2 CRNAs requesting anesthesiologists for the surgery of their parents

[SleepIsGood]

Absolutely hilarious and two cases of this happened at my program this week.

One was with me for a 69 yo patient who was going for a SDH evacuation.

Another case was with a colleague of mine who had a 65 yo scheduled for a knee replacement.

In both instances, the patients' daughters were CRNAs. They knew my program was an academic center but was't certain if we used CRNAs.

At any rate, they asked to speak with the attending Anesthesiologist. IN both cases they specifically wanted to make certain that NO CRNAs/SRNAs took care of their parents !!

Where is the irony in this. If there wasn't HIPPA, I wish I could share video footage of them asking this.

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[Noyac]

Does this surprise you?

 

[Arch Guillotti]

 

[SleepIsGood]

Does this surprise you?

It's the irony and hypocrisy. So typical of the AANA and their constiuents.

 

[coprolalia]

It's the irony and hypocrisy. So typical of the AANA and their constiuents.

So, if we take your story 100% at face value (and there isn't any embellishment... and I'm not saying there is), the patients weren't actually CRNA/SRNA's themselves, right? This was their parents requesting an anesthesiologist. And, it wasn't a CRNA/SRNA requesting an anesthesiologist for their own child? It was the parent of someone, two people, who happened to be CRNAs, is that correct?

How is that "ironic" and "hypocrtical"? Please explain.

-copro

 

[toughlife]

So, if we take your story 100% at face value (and there isn't any embellishment... and I'm not saying there is), the patients weren't actually CRNA/SRNA's themselves, right? This was their parents requesting an anesthesiologist. And, it wasn't a CRNA/SRNA requesting an anesthesiologist for their own child? It was the parent of someone, two people, who happened to be CRNAs, is that correct?

How is that "ironic" and "hypocrtical"? Please explain.

-copro

 

[coprolalia]

It's not ironic or hypocritical, toughlife. We shouldn't chastise or denigrate people for making the right decision, especially on a forum that is read by CRNAs.

I have no idea why these parents of CRNAs didn't want a CRNA or an SRNA participating in their care. Neither does SleepIsGood, unless he asked them specifically (which I could understand fully why he wouldn't necessarily want to know).

Point is this. We have to work together, like it or not. The "tone" of the first post is more "here's a slap in the face" than it is "hey, I thought this was a nice example of our profession standing out." It doesn't englighten anyone. It doesn't help. It's a little mean-spirited.

Fine. If that's the tenor we want this forum to take.

Just tell me exactly how it was "ironic" and "hypocritical" that a parent of a practitioner didn't want someone with their daughter's level of training to participate.

If you're going to sling mud, you'd better be precise.

-copro

 

[G0S2]

It's not ironic or hypocritical, toughlife. We shouldn't chastise or denigrate people for making the right decision, especially on a forum that is read by CRNAs.

I have no idea why these parents of CRNAs didn't want a CRNA or an SRNA participating in their care. Neither does SleepIsGood, unless he asked them specifically (which I could understand fully why he wouldn't necessarily want to know).

Point is this. We have to work together, like it or not. The "tone" of the first post is more "here's a slap in the face" than it is "hey, I thought this was a nice example of our profession standing out." It doesn't englighten anyone. It doesn't help. It's a little mean-spirited.

Fine. If that's the tenor we want this forum to take.


Just tell me exactly how it was "ironic" and "hypocritical" that a parent of a practitioner didn't want someone with their daughter's level of training to participate.

If you're going to sling mud, you'd better be precise.

-copro

I believe it was the pts kids, who are CRNA's, that spoke to the attending and requested MD's. Therefore, it is ironic that a CRNA would ask for an MD anesthesiologist to perform their parents case.

 

[toughlife]

It's not ironic or hypocritical, toughlife. We shouldn't chastise or denigrate people for making the right decision, especially on a forum that is read by CRNAs.

