Friday, January 8, 2010

How Is Anesthesiology Similar To Running A Nuclear Power Plant?

A study printed in the Anesthesia Patient Safety Foundation equates practicing anesthesiology with the complexity of running a nuclear power plant. They describe human activities as a combination of interaction complexity vs coupling. An interaction is more complex when at each decision-making point multiple choices can be made. Linear interactions is self-explanatory; there are few decisions to make for each interaction. A tight coupling implies one consequence after each decision whereas a loose coupling denotes less rigid consequences of an action, thus the system is more forgiving of an error.

The authors rightly state that humans are extremely complex. However when the patient becomes anesthetized suddenly the compexity and coupling tightness leaps into the nuclear plant territory. Why? Because the anesthesiologist is now in control of every vital function of the patient. The complexity is still there but the consequences become catastrophic if not handled correctly, just like running a nuclear power plant. Remember your oral boards exam? What would you do if the patient goes into an arrhythmia, BP plummets, and he desats, sometimes all at the same time. Complex yes. And each action you take will lead to a certain consequence, thus tight coupling. Very little forgiveness if an error in decision-making occurs. With all the new technology currently available to anesthesiologists, the complexity becomes even worse. More information requires more processing leading to a higher pressure to make the right choice.

So you can see how being an anesthesiologist can be as nightmarish as running a nuclear plant. Of course the surgeons will probably agree that anesthesiologists are in fact very similar to a different nuclear plant operator:

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