Pet Peeves

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Tuohy said:
4. Older attendings who need to do MOCA more than any younger attendings-Dogma such as "I don't want to put him to sleep because of his heart (no specific reasons can be listed as to what is wrong with said heart)"
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Same guys that cancel a case because the patient is "too sick" with no other explanation.
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Hawaiian Bruin said:
I have a thousand, but will start with two.

1) "Glide-uh-scope." It's pronounced glide-scope. Why complicate your life with the extra syllable? Was at a code yesterday and someone was doing the clucking hen feather flapping dance, trying to find the "glide-uh-scope" and the "glide-uh-scope stylet." Ugh.
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Never heard that one. As Buzz notes it's undoubtedly an artifact of a non-native English speaker. Specifically in some languages there are euphony rules that a word cannot start with s plus another consonant (thus why it's español)-- this also applies to most forms of Arabic as well as to Persian/Farsi and Japanese. (The superfluous e, or i as in the case of Portuguese, is referred to as an epenthetic vowel.)

http://www.lingref.com/cpp/gasla/10/paper2260.pdf
 
DreamLover said:
I take the patient back with the circulating nurse....of which I'm ALWAYS waiting on
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Thanks, you were scaring me there for a minute. ;) One of our new hospitals had the "anesthesia takes the pt to the OR" system. It lasted one day when we arrived - no further.
 
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jwk, I know a big academic hospital where that's been happening for a good while.

Imagine what an image a solo anesthesia attending pushing the stretcher creates in the mind of hospital personnel.
 
Numbex said:
Never heard that one. As Buzz notes it's undoubtedly an artifact of a non-native English speaker. Specifically in some languages there are euphony rules that a word cannot start with s plus another consonant (thus why it's español)-- this also applies to most forms of Arabic as well as to Persian/Farsi and Japanese. (The superfluous e, or i as in the case of Portuguese, is referred to as an epenthetic vowel.)

http://www.lingref.com/cpp/gasla/10/paper2260.pdf
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Unfortunately no, it's always native English speakers I've heard say this.
 
jwk said:
Thanks, you were scaring me there for a minute. ;) One of our new hospitals had the "anesthesia takes the pt to the OR" system. It lasted one day when we arrived - no further.
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If I took the patient back to the room myself, the room would never be ready no matter what they told me...at least I have true confirmation that the room won't flip out if the circulator goes with me-no one can balk
 
sevoflurane said:
Showing up @ 7:00am while the podiatrist shows up regularly @ 7:40 for a 7:30 start. Then hearing the whining and crying when we take away his 7:30 start time. :dead:
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Your podiatrist get block time? Damn you guys are generous.
 
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Hawaiian Bruin said:
Unfortunately no, it's always native English speakers I've heard say this.
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I'm not surprised at all- I just meant that, most likely, a non-native speaker got the mispronunciation started in the first place. When native speakers choose to imitate the malapropism, well, there you have medical culture in a nutshell.
 
Maybe this has been said but I didn't read all the responses.

Nicely ( or poorly even) placed IV that is hanging in the breeze cuz the nurse thinks the Tegaderm goes over the insertion site only, leaving the hub completely free of security.

I also HATE HATE HATE "sonameter".
 
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Another one:

New grads that think they have all the answers.

I was one of those guys at one time, I'm sure.
 
FFP said:
jwk, I know a big academic hospital where that's been happening for a good while.

Imagine what an image a solo anesthesia attending pushing the stretcher creates in the mind of hospital personnel.
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That totally sucks.

I'm definitely not a TJC guru - but my understanding is that there is supposed to be an RN-to-RN handoff from pre-op to circulator (and circulator to PACU nurse) where the patient is identified, procedure reviewed, etc. You know, one of those "nursing" things. I/we don't do nurse duties and of course nursing policies don't apply to us.

