Friday, March 20, 2015

The Anesthesia Standby

A gastroenterologist I was working with the other day asked me about Sedasys, the self administering propofol infusion pump. I told him that very few places have been using it even though it's been on the market for awhile. It doesn't provide very much sedation as the patient has to be alert enough to respond to the machine before it will continue the infusion. And when, not if, a patient goes into respiratory distress, who's going to be responsible for the airway. The GI doc?

He replied that since there are anesthesiologists working in other rooms at the surgery center, there will always be one around as a standby for an airway emergency. After all, no anesthesiologist will cruelly let a patient die if there is something he can do to prevent it, right? That would be completely unethical as a physician and against the principles of the Hippocratic Oath.

I was livid with anger. I just wanted to sock him in the jaw but that would be breaking my Hippocratic Oath. This guy was taking advantage of anesthesiologists to further his money grubbing career. Unfortunately, he's not the only one.

Our Cardiology department is notorious for using anesthesiologists only when they need somebody to save their butts. Too many times they decide they can't wait for an anesthesiologist to help sedate a very sick patient before starting their cardiac cath. Then halfway through the procedure, as they somehow start dissecting the left main coronary artery, we will get an emergency call for an anesthesiologist to come stat to the Cath Lab to intubate and resuscitate the patient. They know they can get away with this behavior because we oblige them time and time again.

Another recurring issue is the cardiologist who is too impatient for an anesthesiologist to become available so he can put in a pacemaker that was not originally on the surgery schedule. Even though he may be 45 minutes late on all his cases, if an anesthesiologist isn't ready when he is, he will take the patient into the room himself and start sedating with Versed and Fentanyl. When he starts digging into the left pectoralis to form the pocket, the patient becomes difficult to control because he's not alert but still not adequately sedated. Then the call goes out to get an anesthesiologist ASAP.

When I'm faced with a situation like that, I am always tempted to turn around and walk out. I have never met this patient before. The patient is already sedated and it will be impossible for me to get an adequate consent for me to give anesthesia. That's practically assault in the eyes of the law. Plus this is not an emergency procedure that I can attribute for lack of a consent. But my professional side eventually takes over and I help the cardiologist finish his case. Why? Because it would do nobody any good for the patient to not have his pacemaker put in. He could hurt himself by squirming around on the OR table and his pacemaker might not be positioned properly. Sigh.

It's infuriating that other doctors prey on the good intentions of anesthesiologists to further their own agendas. We are physicians too. We deserve the same considerations for establishing a proper doctor-patient relationship as other physicians. I will gladly do my share to help a patient who is truly in dire straits. But if the problem is created by another doctor who knows beforehand that there's a high likelihood that he may need the services of an anesthesiologist during a procedure and doesn't request one before the start of a case, what are my obligations to help him out? Sadly, I just bite my tongue and assist anyway I can until the patient is safely in the recovery room. Because as an anesthesiologist I will never abandon a patient to heartless doctors.


  1. Damn, dude. I would've wanted to punch him in the mouth too! Seriously, what's up with these lame ass doctors treating us anesthesiologists this way? Yet sadly, I know of several doctors exactly like this too. I'm sure we're not the only ones either. I'm sure other anesthesiologists have had the same or similar experiences with other physicians.

    In a way, our colleague doctors are worse than CRNAs. CRNAs might not call us until the last minute, but that's usually due to ignorance, or perhaps because they have been brainwashed by the AANA to not heed our directions. However, our colleagues do this knowing full well how it all works, including what the consequences could be, and thus they can't blame ignorance or somehow being brainwashed.

    If we weren't so "heartless," then I'd almost want to let the doctor (e.g. gastroenterologist, cardiologist) live with the consequences of their actions or inactions (e.g. patient dies). But that'd be unfair to the patient. It's infuriating, but I don't know what we can realistically do, short of becoming a-holes like these doctors.

  2. People don't change. It is not hyperbole to state that the evil among us count on the good among us to do good. Sadly, we can count on them to do evil. Is it rash to call it evil? What if an anesthesiologist is truly unavailable when a crisis erupts? Or anesthesiologists do the moral and legal calculus you yourself do, and decide NOT to intervene when they are confronted with an unknown patient? Do we need a patient to die on the table to demonstrate that a preop anesthesia consult is "worth it?"
    From another angle, anesthesiologists shouldn't cynically be viewed as "good Samaritans" in the operating room. What if a surgeon doing a tummy tuck ran into trouble and needed a cardiac surgeon on the spot, all the while knowing that a preop eval showed that the patient needed a cardiac intervention first? How would THAT conversation go? We are all professionals deserving of respect.