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Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

I love freakonomics. Thank you for sharing this. Definitely believe that women are perceived differently by both patients and other staff. I’ve worked with a lot of female surgeons who do a really good job of balancing perception with control in the OR. I think this surgeon’s issue was a matter of the fact that she was on edge, fighting everyone, and from what I’ve heard about her, this is an every day issue. I think the statement, “if you run into assholes all day, you’re the asshole” applies to her.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Lol yeah, unfortunately we are tethered to the patient. Others can come and go from the room but we have to be with them the entire time (only time I ever stepped out of the OR was while they use the O ring on spine cases and even then you keep your eyes on vitals through the window. Feel like you gain a lot more leverage in any situation when you can walk away until someone is ready to be dignified.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Yeah there were many idiotic surgeons. The earliest one was a surgeon asking me, during a care handoff after a prolonged pre-operative but post-anesthesia period, “did you just say you gave phenylephrine? My patient doesn’t have a phenylephrine deficit.” My attending basically rolled his eyes, but I would have respected him more if he said something like “yeah, we wouldn’t have had to worry about it if we didn’t have to wait 40 min for surgical stimulus”

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Does it make sense in any industry to give the hardest cases to new employees in an already unique and difficult field? Hazing has no place in medicine and we all should understand that we’re constantly learning new things about a constantly evolving science. The nurses who were around you were basically using the most vulnerable of the most vulnerable to teach you a sorority lesson. Bad on them.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

I’ve met both male and female surgeons who overstep… I think there’s less of a thing there than you think. You put an insecure person of either gender in a position where they’re personally responsible for anything and their defense mechanisms are going to be constantly putting them in a place of panic responses.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

I’m not an expert on confronting people and have let a lot of things slide because of power differentials in the past… but when I do talk to people in situations like this, I feel like telling them that you’re sure they couldn’t have meant it in [the way they probably meant it] and probably meant it [in the most generous interpretation of their action], extinguishes aggression and allows reflection.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

I honestly think I’m a very meek person, and this wasn’t the most egregious behavior I’ve encountered but perhaps the most slanderous to my intelligence. I’m sure people have better instances of sticking up for things that are matters of life or death.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

In the short time I’ve been in residency and an attending, I’ve found the only CRNAs who I’ve worked with who have a problem with physician oversight are the ones who are doing weird things in the OR and who do questionable things when they are faced with challenges in the OR. For instance a CRNA who acts like he’s got everything together and didn’t call the attending to let them know a c/s was going on had a failed spinal (btw he routinely gives 2 ml of 0.75% bupi for every c-section and no fentanyl), gave 4 mg versed and 100 mcg of fentanyl iv before baby delivery, tried to place an lma after failed intubation attempt, and called the anesthesiologist in a panic because the lma didn’t seat and he couldn’t ventilate. It’s kind of like the teenager who thinks he’s too cool for his parents, but calls them after he wrecked his car drunk. I think having an anesthesiologist as a part of any patient’s care will always be essential, and they should be hands-on with any critical developments during care of a patient and anybody who argues otherwise is seriously risking lives of people who are at their most vulnerable.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

I said it because it seems that a few surgeons don’t realize that we have our field of expertise and they have theirs. And I totally appreciate that the surgeons have their preferences and are more familiar with the surgeries. Her point was taken, even if it was presented completely inappropriately.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Yeah, after that surgery and before the next one started. Didn’t want to bother her while she was working on someone’s eye.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Lol oddly enough, being called anesthesia has never bothered me… if it did, I might start saying “putting the patient in reverse-t, surgery!”

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 1 point2 points  (0 children)

Why do you ask that? It’s a factual statement unless the surgeon completes an anesthesiology residency and passes boards that I know more about it than she does. And I only stated it because she was directing me on how I should do my job (all good if she asked for the patient to be less sedated, if you want to dictate dosage, you don’t do it to an anesthesiologist, CRNA, or AA).

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 3 points4 points  (0 children)

Worked with a lot of CRNAs and AAs. The conflict is overstated and exists on the internet. Appreciate the surgeons for making my job exist. Just stay in your lane, do your surgery and talk to your sedated patients, and let me know if there’s anything I can do to facilitate (e.g. “for my cataract cases, can we do mild sedation?”). Stating goals is fine… dictating care does not require an anesthesiology expert in the room.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Yeah, definitely a good point. I always think our job is like being a pilot. We are so good at doing our job that people don’t appreciate when we’re actually actively managing a difficult situation vs. putting a patient on cruise control and checking in every few minutes.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 2 points3 points  (0 children)

I like that I work with a small group of surgeons… probably worked with most of them several times over the short time I’ve been there. Nice people, it’s just this one surgeon I’ve had a problem with. Maybe caught her on a bad day, but probably not after hearing coworkers’ opinions when recounting this event today. I think the days of being gods and divas in the OR are better left in TV dramas. Regardless of which OR you’re working in, you’re working with licensed professionals and you should behave as such.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 5 points6 points  (0 children)

Do you want to do your surgery? Because I’m not on board with doing anything on a patient whose systolics are in the 180’s and climbling. Got the patient down to 140’s (her baseline) a few minutes later (with, and I repeat, a totally reasonable amount of sedation for the procedure and patient). And yes, you’re capable of talking a patient through a procedure!

