Surgeon's Pet

I was on call when I was asked to go do a routine case. At least on paper it sounded routine. Upon further inspection the patient was quite sick and warranted further medical workup. Though I will give anesthesia to virtually anybody, I had to balk at this case. I strongly expressed to the surgeon, whom I rarely ever work with, that the patient needs more workup in order to undergo a safe anesthetic. The surgeon was not amused. He was outraged that I was holding up the case when he and the patient's primary care team had already discussed and agreed to the procedure. I calmly reiterated my cautionary stance with this patient. He then told me he will find an anesthesiologist who will do the case and hung up the phone. Later I found out the surgeon found an anesthesiologist he works with frequently. That anesthesiologist, despite obvious contraindications for surgery, proceeded with the case and the patient did well.

What does this episode illustrate? Is anesthesia so safe nowadays that it can be given to anybody at anytime with little consequence? No. In my mind, it tells me that some anesthesiologists will do cases for "their" surgeons despite our duty to be the patients' advocates. I think it's part of human nature. Probably all anesthesiologists have at some point done a case for their favorite surgeon when it was against their better judgement and certainly not what they would do if the case was an oral board question. It's like the good friend you have known for years who suddenly wants to borrow money from you to start a small business. Against your better instinct you do it anyway, hoping and praying everything turns out well and nobody (especially you) gets hurt in the end.

While surgeons love the loyalty of their pet anesthesiologist, guess what happens when the turd hits the fan. The pet is suddenly left out in the cold, at the mercy of the lawyers and insurance companies that come looking for the criminal doctor who messed up the patient. What will the good buddy surgeon say when the attorneys come knocking at his door? He will point the finger straight at the anesthesiologist. "He said it was okay to do the case," will be his deposition.

It took me a few years of practice to understand this relationship with surgeons. Life is too short to be worrying about what the surgeon thinks of your anesthesia skills. No amount of money is worth the heartache and guilt when the patient crashes on the OR table, or worse, in the Recovery Room. Like a good friend who has your back, a good surgeon will never pressure his anesthesiologist to do a case against his will. If there is any arguing with the surgeon, it is probably best to resign yourself from the case and have him call for his pet, I mean, anesthesiologist. Hopefully, if they have any integrity at all, they too will deem the case not acceptable to take to the OR and the surgeon will finally realize we are all looking out for the welfare of the patient.