Wednesday, April 20, 2011

Another Pet Peeve: the Finger-Pointing

People blame anesthesia personnel for EVERYTHING. You name it, they blame us for it. They call us by the umbrella name "Anesthesia" and if there's a problem, it's always "Anesthesia's" fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist's been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia's fault.

No more coffee in the break room? It's because of Anesthesia.

Think I'm exaggerating? Spend a day in any O.R. in the country and count how many times someone says, "It's because of Anesthesia."

Why? Because it's easy to point the finger at the people / work / department you understand the least. The practice of anesthesia is poorly understood by people outside the specialty, so it makes the perfect scapegoat for EVERYTHING.

I recently heard about a conversation that exemplifies exactly what I'm talking about. My chief was explaining to some of the O.R. nurses what happened to a patient who experienced a known but uncommon complication from one of the materials used by the surgeon during the procedure.

"Yeah," my chief said, "X event happened after the surgeon put in Substance Y for that part of Operation Z."

One of the nurses replied, "Really? How did you [anesthesia] guys cause that?!"

The attitude is so ingrained people can't even detect the nonsensical nature of their own illogical utterances. *Sigh*

The practice of anesthesia looks easy but if people were to try it for a day I think they'd come away pretty spent. When the endpoint is a smooth course, with "nothing unusual happening," the expertise, planning, and careful execution are easy to take for granted. For the record: we prevent or correct many more problems than we cause. When you hear someone say, "It's because of Anesthesia," think twice. You're probably not getting the whole picture.


K said...

Of course, when the case goes well, no one says "thank you" to the anesthesiologist, they all look and bow to the surgeon. At my work (PICU) I personally would take an anesthesia fellow over any critical care fellow or a surgeon. Because anesthesia actually HELPS and isn't afraid to DO something, where as a surgeon will stand there contemplate and talk, and the critical care fellow will pee in their pants and run away to call the attending. Sorry you guys get so much flack. My mom is an anesthesiologist, so I understand your concern!

Unknown said...

I always questioned the anesthesiologist more than the surgeon! After 14 surgeries for my son, I knew who I wanted in that role! It's way way too important to ignore.....

thanks for caring so much about your patients!

Arneth R. Ribeiro said...

I totally agree with everything you wrote about people (especially surgeons) blaming everything on anesthetists. I am Brazilian and work as an anesthesiologist for 25 years in a public hospital. It makes me frustrated to work long hours and have to tolerate co-workers who pretend to work when they actually escape whenever they can. I am glad to also have another profession: English/Portuguese translator. I love both but Anesthesiology is exhausting most of the times. I think about reducing my workload also but the hospital pays too little so I need to work extra hours only a few more years. I understand exactly what you feel and enjoy reading your blog. Thanks for putting into words what a lot of colleagues feel. We love our specialty but do not like to be undervalued. Hope to read more of your comments! Arneth

Anonymous said...

I expect that anesthesia when done well, which it is almost all the time, is exhausting. We have awesome anesthesia staff at our facility and I'm grateful for those guys every day.

Anonymous said...

Your friends in "respiratory" feel your pain.

The BlogOR said...

Anesthesiologists are invisible. A surgeon said that to me a few months ago, and he was right on. It is true because we are, at least until things go wrong, or until they need someone to blame. So it's really a good thing not to be means you did a good job. Your blog was right on, and more surgeons need to read it. Good luck with taking a little extra time off, you deserve it!!

Anonymous said...

I'd like all of you anesthesiologists to know that some of the patients are VERY appreciative of your work. In the last 20 years I have had 4 surgeries and never once woke up nauseated! I admire them because I think it must be very complex selecting the meds to use, and the amounts, and then adjusting them as needed during surgery to maintain the patient's unconscious state safely.

The only issue I have ever had was with an anesthesiologist who told me he was giving me something to relax me before going into the o.r., and then I remembered nothing from that point until later in the day back in my room. It upset me because with my previous 3 surgeries I remembered going into the operating room, talking to my surgeon, and waking up in recovery. I found it very disturbing to have no memory of times when I was conscious and talking. I think he should have told me that he was going to give me something like that, and allowed me to decline it if I wanted to do so. If I ever have another surgery I'll insist on no amnesia meds as I don't see the necessity, having had surgery without them.

The BlogOR said...

Anonymous, you are right on. It's just that most people don't want to know anything, they don't want to see anything,and they don't want to hear anything. That being said, I don't routinely use that drug unless a patient asks for it, or there is another strong indication for it.

When I had surgery three weeks ago (we doctors HATE taking on the patient role!!), the first thing I told my anesthesiologist was that I didn't want the drugs that cause amnesia because I really wanted to remember what my surgeon said afterwards, and also what I said and how I behaved, or not;-))

Here's hoping that neither one of us has to have surgery again in the near future!!

Anonymous said...

I'm a second year anesthesiology resident in western NY, and I've have already had my fair share of hearing "it's anesthesia" for anything and everything.

Nausea and vomiting after craniotomy? It's because of anesthesia.

You have decubitus ulcers? It's because of anesthesia.

Cafeteria out of soup? It's because of anesthesia.

The inherent problem with anesthesia being blamed for the OR start delay, it seems, is that the nurses document the causes for delay. Some nurses work only with certain surgeons in the hospitals I work, and of course those nurses are never going to attribute the delay to the surgeon who arrives 10 minutes late for his 7:30 case because he was stuck in traffic.

On the other hand, I have patients shake my hand vigorously after the surgery, thanking me for taking such good care of them. While I find uneventful emergences deeply gratifying in themselves, those little moments really make this job satisfying. I sleep well at night knowing that I've done everything I can to do what's best for my patients.

I love reading your blog. Thank you so much for sharing your thoughts.

Colette said...

I agree that it is not anesthesia's fault as a surgeon. I've found that those who point their finger are always the ones at fault. Some people have to put others down to make themselves feel better. Try to remember that it is not a reflection on you, but on the ones doing the blaming.

As your fellow chocolate loving surgeon- I think you do a great job!