Wednesday, June 16, 2010

8 Simple Rules To Being A "Good" Anesthesiologist

Want to learn how to be a "good" anesthesiologist?  In the OR, it has nothing to do with clinical excellence.  Surgeons just assume that all anesthesiologists possess the same intubation and induction skills.  That's why they consider us interchangeable.  If you try to cancel a case, they just demand another anesthesiologist to work with since, well, we are all one and the same.  No, to be a good anesthesiologist, as in "Oh, I'm working with Dr. Z today.  He's a cool guy.  We like working with him," is more than just being the smartest guy in the room.  It doesn't matter that I just passed my board recertification and can recite the FA/FI ratios of seven different inhalational agents.  I might as well be speaking Klingon to the surgeon who may prefer to work with somebody who was grandfathered in with a lifetime board certificate and has not read a single journal article in 20 years but can wax poetic about the advantages of pancuronium over all these new fangled muscle relaxants.  No, to be a "good" anesthesiologist requires a certain je ne sais quoi that is not taught in any residency.  Follow along to discover how to be the most popular anesthiologist in the operating room.

1.  It helps to be female.  It sounds sexist, but alas it's also true.  Male surgeons like to have a Chatty Patty in the room to talk to, especially if the female anesthesiologist is also young and pretty.  Bonus points if she is still single.  Female surgeons like the XX camaraderie. Since the circulating nurse and scrub tech are also usually female, the OR becomes one big sorority pajama party.

2.  Play good music.  One of our partners likes to play music that can best be described as modern day Gregorian chants.  Needless to say he is not very popular in the OR.  Classic rock will usually suffice as most surgeons are of the age where they grew up with that music.  But be flexible if some surgeon decides to relive his adolescence and wants hip hop despite being fifty and balding.  The biggest mistake? Not bringing any music at all.

3.  Avoid temper tantrums.  Surgeons feel insecure if you can throw an object at the operating room wall harder than they.

4.  Be a comedian.  Nothing endears an anesthesiologist to a surgeon more than telling a really bad joke.  I'll get you started.  What's the difference between a Beverly Hills plastic surgery office and Whole Foods Market?  At Whole Foods the melons are all natural.  Ba da bing.

5.  Show no initiative.  Surgeons don't care what you think.  They only want you to do what they tell you to.  They hate it if you think a case in preop should be delayed because you want the patient to get an echocardiogram when you hear a 3/6 holosystolic murmur that has not been previously documented. 

6.  Watch ESPN as if it was the second coming of The Sopranos.  Surgeons love it if you can discuss sports stats as adeptly as interpreting an ECG.  Be especially vigilant about understanding the local sports scene.  For instance in Los Angeles you should be able to effortlessly parry a surgeon's stats about the greatness of Kobe Bryant by coolly dissecting the career of Magic Johnson.

7.  No eccentricities.  Surgeons dislike anesthesiologists with any kind of character.  They want faceless masked robots who will put their patient to sleep without drama.  A smidgen of wit is good.  Logorrhea is bad.  It is a very fine line.

8.  Buy food for the OR staff.  It can be as simple as blueberry muffins from Costco for breakfast or pizzas from Dominoes for lunch.  Sometimes a giant bag of tortilla chips with salsa will suffice. This last advice is very important.  It makes the surgeon and the OR staff very happy and will make up for a lot of deficiencies in the anesthesiologist.  This is probably the best and cheapest way to ensure your likability. In tough situations the well fed OR staff is your best bet to help you cover your ass.

There you have it.  Don't say you don't learn anything reading blogs from anonymous doctors who may or may not know what he's talking about.  But I guarantee that if you follow these rules, you will be the "best" and most popular anesthesiologist in your hospital.


  1. This post makes me wonder if going into private practice is worth it. I know that academics is a whole other monster, but being able to use your brain rather than being an automaton in the OR seems better.

  2. RAG, where's your sense of humor? This is all tongue in cheek. I love being an anesthesiologist in private practice. Frequently I feel like I have the best job in the world, at least the world of medicine. I would not want the political infighting and power grabbing that is all too common in academia. I arrive in the morning, do my work, then leave when I'm done. I don't have to worry about putting together a lecture for the residents or working with IRB to get a study off the ground so that I can get published and not be dismissed from faculty. But then that maybe what you prefer.

    1. Great advice! I've been on both sides of the drape, so I know it's no use arguing with the reality of your keen observations. The surgeon-anesthetist relationship is a lot like that between a man and dutiful wife, pre-lib. Wife is smarter and better put-together, but woebetide the woman who lets on that she's the one running the show. She's got Hubby's fragile ego to contend with. P.S. Anyone who thinks that this deft navigation of the social shoals of OR life is Capitulation or a Sacrifice of one's professional principles has probably never had a serious relationship with someone, or has never been out on a date.

  3. Was #1 suggested to you by a surgeon? :P

    Here are my simple rules to being a "good" surgeon:

    1. STFU
    2. Be on time.
    3. STFU
    4. Hurry up with the surgery.
    5. STFU
    6. Don't add on cases.
    7. STFU
    8. Go home.

  4. Hilarity. Do you realize there's a whole post about this on SDN?

  5. Yes. Unfortunately, like most internet conversations, that thread quickly degenerated into insults and name calling.

  6. This is probably the best and cheapest way to ensure your likability. In tough situations the well fed OR staff is your best bet to help you cover your ass.

  7. Do anesthesiologists need medical malpractice insurance? I'm not sure hwat I want to go into yet, but my neighbor who is a doctor says insurance causes him to put up six figures every year. That's just for insurance! It's hard to think about how much an office has to bring in each year to cover those kinds of costs.