Is this it?

[fungus]

Where do I start? Im a CA-2 resident and Im starting to get fed up with the way we are treated by surgical staff and surgical residents. Does no one in anesthesiology have a back bone? Today I was taking s@#$ from an ophthomologist who DEMANDED (not asked) that remove EKG patches from my patient before taking them to recovery. I didnt know ophthomologists were also trained as anesthesiologists! I mean, what the hell does he know about the heart, or the body in general for that matter? But honestly, that's beside the point. I dont see why no one in anesthesia (attendings included) sticks up for themselves and why no one is willing to fight for our dignity. Despite the fact that I was seething with anger, I thought it wise to keep my mouth shut. As a resident, you have no clout and any insubordination can get you fired. But our attendings, they too bow down to the surgeons! Sure we have to work with them, but we are also trained M.D.s, not lap dogs. What do you call someone that takes orders from a physician...a NURSE. Unless we are trying to prove that CRNAs are just as capable as MAs, we need to start showing these people that we have our own minds. What's worse is that when the surgeons and surgical residents see us being treated poorly by our own staff, they continue to think its okay for them to do the same. This ultimately just propagates the unnecessary and unwarranted behavior I've seen in the OR.

My biggest question is if this will continue in private practice? Sometimes I wonder if I just dont have the personality for anesthesia. Im not servile; Im not obsequious. After discussing today's problem with fellow residents, most of them were just like, "whatever." In the short term that definitely helps to keep an anesthesia resident sane, but I am not the type to spend the rest of my career whoring myself to these ungrateful losers.

I hope someone out there can provide some valuble insight and wisdom to my predicament. A big part of me thinks that I might have to get out of anesthesia after residency. Im not trying to say Im an ego manic or that I need to constantly have my ego stroked like our "colleagues" on the other side of the curtain, but I also refuse to take this kind of crap for the rest of my career.

fungus

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[toughlife]

Where do I start? Im a CA-2 resident and Im starting to get fed up with the way we are treated by surgical staff and surgical residents. Does no one in anesthesiology have a back bone? Today I was taking s@#$ from an ophthomologist who DEMANDED (not asked) that remove EKG patches from my patient before taking them to recovery. I didnt know ophthomologists were also trained as anesthesiologists! I mean, what the hell does he know about the heart, or the body in general for that matter? But honestly, that's beside the point. I dont see why no one in anesthesia (attendings included) sticks up for themselves and why no one is willing to fight for our dignity. Despite the fact that I was seething with anger, I thought it wise to keep my mouth shut. As a resident, you have no clout and any insubordination can get you fired. But our attendings, they too bow down to the surgeons! Sure we have to work with them, but we are also trained M.D.s, not lap dogs. What do you call someone that takes orders from a physician...a NURSE. Unless we are trying to prove that CRNAs are just as capable as MAs, we need to start showing these people that we have our own minds. What's worse is that when the surgeons and surgical residents see us being treated poorly by our own staff, they continue to think its okay for them to do the same. This ultimately just propagates the unnecessary and unwarranted behavior I've seen in the OR.

My biggest question is if this will continue in private practice? Sometimes I wonder if I just dont have the personality for anesthesia. Im not servile; Im not obsequious. After discussing today's problem with fellow residents, most of them were just like, "whatever." In the short term that definitely helps to keep an anesthesia resident sane, but I am not the type to spend the rest of my career whoring myself to these ungrateful losers.

I hope someone out there can provide some valuble insight and wisdom to my predicament. A big part of me thinks that I might have to get out of anesthesia after residency. Im not trying to say Im an ego manic or that I need to constantly have my ego stroked like our "colleagues" on the other side of the curtain, but I also refuse to take this kind of crap for the rest of my career.

fungus

The best way to fight this is to always have an answer for why you want to do things. Always make it about the patient. That's how I fend off surgeons.

In your case "Patient needs ekg pads because he/she needs to be monitored until he leaves the pacu. That's stardard of care" and keep pushing the patient out of the or and don't stop. You are there to take care of the patient not of surgeon and I always make that clear to them when they have BS requests.

