A Message for all and a Farewell to all

UTSouthwestern said:

Well you know that the smackdown is coming if I post a reply:

I find it more than a little irritating that anesthesiologists seem to complain about respect issues, lifestyle, pay, nurses, etc. and just stew over it.

I have been in practice six years, do every kind of case known to man, 100% solo/no supervision, work hard but play hard, and only twice can I recall being disrespected/questioned in that time.

Both times, by nurses, a quick, educational, and authoritative response quelled any further insubordination. Surgeons, nurses, and administrators know that when I say something, request something, order something, do something, it has a legitimate purpose and MUST be done. It is a confidence they have in my judgement and more importantly, my compassion.

Conversely, I am told regularly about how some anesthesiologists have little to no ability to make a firm decision, bounce back and forth between totally opposite treatments/decisions, speak/act like scared mice, rush out of the PACU or ICU to make a haircut appointment, talk about anything EXCEPT medicine or THEIR patient, etc.

With that backdrop, it becomes increasingly difficult to keep the lines distinguished.

These are YOUR patients, not just the surgeon's. Take ownership of your patients, your situation, your facility, and be heard. Too many expect that M.D. or D.O. acronyms on their badges will instantly afford respect or authority. With Hollywood medical vomitus on TV and in the movies creating an overgeneralized image of the lazy, incompetent, vain, self-centered, dangerous physician, the deck is stacked against you.

Don't jump up and down on the down side of an overloaded ship, throw the baggage overboard.

Get involved in every phase of every case you do. The more you do that, the faster and easier it becomes and the more indispensible you become. "Dr. CT surgeon, I spoke with your AVR, redo CABG patient last night and he has worsening cervical stenosis with OPLL diagnosed over a year ago. I am recommending full neuromonitoring for this case and will consult with his neurosurgeon on post-op followup and care." In the ICU give a full report and direct the care. "This patient requires Q 4h neurochecks including full upper and lower extremity range of motion and strength exams." Do the first one yourself.

When you walk into an OR, or PACU, or preop holding area, or ICU, your presence should be anxiolytic, not anxiogenic. You can see and hear the difference when different anesthesiologists walk in. We need to make a concerted effort across the specialty to change the attitude of and towards the specialty.

It starts with the medical students. I cannot tell you how many PM's and e-mails I still get from this forum from med students with subpar grades and docile personalities, looking for the high pay, easy lifestyle, no stress field. I no longer respond to those students, because this field does not need foot soldiers. It needs leaders and visionaries to push the boundaries of the field and take ownership of our future. It doesn't need fearmongers, supporting cast members, or the spineless.

Work in a hostile environment? Defuse it. Find out what the issues are and tackle them head on. Do it with zeal, a positive, helpful attitude, but most of all with authority. As I have said multiple times in the past, you have to get involved from the top down to understand and develop all facets of your practice and your facilities. That means spending some off time in administration and rooting out problems before they start to fester. I spend a large portion of my free time in administrative meetings both teaching and learning from administrators about issues they may not even have considered.

Cost considerations are always a concern. This group will do it cheaper, this group uses CRNA's, this group will come out to location X, etc. I have been asked to change my practice by facilities before and each time, I have clearly delineated the pros and cons and emphasized the depth and experience of my group to administrators. I am more than willing to take those assets and develop your competitor. That happened again and two months ago, I was reapproached by the facility I left to come back and resume our practice there. I declined. When they sweetened the deal, I accepted with stipulations.

In the future, we need to develop physician specific, core business concepts that will provide reproducible, sustainable models in all situations. The "cheaper is not better" approach combined with sustainable revenues and proven outcomes starts with the ASA and legislative efforts. It is a comprehensive model that can be used to not only sustain our presence but also redefine our roles as providers, leaders, and business developers.

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UTSouthwestern said:

Good Sunday afternoon to all of my friends and acquaintances on SDN.

I have been debating on whether or not to post this information but in light of several posts I have recently seen on the site, I feel that I can contribute to the ideas and thoughts of those of you in training and those of you still young to the private and academic practice worlds.

This past Wednesday at the ripe old age of 40, I was diagnosed with stage IV invasive adenocarcinoma of the lung. Don't smoke, don't drink except socially, never did drugs. Wouldn't have found it had I not gotten pneumonia from my brother. A big curveball on the road of life thrown at me at just the wrong time. Some tears and some down feelings, before my wife and my friends and family threw their support behind me and I kicked myself in the tail to remind myself I'm not dead yet. Close, but not yet.

No overt signs or symptoms over the past 2-3 years (which is the estimate of how long I have had this). Over the last year, some fatigue, but as busy as I am, not something out of the ordinary, and considering I worked out 7 days a week including an hour of cardio every day, well within acceptable tolerances. No weight loss and in fact have gained 10 pounds.

In writing this post, I want to first of all tell everyone, ENJOY LIFE!!! No one goes to their grave wishing they had worked a few more days. I can tell you that having taken this past week off, even something as simple as walking with my wife to a coffee shop (my first caffeine in almost 16 months) during the morning hours with the wind rustling the leaves of the red oaks of our neighborhood, I felt like I had missed out on so much, if even something as mundane as this moved me so much. That doesn't even begin to touch on the times and events I missed with my kids as I drove myself to exhaustion on a day to day basis with work, side businesses, politics, administration, etc.

I am not saying drop everything you are doing and never come back but take time off consistently to enjoy the day to day activities that we as type A professionals tend to forsake for our careers. You will feel better for doing it and you will have more energy to tackle those seemingly insurmountable tasks you have piled up for your work days.

Secondly, don't ignore symptoms. Don't treat yourself without finding out for sure what you are currently experiencing. While I had no symptoms, I did get checked out regularly with my internist, have already had an EGD, colonoscopy, CT scan, X-rays, and lab work done and this still managed to sneak in. That being said, it is still better to be consistent and thorough to pick up more obvious ailments.

Make sure you have good life and disability insurance. That was a topic recently brought up and as a just turned 40 year old now with a much shorter than expected shelf life, I can tell you that the anxiety of wondering what will happen to my family far outweighs any anxiety I have about my condition. I do not fear death. Never have. I fear uncertainty for my family more than anything else. Of course, I just recently terminated a life insurance policy in preparation for changing to another. Now out of both.

Save, SAVE, S A V E! Investments, gambling, stocks, fast cars, big houses, etc. all are fast ways to keeping you poor in the short term and likely unprepared for just such an event. I was balanced but if I had to do it over again, I would have put just a bit more into savings than into risky situations and cars. Of course, that was when I was younger and invincible. Having a war chest of funds safely tucked away in whatever non-depreciating savings form you desire will give you the peace of mind to live comfortably and to be prepared for life's unexpected lightning bolts.

I will certainly miss the wonderful discussions we have seen over the past 8 years and I regret that I have met so few of you face to face to put a proper name and image to the screen name. Maintain the integrity of this board and help each other as we have all seen many people do over the past 8 years that I have been privileged to be a part of.

May all of your lives be filled with happiness and joy and may we all one day see an end to the strife, conflicts, and wars we so readily relegate ourselves to, on Earth or in Heaven.

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UTSouthwestern said:

I am starting a blog to chronicle my time remaining and to offer advice and hopefully inspiration for anyone enduring this situation or just for the curious.

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