I have no idea why these parents of CRNAs didn't want a CRNA or an SRNA participating in their care. Neither does SleepIsGood, unless he asked them specifically (which I could understand fully why he wouldn't necessarily want to know).

Point is this. We have to work together, like it or not. The "tone" of the first post is more "here's a slap in the face" than it is "hey, I thought this was a nice example of our profession standing out." It doesn't englighten anyone. It doesn't help. It's a little mean-spirited.

Fine. If that's the tenor we want this forum to take.

Just tell me exactly how it was "ironic" and "hypocritical" that a parent of a practitioner didn't want someone with their daughter's level of training to participate.

If you're going to sling mud, you'd better be precise.

-copro

I respect you for your stand and I like your posts because I think you speak what I often think. However, I think you are misguided here.

This situation is simple. What I think sleepisgood was pointing out is the double standard displayed by some CRNAs regarding patient care. According to CRNAs, they believe they are qualified to care for anyone and many have stated that they prefer to have their own care for their family rather than a resident or anesthesiologist. After all, aren't we all the same?


His anecdote tells a different story.

 

[coprolalia]

I believe it was the pts kids, who are CRNA's, that spoke to the attending and requested MD's. Therefore, it is ironic that a CRNA would ask for an MD anesthesiologist to perform their parents case.

Maybe I am being thick or fully stewing in my post-New Year's Eve haze, but it wasn't initially clear to me that the CRNAs themselves were asking for an attending anesthesiologist to care for their parents.

And, I have seen it both ways. I've seen staff that comes in for surgery ask not to be treated by a resident, instead opting to have a particular CRNA take care of them.

I just don't find this ironic, still. I think the care team is the best approach. And, unless they are in an opt-out state or are a strong advocate for independent practice (which, contrary to popular belief, many CRNAs are not), it certainly isn't hypocritical.

-copro

 

[toughlife]

Maybe I am being thick or fully stewing in my post-New Year's Eve haze, but it wasn't initially clear to me that the CRNAs themselves were asking for an attending anesthesiologist to care for their parents.

And, I have seen it both ways. I've seen staff that comes in for surgery ask not to be treated by a resident, instead opting to have a particular CRNA take care of them.

I just don't find this ironic, still. I think the care team is the best approach. And, unless they are in an opt-out state or are a strong advocate for independent practice (which, contrary to popular belief, many CRNAs are not), it certainly isn't hypocritical.

-copro

I have seen this also.

 

[dfk]

Maybe I am being thick or fully stewing in my post-New Year's Eve haze, but it wasn't initially clear to me that the CRNAs themselves were asking for an attending anesthesiologist to care for their parents.

And, I have seen it both ways. I've seen staff that comes in for surgery ask not to be treated by a resident, instead opting to have a particular CRNA take care of them.

I just don't find this ironic, still. I think the care team is the best approach. And, unless they are in an opt-out state or are a strong advocate for independent practice (which, contrary to popular belief, many CRNAs are not), it certainly isn't hypocritical.

-copro

truer words have not been spoken!

 

[filter07]

Is there evidence that these particular CRNAs advocate CRNA autonomy? If not, why would this be hypocritical? If anything it's a mistake in applying the view of a few radicals to these specific individuals.

Maybe these particular CRNAs accept that they have limitations in their knowledge and care, and want the best for their parents. I don't think that's hypocritical. If they express a contrary view in other situations, that would be hypocritical, but I don't think that's the case here.

 

[Noyac]

Maybe I am being thick or fully stewing in my post-New Year's Eve haze, but it wasn't initially clear to me that the CRNAs themselves were asking for an attending anesthesiologist to care for their parents.

And, I have seen it both ways. I've seen staff that comes in for surgery ask not to be treated by a resident, instead opting to have a particular CRNA take care of them.

I just don't find this ironic, still. I think the care team is the best approach. And, unless they are in an opt-out state or are a strong advocate for independent practice (which, contrary to popular belief, many CRNAs are not), it certainly isn't hypocritical.

