Is Anesthesia really that stressful???

[Hope2BnMD]

Hello all! I am a 3rd yr medical student and have been really leaning toward doing anesthesia. Only thing is, as a 3rd medical student i dont think we really know how stressful the field can get, since we are merely observers in the OR. While on my 3rd yr rotations, I have shadowed some anesthesiologists and everything seems pretty chill. I mean when things go wrong--is the anesthesiologist all alone?? Or can he get help from his colleagues? Does anyone quit the field b/c it gets too stressful?? Unfortunately as medical students we have to make a decision about a field, and really sometimes don't know what we're getting into--until we're 1 yr deep into a residency. I am trying my best to avoid this. thanks folks and congratulations to those who matched!

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[powermd]

The chairman of the department at my med school once said practicing anesthesiology is very easy now, but back when he got started it was "very interesting." He said that with a smirk that suggested stressful as hell! I think how stressed out you get will depend on your personality. A lot of things that I see other interns get stressed about don't bother me at all. Of course, I do get stressed, just about different things. Crashing patients don't stress me out, but getting loaded down with boring admissions and the ensuing paperwork, I do find stressful. Having to call 5 consults in the morning post-call and explain to all these people why then need to do work on my patient, I find stressful. It all depends on the individual.

 

[jetproppilot]

Hello Hope,
I concur (HA! Sounds like DeCaprio in Catch Me If You Can...DO YOU CONCUR DOCTOR?) with the previous post. First off, the further along one gets in residency, the more comfortable one is with procedures, decisions, urgent/emergent situations, etc. At least in theory. I remember a few of my attendings in residency that were easily freaked out by stuff, and others that were like Iceman on Topgun. The latter is what an anesthesiologist strives for; you are the one who has to deal with airway/hemodynamics etc gone awry, and if you freak out and lose your cool, everyone around you (if they're not freaking already) follows suit.
Your question about "can an anesthesiologist ask for help" is a good question, and the answer is ABSOLUTELY. I don't hesitate to ask one of my partners to step in for a minute if I'm having problems with something (rare, but it happens to me, and it will happen to you). Thats the benefit of a group practice.
I've been in practice 8 years now and still love my job. Clinical emergencies don't get me excited. The stresses of my job now are administrative- keeping on top of everyone to keep the or rolling, getting cases started on time, CRNA scheduling woes, blah blah blah.
There are so many pathways to take as an anesthesiologist that I've never heard of someone changing fields after residency because of stress. Don't like trauma/hearts etc? You can work at a surgery center putting healthy people to sleep all day.
Hope this helps.

Hello all! I am a 3rd yr medical student and have been really leaning toward doing anesthesia. Only thing is, as a 3rd medical student i dont think we really know how stressful the field can get, since we are merely observers in the OR. While on my 3rd yr rotations, I have shadowed some anesthesiologists and everything seems pretty chill. I mean when things go wrong--is the anesthesiologist all alone?? Or can he get help from his colleagues? Does anyone quit the field b/c it gets too stressful?? Unfortunately as medical students we have to make a decision about a field, and really sometimes don't know what we're getting into--until we're 1 yr deep into a residency. I am trying my best to avoid this. thanks folks and congratulations to those who matched!

 

[HomerSimpson]

Your chairman may think it was more interesting back then when the only monitors they had was a precordial stethescope and a bp cuff. However, today we operate on sicker people, so we have the potential for more complex problems.

The stress involves a couple of things in my opinion. First in anesthesiology things happen VERY quickly. Hopefully you will never see someone lacerate the IVC or a cerebral vein but it can turn a routine deal into a nightmare in a matter of seconds. Some people like myself keep bad events in the back of our minds almost supressing it. It keeps us cool most of the time. Others constantly think about it. The are your attendings that yell at people for the slightest things. Really the nervousness they feel comes from real life things that have happened to them.

Second, when cases go badly you are constantly on the move. Example: the lacerated IVC. This happened to me during my residency. Colon resection + lost of adhesions + Arrogant overconfident surgeon = IVC tear. Why bad? arteries can be repaired because they are intact structures that maintain their shape. Veins especially large veins collapse and just bleed.

This is what I and my attending and some help which arrived later had to do while the surgeons were desperately trying to control this.

1. crash cart in room
2. level one in room
3. O neg in room 8 units( patient was not typed and crossed)
4. 10 fr. sheath in the neck for volume
5. 8 Fr. Sheath in subclavian for PA catheter
6. Art line Brachial
7. Infuse blood through level one
8. turn off vapors
9. draw up epi


We had to do this in a matter of minutes.

By the way the patient after being coded a few times for air in the coronaries ended up surviving going to ICU spent about 3 weeks there and eventually died of a PE. Case started as a Partial colectomy and turned into that.

Third 99/100 times a case even like this would turn out routinely. therefore the stress comes not only in preforming under those cercumstances but also being ready to do all thos things at a moment's notice.

