stefan De Hert is the new President of the European Society of Anaesthesiology, taking over from his predecessor Dr Zeev Goldik in January 2018. Stefan is a familiar face to many regular attendees at Euroanaesthesia, and has previously served in other leadership positions, including as Chair of the Scientific Committee that assembles the scientific programme at the congress. Here we find out more about our new President.
Q: Congratulations on your nomination as President of ESA, Stefan. Can you tell us how you felt to be nominated by your peers to lead the ESA and represent anaesthesiologists across Europe?
Thank you. Having been elected as president of a prestigious society such as ESA is of course a very great honour. Our society has developed into one of the leading scientific medical societies worldwide. This is mainly due to the continuous dedication and commitment, over the past years, of many people within the ESA Secretariat and the various committees of our society. Moreover, our members really continue to believe in the society, trusting that we are moving in the right direction.
The fact that my peers nominated me to act as president of the ESA obviously makes me very proud, but also gives me a sense of humility. I promise that I will try to serve our members as best I can. A lot has been achieved but there are still challenges facing our profession. Hence we need to give strong answers, for the benefit of our patients, of anaesthesiologists and their co-workers throughout Europe, and, by extension, of the whole medical community.
Q: Tell us about your own medical training. When did you decide that anaesthesiology was going to be your specialty – did you have a key mentor or situation that influenced you?
My trajectory might seem a little unusual according to nowadays’ standards. I finished my medical education in 1984, without clearly knowing what I was going to do with my professional life. Therefore, I decided to start working for one year as intern in surgery and internal medicine in a general hospital, trying to understand what it meant to work as a medical doctor. What fascinated me the most, was the work at the emergency department and critical care unit, where patients needed urgent help. I liked to collaborate with the anaesthesiologists, who showed me how to take care of patients in a critical condition. Also, the work in the operating room (OR) seemed interesting to me, as well as the postoperative care. That’s why I decided to apply for an anaesthesiology trainee position. I have never regretted my professional choice of more than 30 years ago.
Q: Your career has seen you spend time at Antwerp University Hospital, The University of Amsterdam and your current institution, University Hospital of Ghent. Did you feel it was important to move around a little? How important is it for anaesthesiologists to gain experience in different places?
Indeed, I moved around, although not that far away. I think it is of the utmost importance to discover other horizons. It confronts you with new ideas, alternative technical procedures, other health care systems and even new cultures. It helps you to realise that there are many ways to provide excellent care to patients and that nobody holds the ultimate truth. Working in a new team also requires considerable flexibility and openness of mind. These are skills you always need, not only in medicine but in all important aspects of life.
Q: Can you remember giving your first general anaesthetic to a patient? How much have things changed since when you were doing your training?
Yes, this was a wonderful and at the same time rather scary experience. On one hand the magic of how it was possible that one could anaesthetise a patient within 30 seconds and on the other hand the feeling of a huge responsibility that I was the one who had to make sure that this patient regained consciousness and could again join his loved ones. Even after all these years, both feelings are present when I anaesthetise a patient.
I started my residency in the middle of the 1980s. Things have changed dramatically since. At that time, the only routine monitoring we had – even in the regular general university operating theatre – was ECG and a manual blood pressure measurement. Blood oxygen saturation was still assessed with visual inspection of the skin or mucosae. Ventilators were not equipped with alarms and many patients were still anaesthetised without adequate measures to ensure a free airway, having only the Mayo canula while spontaneously breathing.
The late 1980s and early 1990s were characterised by an immense advancement in the introduction and routine use of adequate monitoring tools to measure all vital signs. Also, the drugs used in anaesthesia have evolved dramatically becoming safer and shorter acting. Finally, the further development of locoregional techniques has increased considerably our ability for preventive perioperative pain strategies. All these advances have only been possible thanks to continuous research in all fields of anaesthesiology.
Q: You are actively involved in various areas of anaesthesiology research. How important is it for anaesthesiologists to participate in research as their careers develop?
Research is of utmost importance for all fields of anaesthesiology. Research is the key element to answer questions, solve problems and move forward on the path of better perioperative patient care.
Not every anaesthesiologist has the time and resources to perform individual research projects. However, for several years ESA has its Clinical Trial Network that coordinates international multicentre research. Over these few years we have started almost 20 such studies among which a number have already been published in high ranked journals. Every individual anaesthesiologist and department can join the network. Please visit our website (www.esahq.org) to look at the ongoing studies that may be of interest to your practice and join the CTN.
ESA also organises masterclasses in research and provides the possibility to apply for grants for those who are interested in performing research.
Q: The ESA has changed immensely since its formation in 2005. Membership has grown steadily and the organisation has produced a huge range of guidelines, increased focus on safety, and of course successfully held Euroanaesthesia each year. What are your plans to take the ESA forward as President?
The society has come a long way indeed! ESA has developed brilliant projects in education, research and patient safety. Without doubt, we will move forward with all these initiatives to better serve our members and by that ultimately provide better care to our core stakeholders: the patients.
Nevertheless, there are still a lot of other issues that will need our attention. Looking to anaesthesiology as a specialty we face an important problem which is gender inequality in executive functions. Even though today, more than 50% of anaesthesiologists are women, they are hugely underrepresented at executive level, and also in ESA. This needs to change and ESA will take up this challenge.
There is growing awareness towards the second victim phenomenon, which refers to the distress in caregivers who have encountered an adverse event with a patient, independent of the patient’s outcome. Anaesthesiologists are among the professions that are most prone to be confronted with this problem because they continuously have to deal with life-threatening situations. Attention is – rightly – always directed to the first victim (patient and the family), but too frequently the impact of the event on the caregiver is neglected. This may lead to substantial consequences such as emotional disconnection, burn out, substance abuse, depression and even suicide. I think it is time that we take the problem seriously and fully recognise it, so that appropriate actions can be taken.
There is also the problem of sustainability. Waste is a worldwide problem, and also occurs in the OR. We need to focus our attention on this and I invite you all to attend the session on sustainable anaesthesia on Monday (session ESAS10, Turquoise Room, 14h00-15h30). Measures have been taken to decrease waste at our congress, such as not having carpet installed in the exhibition hall (which was previously thrown away directly after the congress) and making sure 2018 is a “plastic bottle and cup free” event (meaning no plastic water bottles and the cups we use are made out of biodegradable materials and not plastic). We plan on making more changes in the future.
Finally, there is still a need for advocacy of our profession at various levels. The central role of anaesthesiology in all its pillars of perioperative medicine (anaesthesia, intensive care medicine, critical emergency medicine and acute and chronic pain medicine) needs to be promoted to various stakeholders: other specialist societies, nurses but also – and perhaps most importantly – patient movements. We are now making great efforts to develop these contacts.
It is obvious that the issues I just mentioned need to be addressed via the national societies. I am convinced that the close relationships we have with these societies, via our council members and the NASC, provide a valuable tool to successfully meet these problems.
Q: Thanks Stefan, and enjoy your first Euroanaesthesia as President.
Thank you and I hope that all our delegates will have a most enjoyable and interesting time during this Euroanaesthesia meeting in Copenhagen.