Some people say to be friendly to the surgeon but I never do that. I am there to work and do a good job for the patient not to make friends. I mostly ignore them and unless they have a question for me, I never waste my time talking to them. I rather pay attention to what is going on with the patient and preparing for the next cases.

One of my petpeeves is when some unknown freak comes and stands in my work area to look over the curtain. Unless it is a med student or someone affiliated with anesthesia, I ask them to move and to go elsewhere. Had a nunch of surgeons watching a procedure the other day and one came and stood between me and the patient and I told him to take a hike. He didn't like it but I didn't care. I told him I need full access to the patient at all times and he was interfering with my care of the patient. It works.

 

[CremeSickle]

The reason you see anesthesia take crap from surgeons is b/c pts come to the hospital for surgery not anesthesia. Ergo, the hospital makes money b/c of surgeons. It takes little from a big income creating surgeon to get anyone else fired.

Its not worth your time to argue just do what they as unless it compromises care.

 

[gas87]

The best way to deal with behavior that you don't like is to respond as minimally as possible while still dealing with the patient care issues. The surgeon is probably getting off on making other people miserable. If you don't act upset, he won't get his desired response, and his behavior will eventually extinguish.
It would be great if doctors (in general) and anesthesiologists were more respected nowdays. Unfortunately, we're not. I would suggest boosting your self esteem by reminding yourself that you are the real professional, because you're proud of your own actions and attitude regardless of whatever **** is going on around you.

 

[Arch Guillotti]

One of my petpeeves is when some unknown freak comes and stands in my work area to look over the curtain. Unless it is a med student or someone affiliated with anesthesia, I ask them to move and to go elsewhere. Had a nunch of surgeons watching a procedure the other day and one came and stood between me and the patient and I told him to take a hike. He didn't like it but I didn't care. I told him I need full access to the patient at all times and he was interfering with my care of the patient. It works.

I hate those freaks too.

 

[bluewater]

First of all- I earn the respect of the guys on the other side, because I bust my butt and do a good job.

But I assure you, they will know who runs the room if they come across the curtain with a bad attitude when I am doing the case (residents or attendings, but you damn sure better be able to back it up when you get called on a decision that is counter to the surgeons opinion.) This may not fly in private practice. But it works well now. I make sure I am the dominant personality in the OR by the way I carry myself.

PS- this likely will not work as a CA 1.

 

[jetproppilot]

Where do I start? Im a CA-2 resident and Im starting to get fed up with the way we are treated by surgical staff and surgical residents. Does no one in anesthesiology have a back bone? Today I was taking s@#$ from an ophthomologist who DEMANDED (not asked) that remove EKG patches from my patient before taking them to recovery. I didnt know ophthomologists were also trained as anesthesiologists! I mean, what the hell does he know about the heart, or the body in general for that matter? But honestly, that's beside the point. I dont see why no one in anesthesia (attendings included) sticks up for themselves and why no one is willing to fight for our dignity. Despite the fact that I was seething with anger, I thought it wise to keep my mouth shut. As a resident, you have no clout and any insubordination can get you fired. But our attendings, they too bow down to the surgeons! Sure we have to work with them, but we are also trained M.D.s, not lap dogs. What do you call someone that takes orders from a physician...a NURSE. Unless we are trying to prove that CRNAs are just as capable as MAs, we need to start showing these people that we have our own minds. What's worse is that when the surgeons and surgical residents see us being treated poorly by our own staff, they continue to think its okay for them to do the same. This ultimately just propagates the unnecessary and unwarranted behavior I've seen in the OR.

My biggest question is if this will continue in private practice? Sometimes I wonder if I just dont have the personality for anesthesia. Im not servile; Im not obsequious. After discussing today's problem with fellow residents, most of them were just like, "whatever." In the short term that definitely helps to keep an anesthesia resident sane, but I am not the type to spend the rest of my career whoring myself to these ungrateful losers.