Fourth especially during residency you will find that surgeons, attending anesthesiologists, nurses (OR, CRNA's) will pressure you to help keep the schedule moving.

Therefore it takes a lot of skill, knowledge, foresight etc to be a god anesthesiologist. For those people who matched I congradulate you. You are going into something that is challenging. Don't let anyone tell you differesntly.

 

[ThinkFast007]

Hey guys, thanks for your posts! I'm an MSIII and I had some of the very same feelings as the originial poster.

But this is also a concern. What if (God forbid) a pt dies. And it turns out that it was an anesthesia problem. However, you did everything in your power/ability to resuscitate the pt and followed the appropriate 'protocol'. Could you still get sued (well I guess anyone can get sued but will they win the case?). Obviously a 'guilty' conscious is something one must learn to live with, but what are the legal ramifications?

Thanks again. And yes I know none of you all are JDs but a little insight would help

 

[jetproppilot]

Yes Thinkfast, unfortunately we live in a very litiginous society, and clinicians are sometimes sued even when they DIDNT do anything wrong.
The answer to your question, though, lies within the concept of standard of care. Standard of care refers to the level of care that should be delivered by clinicians in your specialty. Was the standard of care breached? Obvious examples of a breach of standard of care would be things like unrecognized esophageal intubation (which, with all our monitoring available today, would be hard to do), inappropriate management of hemodynamics, like resultant renal failure from persistent, untreated hypotension, etc. The lawyers ask themselves, how would a similarly trained clinician have handled this problem?
The problem with the system, however, is that there is a plethora of lawsuits filed by plaintiff attorneys, even when there is no real breach of standard of care. They can do this because of 2 reasons:
1) Malpractice companies will sometimes "settle out of court" for some monetary amount, with no admission of guilt. Remember that lawsuits are expensive to defend, even if the clinician did nothing wrong. Settling out of court is bad for the clinician when nothing was done wrong because it goes on your "record" and must be reported when you renew your malpractice insurance, and can lead to increased premiums or even denial of coverage.
2) There are "hired guns" (doctors) in every specialty, willing to testify to just about anything for the $500.00 per hour they charge.

This occurs in all specialties, not just anesthesia. One has to know the "style" of their malpractice company. Many reputable malpractice companies will not settle out of court if they are convinced nothing was done to breach the standard of care.

Our country is in dire need of tort reform to stop the needless lawsuits that leads to spiraling malpractice premiums, among other things.

Hey guys, thanks for your posts! I'm an MSIII and I had some of the very same feelings as the originial poster.

But this is also a concern. What if (God forbid) a pt dies. And it turns out that it was an anesthesia problem. However, you did everything in your power/ability to resuscitate the pt and followed the appropriate 'protocol'. Could you still get sued (well I guess anyone can get sued but will they win the case?). Obviously a 'guilty' conscious is something one must learn to live with, but what are the legal ramifications?

Thanks again. And yes I know none of you all are JDs but a little insight would help

 

[HomerSimpson]

Good question. Let me just tell you that I am a practicing anesthesiologist. About 3 years out.

There are 4 things you need for a case in most states to constitute malpractice.
1. Doctor patient relationship(Duty)
2. Reasonable(not excellent) standard of care
3. Proximate Cause
4. Permanent or long term damages

All people taking part in the care of the patient are liable for actions performed in there. In other words lets say the patient has an iodine allergy and the OR nurse overlooks it when he preps and the patient ends up with a permanent injury. Guess what you will be liable. That case I described in my previous post, you will be liable at least partially even though it was the surgeon who caused the injury. Why you may ask?

Malpractice cases are almost never about obtaining any kind of justice or punishing a doctor. It is about $$money$$. Therefor, the approach most plaintive attorneys take is to sue anyone and everyone involved in the case. Even the med student who might have just stuck his head in for 20 min to see what was going on will usually be named. They usually won't follow through because again they usualy have no money. One of my collegues was sued for something that happened about 12 hours after the case. He was not contacted or even in the building when the event happened. Why? because he does have money. He was dropped from the case but after 8 years 12 depositions. Think about money lost from not doing cases and personal lawyer fees inc malpractice insurance.

Therefore being a control freak often helps you in the long run in the OR.

My fees this past year were about $10K for $1/$2 mil. I've never been sued (knock on wood)

The last thing I wanted to say is that most cases these days defendent Doctors do not settle. Especially in questionable cases. Reason is that settling only 1) encourages more suits (by enterprising plaintive attorneys) 2) raises insurance rates. because your defending lawyers will be hired by your malpractice insurance carrier they will not settle easily. This makes cases last typically for many years.

Additional info: most common type of event causing suits according to ASA closed claims study is bovie burns.

Most states have passed reform laws that limit non-economic damages to a ceiling. economic damages are funds lost from potential earnings. non-economic damages are pain and suffering defined by the courts usually. This is a good thing.

This is of course the case of all doctors not just us.

Most people who practice good safe medicine will not have to deal with this all that much. So good luck and be careful out there.

