We physician anesthesiologists have a justifiable reputation for improving patient safety. We were positively cited in To Err Is Human, we’ve invented and promulgated dozens of new monitors and medications, our society’s registry is one of the largest in medicine, and we’ve driven our collective malpractice insurance rates into the lowest quartile of all medical professionals. Indeed, the rate of occurrence of serious adverse outcomes during anesthesia is so low that it’s become statistically difficult to demonstrate further improvements, and nearly impossible to show a difference in outcomes between individuals or institutions. Based on a quick look at practices reporting mortality to the National Anesthesia Clinical Outcomes Registry (NACOR), the hypothetical median anesthesiologist in America sees only one intraoperative death a year. And if we dig into this even further – extrapolating from the published literature – the...

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