I hope someone out there can provide some valuble insight and wisdom to my predicament. A big part of me thinks that I might have to get out of anesthesia after residency. Im not trying to say Im an ego manic or that I need to constantly have my ego stroked like our "colleagues" on the other side of the curtain, but I also refuse to take this kind of crap for the rest of my career.

fungus

What you endured is uncalled for. Pick your battles for sure, but I wouldda said something to the dude. Something harmless, like as you're rolling outta the room ignoring his demand:

"You must be kidding."

Then roll to the PACU.

That eye-guy needs an old fashion redneck ass wipping. What a jerk.

 

[UTSouthwestern]

For the most part, it doesn't continue in private practice. It isn't as easy to maintain an attitude like the one mentioned above without putting yourself into a deep hole. I have seen guys struggle to get coverage because they run off every anesthesiologist they work with, then complain that they can't get coverage. No one wants to work with them, doctors or nurses. It becomes an eye opening experience for them. People with that kind of attitude tend to have it permeate all of their interactions with other people and that leads to an undesirable surgeon that can become a liability to the hospital. I have seen and heard of surgeons getting kicked off staff simply because no one (fellow surgeons, nurses, anesthesiologists, clerks, pharmacists, etc.) could stand to work with or for them. One guy I met and covered thankfully only once, was on his fourth STATE, not to mention his tenth hospital or practice in his career.

Removing EKG pads prior to going to the PACU is just ******ed. They will get a fresh set placed and will now have twice the number of marks on their body after the second set is removed

I had a similar experience as above with an ophthamologist who called a patient an emergency on a Friday afternoon because his CRNA called in sick. He used the ER call list, which I was up for that day. After I arrived, I learned of the circumstances and that in fact it was not a true ophthamologic emergency (open globe, penetrating trauma, etc.) but in fact an elective procedure he wanted to clear out before going on vacation the next week.

Because the patient was already in the room and prepped, I agreed to do the case. During the case, I relentlessly pointed out the facts behind why he could not find consistent coverage and had to use the staff CRNA (who hated his guts by the way), promised to punish him for improper use of an emergency call list, and promised to bill him for the added charges that the patient's insurance company was sure to deny based on a false classification of a procedure as emergent (vitrectomy - which took two hours as well).

You are there to be a patient advocate and guardian, not a doormat. The person who mentioned above that he/she projects the dominant personality of the OR in order to maintain order is correct. You do not and should not be more arrogant than anyone else in the room. You should be a central figure in the room that directs and maintains the flow of the room. If someone is stepping out of line, I put them back in line and make sure that they understand that it isn't personal, it's for the safety of the patient and for the sake of expediency.

As a resident, it is a more difficult task, however, projecting an air of appropriate confidence and knowledge of the procedure, pre and post op issues associated with the procedure and the patient's comorbidities, and all aspects of anesthetic care. Showing your concern for the patient to even the most minute detail is what all physicians are trained to do. If someone doesn't understand that, it is your job to remind them of that.

If a surgeon or surgical resident disrespects you, I will be honest, it would be hard for me not to give it right back and I was fortunate that I only had to do that a few times during residency, but the best option is remaining calm, LOOKING THE INDIVIDUAL UNWAVERINGLY IN THE EYE, and stating why you will or will not do something unsafe. I show interest in the case at all times, know my patients backwards and forwards, and have a clear plan in mind at all times. I also preemptively question the surgeon and residents on critical points of the procedure and I try to keep the atmosphere as light as possible without compromising the focus of the room. You have an opportunity to show your strengths as well as make connections with possible future sources of business. Don't let stressful situations turn you into jaded, resentful individuals. This is residency. Look ahead. Learn all that you can and take advantage of being able to practice medicine under a free license. If nothing else, bad experiences with your surgical colleagues in residency should be an opportunity for you to learn to maintain your sense of self, your inner peace, and ability to manage stressful situations. Getting upset, stressed out, etc. only leads to personal health and psychiatric problems and future problems in dealing with adverse situations.

