Anesthesia Spotlight: May Pian-Smith, MD, MS, and Jean Kwo, MD

The Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital is home to pioneers who have transformed patient care through practice, research, innovation and education. In doing so, they have paved the way for others to follow in their footsteps.

May Pian-Smith, MD, MS, is an obstetric anesthesiologist, the chief of the department’s Division of Quality and Safety and a board member at the Society for Obstetric Anesthesia and Perinatology (SOAP) and the Anesthesia Patient Safety Foundation. A faculty member at Mass General since 1994, she leads several initiatives, including those that seek to improve worker wellness and resiliency, diversity and inclusion in the workforce, and quality and safety in patient care.

Jean Kwo, MD, is an intensivist, the medical director of the surgical intensive care unit at Mass General and a member of the department’s Division of Quality and Safety. She became faculty at Mass General following completion of the Mass General Critical Care Anesthesia Fellowship in 1997. Her clinical interests are the preoperative evaluation and risk assessment for patients undergoing anesthesia and surgery, as well as the treatment and management of acute and chronic respiratory failure.

In celebration of Women’s History Month, Dr. Pian-Smith and Dr. Kwo share how they got to where they are today, their advice for women pursuing a career in medicine and their visions for the future of their field.

Q. How have anesthesia and critical care medicine changed throughout the years?

Pian-Smith: Research has advanced our understanding of both wakefulness and unconsciousness; the development of novel medications has helped us impact sensation and physiology more precisely; innovation has improved quality and patient safety. Anesthesiologists increasingly are leaders in non-OR settings, including in ICUs and with pain management and pre-operative patient optimization. Now we are even contributing to new practices to decrease greenhouse gases and waste. I have seen more women and underrepresented minorities enter our department, enriching our environment and helping us better reflect the patient population we serve.

Kwo: Critical care medicine has become more evidence-based with landmark trials in protective lung ventilation for acute respiratory distress syndrome, spontaneous awakening and breathing trials, and blood transfusion. Technology like ultrasound has changed the way we assess hemodynamics and allow clinicians to place lines.

Q. How do you hope to see it evolve?

Pian-Smith: Significant disparities in access to and delivery of care and in maternal outcomes have become more evident with time. This is a critical and urgent priority for our specialty, and I hope we can address these inequities locally and globally. The Mass General obstetrics floor was one of the first to receive the national SOAP “Centers of Excellence” designation for OB anesthesia; we have developed many best practices to anticipate and identify complications, communicate effectively during rapidly evolving situations and team up through simulation, debriefing and other deliberate practices.

Kwo: Advances in surgery and anesthesia have made procedures available to patients in critical condition, which should be administered safely and appropriately. The COVID-19 pandemic has also shown us that quality care involves the caregiver. Finally, we must recognize the social factors and unconscious biases that may affect the quality and safety of the care we provide as well as the patient’s health.

Q. What’s been your approach to leadership?

Pian-Smith: I believe that we are greater together than the sum of our parts, and strive to build connections between people so that they can thrive as individuals and flourish as a team. Especially with issues like burnout, it’s good for us to remind each other of the purpose that drew us into this profession. I try to provide support and systems-based resources to help everyone accomplish what’s important.

Kwo: I’d like to think that I see things from others’ perspectives and that I’m an inclusive leader. When you work with many role groups, you have to break down the barriers and silos between them to start the conversation. We all have one goal: to give patients the absolute best care that we can. I believe that we need to work together to achieve this goal.

Q. What’s helped you to achieve success?

Pian-Smith: Everything important that’s happened has been with the help of others. For me, this includes working within national societies and foundations and serving on editorial boards to help shape the education of the next anesthesia generation. I’ve worked with women across Harvard Medical School as member and chair of the Joint Committee on the Status of Women. Working on women’s issues is very important to me—anything that is good for women and other underrepresented groups is excellent for the organization. I cannot overstate the importance of mentorship and sponsorship, as it’s helped me to contribute to several organizations in an advisory capacity.

Kwo: I always try to look at the positive side of things, and I’ve had so much support at Mass General. Warren Zapol, MD, Jeanine Wiener-Kronish, MD, and Seun Johnson-Akeju, MD, provided me with opportunities through mentorship. Women role models such as Michele Szabo, MD, Laurie Shapiro, MD, Lucy Everett, MD, and May Pian-Smith, MD, MS, led by example. Peer role models such as Vilma Ortiz, MD, and Rebecca Minehart, MD, provided encouragement and support.

Q. What would you consider to be your greatest accomplishments?

Pian-Smith: I’m a work-in-progress and there’s so much more to be accomplished! I’m very proud of the two amazing kids that my husband and I raised while working (more than) full-time. This past year, I was honored to deliver the Fred Hehre Honorary Lecture at the national meeting of SOAP and present data that shows how having positive, trusting relationships leads to improved patient outcomes as well as joy and resilience in the workforce. To be member of such a highly matrixed and supportive community feels like my best accomplishment.

Kwo: I’m most proud of my work with our residents. I’m constantly in awe of their commitment to learning and patient care, and love to watch them gain knowledge, experience and confidence. They are an inspiration to me, and I keep in touch with many of them throughout their lives and careers.

Q. What advice do you have for women interested in pursuing a similar career?

Pian-Smith: Come see me! Ask for help and don’t feel like you need to figure out everything on your own. Developing relationships helps us feel part of something bigger and more purposeful.

Kwo: Do what you love and if you stop loving it, don’t be afraid to look for another path. I did other things before going into medicine and critical care. For me, it took a while, but I found a career path that has kept me challenged and engaged for over 20 years.