Back to the OR of the Future: Reply

I wish to thank Kevin Tremper for his kind words¹  regarding my recent Editorial and his impeccable cinematic taste, as well as for verifying that I alone am not the only baby boomer anesthesiologist suffering from “manual blood pressure posttraumatic stress disorder” or chronic otitis externa.²  Although the controversy related to noninvasive blood pressure accuracy has moved on from the now nearly extinct manual blood pressure measurement in the operating room, it does continue to rage with regard to invasive arterial monitoring that does systematically alter clinical management, as has been well described in the Journal.³ 

I greatly appreciate Kevin’s request for more support for decision support systems, and in my somewhat wide-ranging and admittedly hyperbolic riffing on the future, I do apologize for giving short shrift to this important topic. Process outcomes are extremely important to patients and institutions. Given that they are often hard to quantify (particularly on a patient level) or may not be universally generalizable (e.g., length of stay or cost may vary widely between institutions and can be highly confounded), “hard” clinical outcomes are most often accorded higher priority; however, this may not always be the most appropriate approach.

Thanks again to Dr. Tremper for sharing his thoughts and expertise on the upcoming future. I once again call on some late 1980s pop music philosophers—the now defunct band Timbuk 3—for guidance: “Things are going great, and they’re only getting better…The future’s so bright, I gotta wear shades…”

The author declares no competing interests.