I'm really considering anesthesiology as my specialty... BUT

[MedicalStudent8]

First off, let me say that I'm no where near residency yet, but I want be VERY prepared; that's just the kind of person I am, so please excuse my naive nature about the subject. I'm really considering anesthesiology as my specialty... BUT one of the things that I am very worried about is malpractice lawsuits. I read the other day that anesthesiology has one of the highest malpractice suit rates, and that worries me. Not that I'm going to make a mistake, but rather that if a patient has a bad reaction to the anesthesia, I will be held responsible (even though I did everything correctly and it was just their body chemistry that disagreed with it), since quite a few people have anesthesia problems. Is that a realistic fear or am I just being paranoid?

Also, to anyone who is currently doing anything (MSIII, MSIV, residency, etc.) in anesthesiology, how do you like it? Would you recommend it, or is it horrible? I've always had a strong interest in pharmacology, but didn't want to become a pharmacist because of the relative lack of patient interaction (at least in a treating sense), so anesthesiology has always appealed to me.

But anyway, thanks a lot for any help!

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[amyl]

hey -- anesthesiology is a great choice but not for everyone. malpractice is a problem for everyone but is worse for other specialties like OB. there is a lot of pharm but there is also a lot of physio so you gotta know that cold too. there is not much patient interaction in anesthesiology -- no long term relationships unless you do pain. i like the role anesthesiologists play in patient interaction but it is brief (while they are still awake ;-). try and shadow an anesthesiologist for a weekend or something...this is the best way to know if its for you. but i will caution you, anesthesiology is sometimes boring to watch but it is different when the responsibility is yours.

 

[MedicalStudent8]

Hey thanks for the quick reply!

there is not much patient interaction in anesthesiology -- no long term relationships unless you do pain.

That's fine by me (not to sound cruel or anything! )... I think that I am good at quickly calming a situation and anxious people, which I know often happens pre-operative. Also, although I really want to help people, I wouldn't really look to build the kind of relationships with patients like, say for example, a primary care physician would. Don't get me wrong, they are very talented and they have the patience of a saint, but I don't know if I could deal with some of the generalized, long-term care of crazy patients (much like myself and some of the absolutely insane and arbitrary phone calls I have made to my own PCP, God bless him, when I'm sure he's thinking "What on earth is it THIS time?!"!).

 

[InductionAgent]

I believe that anesthesiologists got sued less frequently than OBs or surgeons. However, if you are overly concerned about lawsuits, anesthesiology is not your specialty. While it is important to be conscientious and detail-oriented, anesthesiologists who are always practicing defensively run the risk of getting every lab test known to man before taking a patient to the OR. This creates delays that at best cause a huge waste in OR utilization, and at worst delay a necessary surgical intervention.

You often have to make quick decisions based on the best assimilation at the time of information available, your medical knowledge, and your clinical judgment. You simply won't have time to obtain more test results and do more reading in the heat of the moment. (Yes, you can send off blood samples, even call for an X-ray, but the information won't always be available before you have to make a decision.)

 

[MedicalStudent8]

I believe that anesthesiologists got sued less frequently than OBs or surgeons. However, if you are overly concerned about lawsuits, anesthesiology is not your specialty. While it is important to be conscientious and detail-oriented, anesthesiologists who are always practicing defensively run the risk of getting every lab test known to man before taking a patient to the OR. This creates delays that at best cause a huge waste in OR utilization, and at worst delay a necessary surgical intervention.

You often have to make quick decisions based on the best assimilation at the time of information available, your medical knowledge, and your clinical judgment. You simply won't have time to obtain more test results and do more reading in the heat of the moment. (Yes, you can send off blood samples, even call for an X-ray, but the information won't always be available before you have to make a decision.)

Very good point -- I don't think I would be worried about that (since in court it would 'hold up' to questioning since it is the proper thing to do and it is in the best interest of the patient), but I'm talking about how people are just sue-happy nowadays. If someone has a fatal reaction to one of the anesthetics, and you do everything you can to revive them but were unable to do so, is it common for the family to try to sue?

Also, just on a side note that really has nothing to do with this but it was something I was just pondering anyway... how do you know that a person is really funny unconscious and not in pain? I've heard stories (haven't we all), about how people were paralyzed but they could feel everything and hear what was going on. Sure you can follow the proper doses of medications per kg or however it is calculated, but what if for whatever reason it is not effective on them?

Thanks again so much!!

 

[InductionAgent]

Also, just on a side note that really has nothing to do with this but it was something I was just pondering anyway... how do you know that a person is really funny unconscious and not in pain? I've heard stories (haven't we all), about how people were paralyzed but they could feel everything and hear what was going on. Sure you can follow the proper doses of medications per kg or however it is calculated, but what if for whatever reason it is not effective on them?

Thanks again so much!!

Ask the patient about it later to see if they remember. And keep a playlist of all the songs you listened to, and ask them to recall one of them. If they can't remember any particular details, they could just be BSing you, because recall under anesthesia is all over the news these days. I have yet to have any patients claim to recall anything other than sometimes the induction.

Definitely a controversial topic as to preventing recall. The BIS monitor helps determine level of consciousness and gives some comfort in the area, but has yet to be verified concretely. The expiratory concentration of volatile anesthetic also is a good gauge of whether the patient is adequately anesthetized to prevent recall, although no firm level has been established. I am in the 0.5 MAC camp on this topic. The less volatile anesthetic the patient tolerates, the more Versed you give in hopes of ensuring amnesia. However, I don't care what anyone says, Versed drops a patient's BP, even if not as dramatically as volatile agent.