We make sure we are always ready to go, and we have hospital cell phones assigned for anesthesia staff for each OR. When the nurse is ready (and surgeon physically present in the OR suite) they call us, we meet them in pre-op, and head to the OR. You don't have your implants yet? Don't call me. You haven't checked all your trays for your sterility indicators yet? Don't call me. Surgical assistant isn't here yet? Don't call me. We emphasize that every minute in the OR costs money, both in OR charges and anesthesia professional charges. My billable time starts when we enter the OR - they better be ready.
 
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Noyac said:
Another one:

New grads that think they have all the answers.

I was one of those guys at one time, I'm sure.
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Never!
 
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In every hospital I've every worked/rotated, the anesthesia team takes the patient to the operating room.
 
Two buddies just went into practice at different hospitals. The nurses push the patient to the room, put on monitors, even start preoxygenating while they draw up their drugs. Perks of physician only practices where anesthesiologists are actually treated like doctors.
 
BobBarker said:
Two buddies just went into practice at different hospitals. The nurses push the patient to the room, put on monitors, even start preoxygenating while they draw up their drugs. Perks of physician only practices where anesthesiologists are actually treated like doctors.
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This is how its for me. Once the patient is in the room, I'll get a call overhead. By the time I get to the room, the patient is usually on the table, monitors placed, and (depending on the nurse) even BP cycled.
 
sleepallday said:
This is how its for me. Once the patient is in the room, I'll get a call overhead. By the time I get to the room, the patient is usually on the table, monitors placed, and (depending on the nurse) even BP cycled.
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What are you doing that makes you unavailable to help with that stuff? Not being argumentative, just wondering.
 
Pooh & Annie said:
What are you doing that makes you unavailable to help with that stuff? Not being argumentative, just wondering.
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Really whatever I want. I could be finishing the pre-op, using the bathroom, or drinking some coffee. Our group is highly respected in the hospital and hard working. No one here would ever accuse us of slacking off.
 
sleepallday said:
Really whatever I want. I could be finishing the pre-op, using the bathroom, or drinking some coffee. Our group is highly respected in the hospital and hard working. No one here would ever accuse us of slacking off.
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I don't think that's unreasonable, and it's not "slacking off."
Some gestures like this go a long way though, and not assisting when it's known that you're available can really sour attitudes toward you. The "that's not doctor work" conceit of some folks makes it clear why they may be made unhappy by their work environment and co-workers.
 
Pooh & Annie said:
I don't think that's unreasonable, and it's not "slacking off."
Some gestures like this go a long way though, and not assisting when it's known that you're available can really sour attitudes toward you. The "that's not doctor work" conceit of some folks makes it clear why they may be made unhappy by their work environment and co-workers.
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Quick question: Have you ever seen a surgeon bring a patient to the OR or help move the patient from the OR table to the stretcher after the surgery? I've been doing this for 15 years and haven't.
 
Pooh & Annie said:
I don't think that's unreasonable, and it's not "slacking off."
Some gestures like this go a long way though, and not assisting when it's known that you're available can really sour attitudes toward you. The "that's not doctor work" conceit of some folks makes it clear why they may be made unhappy by their work environment and co-workers.
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It isn't. I will NEVER push a patient into the OR since I am far, far, busier doing a multitude of more important things.
 
Pooh & Annie said:
I don't think that's unreasonable, and it's not "slacking off."
Some gestures like this go a long way though, and not assisting when it's known that you're available can really sour attitudes toward you. The "that's not doctor work" conceit of some folks makes it clear why they may be made unhappy by their work environment and co-workers.
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I wonder how one performs a pre-anesthesia interview if they don't see the patient until they meet them in the OR?
 