-copro

Many here may be confused by this statement. So could you explain why it is that you believe this?

 

[coprolalia]

Many here may be confused by this statement. So could you explain why it is that you believe this?

First off, let's make sure we agree who are the members of the an anesthesia care team...

ANESTHESIA CARE TEAM – Anesthesiologists supervising resident physicians in training and/or directing qualified nonphysician anesthesia providers in the provision of anesthesia care wherein the physician may delegate monitoring and appropriate tasks while retaining overall responsibility for the patient.

http://www.asahq.org/publicationsAndServices/standards/16.pdf

Now, in the "care team" model, the assumption is that "two heads are better than one", in that you have two sets of eyes looking at all variables.

The only agreed upon conclusion between the much argued and controvertible findings in the Silber and Pine studies was that two care providers - whether a physician-nurse, physician-resident, or physician-physician - trended towards consistently rendering safer care.

Hope that clarifies any confusion.

-copro

 

[Noyac]

First off, let's make sure we agree who are the members of the an anesthesia care team...



http://www.asahq.org/publicationsAndServices/standards/16.pdf

Now, in the "care team" model, the assumption is that "two heads are better than one", in that you have two sets of eyes looking at all variables.

The only agreed upon conclusion between the much argued and controvertible findings in the Silber and Pine studies was that two care providers - whether a physician-nurse, physician-resident, or physician-physician - trended towards consistently rendering safer care.

Hope that clarifies any confusion.

-copro

How often in the "anesthesia care model" are 2 heads actually looking at all variables? Mostly if the doc is very vigilant he is there for intubations and then off to the next room leaving the nurse to make decisions thereafter. Once trouble has reared its ugly head then there may be 2 heads again but who's to say that the trouble would have occurred had it been a doc from the start. I know trouble occurs with docs as the sole caregiver but and that is not what I'm arguing, but 2 heads are frequently not present.

So I know the ASA supports the care team model but I have doubts. I think they are supporting it for political reasons as much as anything. We (docs) can't possibly cover all the anesthetizing locations in this country so we need nurses. But since we need the nurses we also need to make it apparent that these nurse need supervision and not independence. The ASA supports the care team model as a means to retain supervision, IMO.

I have practiced in both models. I much prefer the all MD model. And there are also some practices where the care team model doesn't fit. Small practices for instance. We ran the numbers and using nurses become feasable after about 6-8 rooms.

So in my opinion the care team model is over blown but I understand the need for it and that it can work very efficiently and make more money which is another reason docs support it.

 

[coprolalia]

The Care Team Model is predicated on the person working under its confines calling the "other head" if there is a problem. If that doesn't occur, that's not so much a problem with a model as it is a specific personnel issue.

-copro

 

[SleepIsGood]

It's not ironic or hypocritical, toughlife. We shouldn't chastise or denigrate people for making the right decision, especially on a forum that is read by CRNAs.

I have no idea why these parents of CRNAs didn't want a CRNA or an SRNA participating in their care. Neither does SleepIsGood, unless he asked them specifically (which I could understand fully why he wouldn't necessarily want to know).

Point is this. We have to work together, like it or not. The "tone" of the first post is more "here's a slap in the face" than it is "hey, I thought this was a nice example of our profession standing out." It doesn't englighten anyone. It doesn't help. It's a little mean-spirited.

Fine. If that's the tenor we want this forum to take.

Just tell me exactly how it was "ironic" and "hypocritical" that a parent of a practitioner didn't want someone with their daughter's level of training to participate.

If you're going to sling mud, you'd better be precise.

-copro

Copro

you are misinterpreting what I wrote.

Let me clarify. The irony is that these KIDS (who are CRNAs) specifically requested an anesthesiologist for their OWN parents.

Must of been the booze Copro

 

[Lonestar]

Life is like a box of chocolates. ya never know what you gonna get.