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Anesthesia vs. Surgery: Can’t We All Just Get Along?

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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,500 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,500 followers on Twitter.

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"Anesthesia is one of the few specialties that you must consult and work with but have no control over who is assigned to your cases. "
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A surgeon did an operation under local anesthesia with sedation in a very anxious, elderly patient. Everyone was aware of the patient’s anxiety, and she was maintained on midazolam (Versed) by an anesthesiologist throughout the procedure, which went smoothly.

When she returned a few weeks later for a similar procedure at another site, a different anesthesiologist was involved and refused to sedate the patient, who complained bitterly after the case.

She said if she had known that sedation was not going to be given for the second procedure, she would not have undergone it. She filed a formal complaint with hospital administration as did the surgeon.

The preoperative nurse told the surgeon that she had spoken with the second anesthesiologist and informed him that the patient was anxious and wanted a similar type of sedation for the second case, but he refused to give it.

He accused the nurse of telling him how to do his job.

For now, the anesthesiologist in question is no longer being assigned to the surgeon’s cases.

What happens when anesthesia and surgery disagree?

There is no simple answer to this issue.

Anesthesia is one of the few specialties that you must consult and work with but have no control over who is assigned to your cases. You may have a couple of “go to” internists or cardiologists. You can ask your favorite radiologist to look at an x-ray for you. But anesthesiologists are assigned to you by the chief of anesthesia or the anesthesiologist-in-charge for the day. So no matter how incompetent or disagreeable a particular anesthesiologist is, you may have to work with her whether you like it or not. This also is true of emergencies on nights and weekends.

To be fair, I suppose they feel the same way about certain surgeons too.

The situation will not likely be resolved to everyone’s satisfaction although the administration might pay a little more attention since the patient complained too.

The surgeon’s reward for complaining will probably be a large helping of passive-aggressive behavior from that anesthesiologist the next time they do a case together.

This reminded me of what happens when you get an anesthesia consult ahead of time for a patient you know is going to be complicated. The anesthesiologist who does the consult may say, “The patient doesn’t need a cardiac stress test.” But on the day of surgery, it’s is ALWAYS a different anesthesiologist who, of course, will not put the patient to sleep without a stress test.

Don’t get me started on stress tests, which a recent study found were inappropriate in many instances possibly wasting half a billion dollars.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,500 followers on Twitter.

4 Comments

  1. I recently had a colonoscopy and was told before the procedure that I would receive a sedative and something for the pain. I received diphenhydramine but the doctor started without the fentanyl 125mcg and midazolam 5mg they had prepared. I complained and pleaded throughout and told them to stop 3 times and they ignored my complaints and continued anyway. Since then I have been having nightmares of rape and panic attacks. The post op report claims I did receive fentanyl and midazolam. I dressed myself and walked out of the hospital within 10 minutes of the colonoscopy without assistance and took a bus home with a friend. Is it possible they gave me the pain medication they described without me knowing it? My friend has known me for 30 years and says I was sober as a judge when we left.
    Mad As Hell

    Reply
    • Anything is possible. I can’t say whether you received the meds or not. I hope you’re ok.

      Reply
  2. The door does swing both ways. Today at my place of practice, a surgeon refused to operate on a patient under the care of a particular anesthesiologist. The result was that the patient had to be awoken and sent home without her planned procedure.

    The two had been involved in an earlier case which the surgeon had been sued unsuccessfully for allegedly perforating a great vessel during a vascular access port placement resulting in the death of the patient. The anesthesiologist had not been named in the case and did not testify against the surgeon, yet the surgeon refuses to work with him.

    Something else to also watch a different surgeon, a former chair of surgery, misuse an ultrasound machine and enter the carotid artery during a port placement but document “no complications” in the post-op note.

    Or how about the surgeon who under her breath during a case comments how detestable a negative laparotomy is (it was negative) but dictates that the intussusception was reduced during the exploration.

    Or how about another surgeon who refuses to put more local anesthetic in for the last two stitches of a monitoring with sedation case because the needle pokes are the same in number resulting in the patient retaining an attorney to ask for $40,000 in pain and suffering from the anesthesiologist.

    Or how about a surgeon who does his rant under the anonymity of SkepticalScapel but want commenter to share their names and emails.

    Reply
    • I am sorry you practice with such unsavory surgeons. I hope you have gone to your administration with the complaints you have listed here. To remain silent puts future patients at risk.
      ***
      Maybe you missed this part of my rant. “To be fair, I suppose they feel the same way about certain surgeons too.” Just to be sure you understand, “they” means anesthesiologists.
      ***
      I don’t recall asking anyone who comments on this website or my personal blog to share their real name or email. You can put any name you want on a comment just as you did. The Internet is open to anyone. Feel free to start your own blog.

      Reply

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