Previous to spectrometry or BIS monitors, anesthesiologists relied heavily on vital signs to titrate anesthesia. If a patient displayed tachypnea (during spontaneous ventilation), tachycardia or hypertension, they were too light and needed more. If a patient was hypotensive/brady and could not tolerate the anesthesia, then they backed down on the agent. This is still largely the way we do things today, after all hemodynamic stability is a major goal. Simply because a patient has stable (or low) hemodynamic values does not guarantee that they are not aware, but in general it's a reliable indicator. Some practitioners favor heavy anesthetic and more liberal use of vasopressors. I tend to believe that if I need a lot of vasopressor, I may have too much agent on board unless there is some obvious reason why the patient should be hypotensive (blood loss, cardiac failure); even if the latter is true, I still back down on the agent while I'm trying to correct things.

If you can weigh the sum total of what the vital signs are telling you, how much inhaled agent/Versed is on board, and BIS(if you're using it), you can be fairly confident of lack of recall. Then again, remember that "recall is better than no call at all." The most common fatal/debilitating reactions to anesthetics are not MH or anyphylaxis, they're by-products of the intended actions of the anesthetics, which are severe poisons to the neurologic, respiratory, and cardiovascular systems. Every time you induce anesthesia, you're placing the patient's life at risk if you're not able to appropriately manage their airway and address the hemodynamic effects of the medications.

 

[Goofyone]

Your worrying to much. I live in the midwest so i can only speak for this area but i know the physicians i work with told me their malpractice is something like 18K per year. To compare, a general surgeons in the same area is somewhere around 160K. And when anesthesia docs get sued, its usually over a chipped tooth or a tingling hand, not malignant hyperthermia. Think about it this way: our specialty is safe enough that staff leaves the room and lets newbie residents and CRNAs do most simple cases totally independently.

 

[Goofyone]

Oh, and true intraoperative awareness is actually rare.

 

[fakin' the funk]

I live in the midwest so i can only speak for this area but i know the physicians i work with told me their malpractice is something like 18K per year. To compare, a general surgeons in the same area is somewhere around 160K.

So you're telling me that the typical general surgeon spends over 50% of his/her salary on malpractice? No freaking way.

 

[OHMAN0125]

So you're telling me that the typical general surgeon spends over 50% of his/her salary on malpractice? No freaking way.

Generally the salary surveys report the earnings AFTER malpractice. So in other words the general surgeon would make 450K before malpractice.

 

[Ferdie]

First off, let me say that I'm no where near residency yet, but I want be VERY prepared; that's just the kind of person I am, so please excuse my naive nature about the subject. I'm really considering anesthesiology as my specialty... BUT one of the things that I am very worried about is malpractice lawsuits. I read the other day that anesthesiology has one of the highest malpractice suit rates, and that worries me. Not that I'm going to make a mistake, but rather that if a patient has a bad reaction to the anesthesia, I will be held responsible (even though I did everything correctly and it was just their body chemistry that disagreed with it), since quite a few people have anesthesia problems. Is that a realistic fear or am I just being paranoid?

Um, you will definitely make mistakes. Such is the nature of life. If you practice medicine long enough, $hit will happen, guaranteed. Hopefully it won't be disasterous, but you will have bad days in the OR...

 

[fakin' the funk]

Generally the salary surveys report the earnings AFTER malpractice. So in other words the general surgeon would make 450K before malpractice.

SHE-NAN-I-GANS

 

[coprolalia]

And when anesthesia docs get sued, its usually over a chipped tooth or a tingling hand, not malignant hyperthermia.

Actually, they usually address this in follow-up, apologize to the patient, pay for the referral to the dentist or neurologist, and the patient never sues. The practice digs into their pocket and foots the bill. It's much cheaper denying you did anything wrong, which is what usually starts the legal maneuvering.

-copro

 

[johankriek]

First off, let me say that I'm no where near residency yet, but I want be VERY prepared; that's just the kind of person I am, so please excuse my naive nature about the subject. I'm really considering anesthesiology as my specialty... BUT one of the things that I am very worried about is malpractice lawsuits. I read the other day that anesthesiology has one of the highest malpractice suit rates, and that worries me. Not that I'm going to make a mistake, but rather that if a patient has a bad reaction to the anesthesia, I will be held responsible (even though I did everything correctly and it was just their body chemistry that disagreed with it), since quite a few people have anesthesia problems. Is that a realistic fear or am I just being paranoid?

Also, to anyone who is currently doing anything (MSIII, MSIV, residency, etc.) in anesthesiology, how do you like it? Would you recommend it, or is it horrible? I've always had a strong interest in pharmacology, but didn't want to become a pharmacist because of the relative lack of patient interaction (at least in a treating sense), so anesthesiology has always appealed to me.

But anyway, thanks a lot for any help!

the problem with anesthesia is that many people can get you sued. The surgeon bringing a poorly worked up case and throws it on the schedule and its sitting in the holding area, someone else sees the patient and it ends up on the table while you are at lunch and you come back and theyy are waiting for you. .. Crnas can get you sued.. or nurses can get you sued.. Just many things can get you sued.. however in radiology and other specialties seemingly they are the sole ones that can be at fault in a malpractice suit. They have plenty of time to read the films,, and not that much real time pressure as we do constantly.