focusing on making surgeons happy is a slippery slope that leads to bad patient care.
agree 100%. patient care comes first always, as often we are the only advocates for a patient in the perioperative world. h0wever it does lead to an interesting discussion.
the rest of this post isn't really for you
@FFP - you're already an attending and and likely agree with at least some of the following. or, you don't, and that's fine also. this is more for the residents and medical students:
my order of things:
1. patient care
2. making the surgeons happy
3. everything else
i try to never forget that we are in a service industry.
they see the patient in clinic 1-2 times. see them in preop. operate on them. see them POD#0,1,2 to whatever day they are discharged. see them at one week. one month. one year. again for a different surgery. and so on.
we are there for 10% or less of the patient's overall surgical experience. so as long as whatever the surgeon is asking for does not harm the patient, i say "sure."
"sure, i can raise the MAP a little" (whether or not Ii turn the gas down, give some pressor, give fluid, or just move the stupid transducer is up to me)
"oh, he's getting a little light? sure, i'll deepen him" (whether or not i actually deepen him is up to me)
"seems tight to you? sure, i'll make sure he's fully relaxed" (usually i just push saline, but they THINK i'm doing something. i sometimes also even say "guys, give it a minute while the relaxant works." and then wait and do nothing. and then 3 minutes later "is it better?" the answer 100% of the time is "yeah it's so much better!!!")
"want vanco instead of ancef? sure."
"sure, i can put in a TLC after the case"
"want an epidural? sure"
"don't want an epidural? sure"
"want general? sure"
"want MAC? sure"
"raise the table? lower the table? raise the table? lower the table? raise the table? lower the table? sure"
if you say "sure" 95% of the time, then, that other 5%, when it REALLY matters and you say "ABSOLUTELY NOT", the surgeon thinks "wow, he always says 'sure' and now he is saying 'ABSOLUTELY NOT'- maybe i should listen to him." and they usually do.
i generally only fight battles when i believe in the issue strongly enough to die on that hill.
a couple of the anesthesia residency programs that i have worked at train their residents essentially the opposite of this - to be aggressive, argue, and fight everything the surgeon wants - "the surgeon doesn't know anything, we know better" - which is then supposed to lead to better patient care.
i find my method of being deferential results in an exponentially more pleasant work environment and a better relationship with my surgical colleagues - which I believe results in better patient care overall. will this work at every hospital with every group of surgeons in every situation? of course not. but in my practice it works wonderfully, and myself and my colleagues generally act in this manner.