Sorry for the long post

 

[ThinkFast007]

Thanks Drs JetPro and Homer

Your posts put some insight into a topic that's not to often referred to in this forum. It's great to always be aware of these things as a MSIII.

Later

 

[seattledoc]

The last thing I wanted to say is that most cases these days defendent Doctors do not settle. Especially in questionable cases. Reason is that settling only 1) encourages more suits (by enterprising plaintive attorneys) 2) raises insurance rates. because your defending lawyers will be hired by your malpractice insurance carrier they will not settle easily. This makes cases last typically for many years.


I'm interested to hear where this information is from. My understanding is that the large majority of cases don't ever get to court, i.e., they're settled.

 

[GeddyLee]

Good question. Let me just tell you that I am a practicing anesthesiologist. About 3 years out.

There are 4 things you need for a case in most states to constitute malpractice.
1. Doctor patient relationship(Duty)
2. Reasonable(not excellent) standard of care
3. Proximate Cause
4. Permanent or long term damages
:

Unfortunately, a particularly sympathetic jury can make short work of this list and award large sums of cash to patients even when the standard of care was reasonable. In talking with malpractice attorneys, this is the meat of the case, the part that the fighting in court will be over. Unfortunately, jury's aren't always so objective, nor so intelligent, as to determine whether or not standard of care was met.

 

[Goober]

I think the reason that many physicians don't want to settle these days is that your name goes into the National Practioner Data Bank if you settle a case or lose a case. Once you get your name in there, it will come up on any Hospital or insurance credentialling search. It could adversely affect your ability to work.

One of my colleagues was recently in a lawsuit. The plantiff's attorney basically would not allow anybody who was educated on the jury. Fortunately the expert witness was thoroughly discredited so he was able to win the case- 5 years, a bunch of depositions and a trial later.

 

[HomerSimpson]

It is amazing how little control you have over your own case and your own name when you are named in a suit. This is because your name is not important to the insurance company which might lose thousands or millions of dollars because of the event. If you ask an attorney they will say that it depends on the event and the persons involved. What I meant to say in my previous post is that most cases were eventually settled out of court 10-20 years ago. Today the awards have become so great that it is more cost effective to fight the case especially if there is a chance to win. In my state the TMLT is a large insurance carrier. They boast that they win about 85% of the time. As far as deciding the reasonable-ness of the care provided that is where your experts come in. Experts are there to determine if the care was reasonable or not. You are correct that most cases are fought here. This is why expert witnesses for the plaintiff makes $500-1500/hour.

By the way you are the defendent so if it so disadvantageous to choose a jury then why do most defendent lawyers choose a trial by jury instead of a trial by judge? Reason is that first there is more of a chance of contention in the jury room rather than one guy(the judge and educated man by the way) thinking for himself. No matter how uneducated the jury seems most people take the job seriously. Defendent lawyers who I have spoken with all tell me that jurors tend to side with the physicians and not the plaintiff patients. Take that for what it's worth.

All I can say is that bad things happen in hospitals every day at no fault of the doctors nurses or staff.

I have a few rules to protect myself.

1. Income protection(incorporate etc)
2. Document meticulously
3. Provide excellent care
4. Educate yourself on the process.

later

 

[gaslord]

Has there been any attempt to hold the prosecution liable for the defendant's (doctor or insurance co) legal fees? I'm sure that would help decrease the amount of lawyers/pts suing to try and make a quick buck.

 

[Justin4563]

Hey homer why would you even bother putting a swan in for a lacerated IVC Just put in as many big lines as possible.. get the janitor et al to squeeze the ball so blood gets in fast... FOrget the swan.. DOnt mention that on your boards.. wont help you

 

[Yoz1711]

I'm applying to anesthesia this year and currently doing a rotation at my home institution. A few of the 2nd year residents are quitting the program due to the stress. As a medical student, we don't really get exposure to the stress nor do we feel it because it's we have a resident and attending there to support us.
Can some current residents or attendings comment and give some advice about the stress?
I like anesthesia but the comments by the residents at my home institution worry me. I was under the impression is that anesthesia is stressful but with more experience and knowledge it becomes more manageable. I don't want to become a Ca-1 and feel the same way these residents feel.

 

[caligas]

Has there been any attempt to hold the prosecution liable for the defendant's (doctor or insurance co) legal fees? I'm sure that would help decrease the amount of lawyers/pts suing to try and make a quick buck.

That would require new legislation or a countersuit, which is difficult. See:

http://www.haciendapub.com/medicalsentinel/fighting-fire-fire-physician-countersuits

 

[Mad Jack]

That would require new legislation or a countersuit, which is difficult. See:

http://www.haciendapub.com/medicalsentinel/fighting-fire-fire-physician-countersuits

Considering that he was last seen 6 years ago and only had 18 posts, I think it's safe to say he'll never receive your reply.

 

[IlDestriero]

What's up with all the Lazarus posts lately?