Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]
If young teenagers can embrace activism and say #Enough by engaging in the political conversation, doctors can, too
Check out @ASAGrassroots’s Tweet: https://twitter.com/ASAGrassroots/status/981951115062337536?s=09
#NewYork budget excluded provision that would have undermined physician-led anesthesia care, opposed by @ASALifeline & @NYSSApga. #THANKYOU to New York lawmakers for protecting patient safety. #SafeAnesthesia4NY
I was shocked to see that the NHS could ban surgery for the obese and smokers. That’s socialized medicine. You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare. But in a way, it’s empowering patients to take responsibility for their own health. Smoking, for sure — I agree 100% that surgery should be banned for this population. Obesity is a bit trickier — there’s genetics and environmental factors at play in this one. I don’t think anyone chooses to be obese. But, people do have the power to change their eating and exercise habits. Despite these efforts, there are some people who are still obese…. and these people should not be faulted.
Why single out the obese and smokers?
Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.
I think the NHS is on to something here. They’re opening doors to moving the liability and responsibility away from physicians and towards patients. This is a plus. Outsiders may see it as separatism and elitist to only provide care for people who are healthy. But look at the facts and the data…. obesity has a lot of co-morbidities associated. Smoking has a lot of co-morbidities associated as well. Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough? In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness. With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health. I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation. It’s not easy, but my health is 100% my responsibility. I refuse to pass the buck to my husband, my family, my physician, etc. I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.
Patients need to change their mindset re: health. It is not your spouse’s responsibility to track your meds. It is your responsibility to know your medical conditions and surgical history. The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery. This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care. Please do not forget recreational drugs, smoking habit, and drinking habit in this list. It is very important to know all of these things. Also, your emotional history is very important. Depression, anxiety, failure to cope, etc. This all helps tie in your current living situation with stressors and your medical history.
Links for educating yourself in taking responsibility for your health:
- Patients Should Share Accountability for Own Health — A new report recommends doctors not be penalized for poor outcomes if patients fail to follow recommended protocols
- Getting patients to take responsibility for their own health
- Responsibility, fairness and rationing in health care.
- What the Health documentary
Work-life balance and taking care of yourself #anes17 #meded #stress #medicine #burnout #administrators
The ASA 2017 had an interesting self-study module called Physician Wellness Beyond the Usual Suspects. It was a great learning tool to focus on the importance of the anesthesiologist to consider their own stress levels and seeing how to best mitigate the issues that could be problematic.
Check out these great articles from that self-study module:
- Time in the bank: A Stanford plan to save doctors from burnout
- Holmes and Rahe stress scale
- Suffering in silence: a qualitative study of second victims of adverse events
- On the Road to Professionalism
- Understand your own stress levels.
- Make changes: speak to your staff, your administrators, your hospital to see what’s available to help you cope
- Get help
- Sometimes you can’t fix everything… and ultimately that’s ok.
“It is obvious that we can no more explain a passion to a person who has never experienced it than we can explain light to the blind.”
-T. S. Eliot
Dr. Atul Gawande: What are the outcomes that matter? From A Penned Point #ASA2017 #MedEd
The real surprise – to me, at least – came more than halfway through Dr. Atul Gawande’s keynote address at the opening session of the American Society of Anesthesiologists’ annual meeting in Boston. Much of his talk on October 21 celebrated the virtues of checklists and teamwork, topics that have turned into best-selling books for the…
Why is this even a debate?
It seems to me that the CRNA-led debate is financial… once you tease through all the fluff.
So here’s some literature I found:
- Evidence-based review did NOT find nurse anesthetists’ care equal to that of physician anesthesiologists
- Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety
- Anesthesiologist Direction and Patient Outcomes
- Is Physician Anesthesia Cost-Effective?
- I chose not to include biased studies where sick patients were not compared as well as morbidity and mortality.
As an anesthesiologist, I work in an MD-only anesthesia group. This is by choice: I prefer doing my own cases and being responsible for my own liabilities. The times I have required an anesthetic, I have requested a physician anesthesiologist. As a resident, I had very good insurance coverage, so I wanted a physician for my surgery. At that time, I was ok with having a resident anesthesiologist paired with an attending anesthesiologist for my case. My second surgery was done at my current hospital, and we only have MD anesthesiologists. Perhaps I’m biased? I know and I understand the path/journey/training it takes to get to become a physician anesthesiologist. I want someone who is well-trained, independently thinks, vigilant, and knowledgeable.
I’m sure there are great CRNAs out there… but when I was a resident… we used to supervise CRNAs in our final training year…. and it was scary some of things they would do. Who extubates from a trach R&R on 30% FiO2? Yeah, that particular CRNA told me they had 30 years experience. 30 years experience of doing something wrong doesn’t equate to 30 years of knowledgeable experience. And let’s not forget that CRNAs need a 15 minute morning break, 30 minute lunch break, and 15 minute afternoon break and they go home when their “shift” ends (even if it’s in the middle of a complex case). I take a break when I can… I eat lunch and take a bathroom break when I can…. and I choose to stay and finish complex cases for better continuity of care.
Would you want a nurse practitioner or physician assistant solely performing your surgery without a surgeon? I know I would NOT. I think there’s plenty of room for teamwork in healthcare. This is how to improve hospital efficiency and patient care. My fear is if CRNAs gain independence for purely financial reasons. But then, they will have to carry their own liability, cover their own breaks, take night call and discover that they had it so good in a healthcare team.
Opinions from other physician anesthesiologists:
- Proof that CRNAs don’t care about patient access to anesthesia
- Numbers don’t lie: Anesthesiologists are more qualified than CRNAs
- Doctor by your side: Get the Facts
- How MD anesthesiologists have become victims of their own excellence
- CSA legal analysis: Unauthorized opt-out of Medicare requirement
- Karen Sibert MD: Nurse anesthesia supervision and online opinion
- Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety
- CSA: Role of a physician anesthesiologist
- ASA: Patients demand physicians provide anesthesia care
- Primer on the anesthesia care team model
- Physician-led anesthesia is safe anesthesia
- ASA: Doctors and nurses are simply not one and the same
- Independent nurse practitioners are not the primary care solution
Bottom line in my opinion:
- Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training specifically in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
- Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school. The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
- I will continue to be FOR team-based physician-led anesthesia care.