Nurses who are "assisting" me with induction who refuse to actually hold the mask to the patient's face (apparently on the assumption that every patient is claustrophobic and will wig out if the mask makes contact, despite the fact that I've given Versed). Cricoid pressure assistant releasing cricoid when the tube goes in, i.e. before the cuff is up and breath sounds confirmed. "Giving a baby even one breath with a PIP > 25 cmH2O is GOING TO KILL THEM." Anesthesia techs that don't wipe down the laryngoscope handle in between cases (ick.) Those toy stethoscopes they use for isolation patients. Having to do the isolation theater for a patient who had a MRSA wound infection that healed 10 years ago but they haven't had their three negative nasal swabs yet. Having simple medications like dextrose, bicarb and cefazolin on backorder "because reasons."
 
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These are all good responses. For me, #1 still has to be being referred to as "anesthesia". I heard a pre-op tech say the following recently while rooming a patient.

"Go ahead and change into this gown. Anesthesia will come to talk to you about anesthesia. Then the doctor will be in"
 
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MRSA theater for anyone. Who has taken care of in the hospital, or meet a MRSA carrier on an airplane/bus/Starbucks? Everyone. When were you last tested? For me - 2003. Me, or you, or the circular, or surgeon is a carrier, we just haven't been tested. Why bother with the sham of MRSA precautions?
 
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Numbex said:
Nurses who are "assisting" me with induction who refuse to actually hold the mask to the patient's face (apparently on the assumption that every patient is claustrophobic and will wig out if the mask makes contact, despite the fact that I've given Versed).
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LOL. Most people are actually not claustrophobic... Maybe the nurses are projecting?
 
Consigliere said:
It isn't. I will NEVER push a patient into the OR since I am far, far, busier doing a multitude of more important things.
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If you're busy, you're busy. You don't have to convince anyone here.

To me, you're either:
1) in academics, working on grants/research/academic stuff
2) doing your own cases. At fifteen years in, you should be efficient enough to get your **** done before the room's ready to go. Unless your turnover is <10 minutes.
3) supervising CRNA's. At fifteen years in, your pre-op takes <5 minutes in all but the sickest patients. Then you come in at induction. So as a patient, who took care of you? Who got to know you and formed the bond that made you comfortable for surgery? When the patient gets asked to describe the day, how do you think you vs the CRNA will be portrayed?

And we have only one surgeon who helps roll back and a few who help move. I'm not sure what that has to do with anything, since they're a different field of medicine.
 
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Pooh & Annie said:
If you're busy, you're busy. You don't have to convince anyone here.

To me, you're either:
1) in academics, working on grants/research/academic stuff
2) doing your own cases. At fifteen years in, you should be efficient enough to get your **** done before the room's ready to go. Unless your turnover is <10 minutes.
3) supervising CRNA's. At fifteen years in, your pre-op takes <5 minutes in all but the sickest patients. Then you come in at induction. So as a patient, who took care of you? Who got to know you and formed the bond that made you comfortable for surgery? When the patient gets asked to describe the day, how do you think you vs the CRNA will be portrayed?

And we have only one surgeon who helps roll back and a few who help move. I'm not sure what that has to do with anything, since they're a different field of medicine.
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This is exactly why I chose roll back with the patient. With this gesture I am trying to help change the perception of what anesthesia is and who we are as physicians in this field for each patient that I provide care. It is no wonder why a lot of the general public do not think we are physicians or could care less who actually is providing the care.

I do not supervise CRNAs (yet) but I can imagine how doing this for all patients would be challenging. I do my own cases at a couple of institutions and most of us roll back with the patient as well. I feel this extra 5 minutes of your time goes pretty far.
 
There is a big difference between going back voluntarily with the circulator and the patient, to establish a better patient-doctor relationship, and being the (only) one who has to take/push the patient to the OR. The latter is demeaning to us and our image, and should never be permitted (except maybe together with the equivalent-ranking surgeon).

I am sick and tired of this hospital "democracy", where everybody gets to be equal regardless of education, experience, IQ, and responsibilities. Especially in crisis situations, there should be a functional hierarchy, and it should be based not on social skills, but on a ranking system, like in the military. If you don't do what you're told by the guy where the buck stops, you're out. This is probably one of the few countries I know where a nurse or a pharmacist can refuse a doctor's order just because it's beyond their knowledge level, and get away with it.