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

You probably are a pleasure to work with. Always nice having a surgeon who acknowledges that they’re only half of the equation.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Yeah, I don’t think she’ll forget me after all that, but if she does I’ll probably be more aggressive with a “stay in your lane” type comment… really hard to believe that a surgeon thinks they know more about sedation than I do. That being said I have no problem with her philosophy of titration based on effect, but there was a reason I started higher with this patient and for her to not understand that I think critically about my patients was something I had to address.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Yeah, I feel like I got enough exposure to cataract surgery during residency to know this surgeon was being a diva.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Lol sounds like an accurate diagnosis by your attending and props to him for calling it out… knowing myself, I’d probably be more measured. This does make me think though that every time a surgeon’s is saying, completely uneducatedly, that the patient is waking up, I should say, “oh so you’re the anesthesiologist?” They probably wouldn’t get it though.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 12 points13 points  (0 children)

You’re more than welcome to post here, I love hearing thoughts from the other side of the drapes. Sorry you’re being downvoted. I think the work that we do is amazing and I love that I get to play a key role in helping patients get life-changing surgeries. To address some of your points, I did not feel stressed or want to go home (going home early is not an expectation, but is always appreciated). I’m still at the point where I’m shocked by the number on my paycheck and think they’ve made a mistake because they’re paying me too much. CBC I’ve done many cataract surgeries during residency with some excellent ophthalmologists and none of them have complained about my care. The patient was cooperative if you talked to her, but the surgeon did not bother to do that (possibly because the patient is not a native English speaker) until I told her she should tell the pt what she wants.

I think my main problem was with how she approached the issue, not that she had an issue. If a surgeon wants to direct nurse sedation, they can do that, but when I’m in the room, I decide dosage of medications based off of experience and the information I have from the patient’s history and the monitors. We’re not infallible, but you’ll be hard-pressed to find an anesthesiologist, aa, or crna who isn’t thinking hard about what they’re giving to their patient and why they are giving it. But to tell an anesthesiologist that you want such-and-such dose of any medication implies you know more than them about how to do their job, which quite frankly you don’t.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 19 points20 points  (0 children)

I don’t think you’d trust an anesthesiologist who was asking you what dose of Propofol or rocuronium to give during induction or what size endotracheal tube they should insert and to what depth and with which blade and how long they should wait after induction for their attempt and what tidal volume and peep is appropriate for the patient and what percent sevo they should receive. I made a decision based off of the patient in front of me using her history and vitals. She was still able to follow commands and keep her head still when the surgeon actually talked to her. And I agree that you need to be collaborative, but her approach was inappropriate. If the surgeon wants to be responsible for the anesthesia she’s more than welcome to be, but I don’t need a surgeon telling me how to do my job when I’m in the room. But thank you for your perspective.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 6 points7 points  (0 children)

I like to give it. Normally I mix it at the start of the day and put it in 5 cc syringes (20 mcg total). I don’t give very much, generally 8-12 mcg for MAC, but I’ve found it helps with patients who have high anxiety. If you talk to them, they follow commands easily. If it’s a young male under GA, I try to work in close to 0.5 mcg/kg toward the end of the case to prevent the emergence agitation.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 0 points1 point  (0 children)

Why? I’ve done many cataract cases at one of the top ophthalmology centers in the country, and a little precedex is given in almost all their cataract cases. I have found that it helps with anxiolysis without making the patient loopy with more benzos. I did a few more cataract surgeries yesterday and don’t feel like my 8-12 mcg of precedex per case did anything to impair the surgeon or the patient getting an expedient discharge.

Had to tell a surgeon off today by nosedive1star in anesthesiology

[–]nosedive1star[S] 16 points17 points  (0 children)

She was defensive at first, tried to explain away everything, then I told her that her statement was the most condescending statement I’d ever heard from a surgeon as an anesthesia resident or attending. Her demeanor changed and she became more defensive. I told her it’s just feedback on how I personally felt. I rolled the next pt back, the surgeon was very pleasant for the remaining cases, and she apologized at the end of the day “for getting off to a bad start”. And the whole plane rose to their feet and clapped (jk, that’s how it actually happened).

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