Be the Yoda of your room.

 

[coprolalia]

Man, awesome post UT. Use the force, young Jedis.

-copro

 

[toughlife]

For the most part, it doesn't continue in private practice. It isn't as easy to maintain an attitude like the one mentioned above without putting yourself into a deep hole. I have seen guys struggle to get coverage because they run off every anesthesiologist they work with, then complain that they can't get coverage. No one wants to work with them, doctors or nurses. It becomes an eye opening experience for them. People with that kind of attitude tend to have it permeate all of their interactions with other people and that leads to an undesirable surgeon that can become a liability to the hospital. I have seen and heard of surgeons getting kicked off staff simply because no one (fellow surgeons, nurses, anesthesiologists, clerks, pharmacists, etc.) could stand to work with or for them. One guy I met and covered thankfully only once, was on his fourth STATE, not to mention his tenth hospital or practice in his career.

Removing EKG pads prior to going to the PACU is just ******ed. They will get a fresh set placed and will now have twice the number of marks on their body after the second set is removed

I had a similar experience as above with an ophthamologist who called a patient an emergency on a Friday afternoon because his CRNA called in sick. He used the ER call list, which I was up for that day. After I arrived, I learned of the circumstances and that in fact it was not a true ophthamologic emergency (open globe, penetrating trauma, etc.) but in fact an elective procedure he wanted to clear out before going on vacation the next week.

Because the patient was already in the room and prepped, I agreed to do the case. During the case, I relentlessly pointed out the facts behind why he could not find consistent coverage and had to use the staff CRNA (who hated his guts by the way), promised to punish him for improper use of an emergency call list, and promised to bill him for the added charges that the patient's insurance company was sure to deny based on a false classification of a procedure as emergent (vitrectomy - which took two hours as well).

You are there to be a patient advocate and guardian, not a doormat. The person who mentioned above that he/she projects the dominant personality of the OR in order to maintain order is correct. You do not and should not be more arrogant than anyone else in the room. You should be a central figure in the room that directs and maintains the flow of the room. If someone is stepping out of line, I put them back in line and make sure that they understand that it isn't personal, it's for the safety of the patient and for the sake of expediency.

As a resident, it is a more difficult task, however, projecting an air of appropriate confidence and knowledge of the procedure, pre and post op issues associated with the procedure and the patient's comorbidities, and all aspects of anesthetic care. Showing your concern for the patient to even the most minute detail is what all physicians are trained to do. If someone doesn't understand that, it is your job to remind them of that.

If a surgeon or surgical resident disrespects you, I will be honest, it would be hard for me not to give it right back and I was fortunate that I only had to do that a few times during residency, but the best option is remaining calm, LOOKING THE INDIVIDUAL UNWAVERINGLY IN THE EYE, and stating why you will or will not do something unsafe. I show interest in the case at all times, know my patients backwards and forwards, and have a clear plan in mind at all times. I also preemptively question the surgeon and residents on critical points of the procedure and I try to keep the atmosphere as light as possible without compromising the focus of the room. You have an opportunity to show your strengths as well as make connections with possible future sources of business. Don't let stressful situations turn you into jaded, resentful individuals. This is residency. Look ahead. Learn all that you can and take advantage of being able to practice medicine under a free license. If nothing else, bad experiences with your surgical colleagues in residency should be an opportunity for you to learn to maintain your sense of self, your inner peace, and ability to manage stressful situations. Getting upset, stressed out, etc. only leads to personal health and psychiatric problems and future problems in dealing with adverse situations.

Be the Yoda of your room.

Excellent post.

I could not agree more with knowing the patient forwards and backwards and find this is a HUGE deal for me. My preops take me longer because I obsess about the patient's medical issues but I find this to be a powerful tool in the OR. Being able to answer questions from the surgery attendings about the patient better than the surgery residents/fellows makes you look like you know what you're doing.

For knowing about the procedure, I read Jaffe the night before and take notes on crucial issues and that helps to know what to do in terms of positions, expected duration, complications, etc.