There is no such thing as "teamcare", except for teams that have been training and working together for a long time (again the military is the best example), which does not happen in medicine (most of the "teams" are ad-hoc). How would this country work if everybody in the government would be equal to the President? If the buck stops with the physician, then the physician should have the final word and veto for anything, and that should not be open for debate.
 
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If I give versed, I come back with the patient.

I hardly ever give versed.

Usually, go talk to patient, spend a little time with them, reassure them. This obviates the need for anxiolysis.

Then I go back to the room and set up while the circulator brings the patient.

Now, more pet peeves please.
 
Intraop fentanyl given to people with functioning blocks.

Surgeon injecting local in the field fully cognizant that there's a functioning block.
 
Pooh & Annie said:
If you're busy, you're busy. You don't have to convince anyone here.

To me, you're either:
1) in academics, working on grants/research/academic stuff
2) doing your own cases. At fifteen years in, you should be efficient enough to get your **** done before the room's ready to go. Unless your turnover is <10 minutes.
3) supervising CRNA's. At fifteen years in, your pre-op takes <5 minutes in all but the sickest patients. Then you come in at induction. So as a patient, who took care of you? Who got to know you and formed the bond that made you comfortable for surgery? When the patient gets asked to describe the day, how do you think you vs the CRNA will be portrayed?

And we have only one surgeon who helps roll back and a few who help move. I'm not sure what that has to do with anything, since they're a different field of medicine.
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To answer your questions........

We have a pre-op clinic where every pt. (except cataracts) comes in for a pre-op visit and is seen by an anesthesiologist. That's where this magical bond that makes the pt. "comfortable for surgery" occurs. Most patients remember NOTHING about their anesthesia experience so your second question is irrelevant. Besides, I don't care what John Q Public thinks about what I do. Public perception of anesthesiologists is something I don't concern myself with (and neither does the ASA apparently).
 
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-Empty saline bottles thrown across the floor for me to first find and then use to empty the foley with. Glwt.
-Anyone other than the surgeon who feels the need to notify me when the patient is"waking up". Especially nurses who note that the patient is moving during foley insertion, after going without any stimulation for the last thirty minutes post induction as we locate our surgical team.
-pacu nurses who feel the need to scream at comfortably emerging patients upon arrival, so that they can open their mouth to remove an oral airway, which is keeping them from obstructing...
 
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Using "than" instead of "then"; "You're" instead of "your" and vice versa. I see it a lot on this site. From physicians.

And yeah, CRNA's giving everyone Versed. Even 90 year old. I walked in one time to induce and I kid you not, the CRNA was bagging this little 9o-something year old after giving 1mg of versed. Really? Why? Apparently, according to the boss, he is the Best CRNA. I swear, 5/7 CRNA's I work with all give versed. No matter if they've already received it in preop.
 
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chocomorsel said:
Using "than" instead of "then"; "You're" instead of "your" and vice versa. I see it a lot on this site. From physicians.
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I wasn't going to go this direction, but since you started with the grammar....

Using LOOSE when you meant to write LOSE...drives me nuts. I think it's the most common one I see EVERYWHERE (here included). Doesn't sound the same, like the ones you mentioned, and you have to write an additional letter to screw things up. With "you're/your" and "than/then" I can at least understand why the mistake is made...
 
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Where i currently work at, every crna uses that damn LTA lido for every case. This is usually after I placed a prep block plus their 100 mg lido on induction. And to top it off most of the surgeries last > 90 min. I ask why they used this?? "So I can use less inhaled since now they won't feel the breathing tube...."
 
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somedumbDO said:
Where i currently work at, every crna uses that damn LTA lido for every case. This is usually after I placed a prep block plus their 100 mg lido on induction. And to top it off most of the surgeries last > 90 min. I ask why they used this?? "So I can use less inhaled since now they won't feel the breathing tube...."
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What...

I don't even....
 
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