are things changing??

[militarymd]

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Except that it's usually the surgeons who are the last line of defense.

I don't say that to dismiss what anesthesiologists do because what they do is important, but when things go haywire it's usually the surgeon who steps up and runs the show.

Interesting line of thinking.

I would say it really depends on what you're defending against.......medical vs surgical problem.....

If you're practicing at a location where you are calling a surgeon for rip roaring ARDS from pneumonia as "the last line of defense".....you're probably not living where I would want to live.

 

[Chief Resident]

Interesting line of thinking.

I would say it really depends on what you're defending against.......medical vs surgical problem.....

If you're practicing at a location where you are calling a surgeon for rip roaring ARDS from pneumonia as "the last line of defense".....you're probably not living where I would want to live.

What I'm saying is that a general surgeon (especially one with fellowship training in critical care/trauma) can do almost anything an anesthesiologist can and more (surgical intervention that an anesthesiologist can't). So in that sense a general surgeon is the "last line of defense" because he/she can take care of both medical and surgical problems, whereas an anesthesiologist is more confined to medical ones.

 

[powermd]

I've reread the posts.....I noted that I feel folks who are considering "lifestyle" before evening starting training are "lazy"....It is not an insult....it is how I and many of my colleagues feel.

It is interesting how you take offense at being called "lazy"....struck a chord huh? Some of your previous attendings called you lazy??? Or previous co-workers????

Anyways, read the posts again in order.....actually I encourage everyone to....I've responded to you in an appropriate manner....

I didn't start the name calling....Actually, I never called names...I simply said f uck you.....which Jet has also said.

I'm kind of disappointed by what I see you posting, Military. Ordinarily you seem to be a pretty reasonable guy. You maintain (correct me if I'm wrong) that anyone considering the hours/flexibility/stress (my idea of "lifestyle") of a specialty as their number one priority in picking a field is simply "lazy". What if priorities 2, 3, and 4 reflect interest in the field, and a very busy and productive llfe inside or outside medicine? How can you call that person lazy?

 

[militarymd]

What I'm saying is that a general surgeon (especially one with fellowship training in critical care/trauma) can do almost anything an anesthesiologist can and more (surgical intervention that an anesthesiologist can't). So in that sense a general surgeon is the "last line of defense" because he/she can take care of both medical and surgical problems, whereas an anesthesiologist is more confined to medical ones.

Ahhhh....I see.....a surgeon is an Internist/anesthesiologist/Intensivist/pulmonologist who has completed their training....is that what you are saying?

 

[militarymd]

I'm kind of disappointed by what I see you posting, Military. Ordinarily you seem to be a pretty reasonable guy. You maintain (correct me if I'm wrong) that anyone considering the hours/flexibility/stress (my idea of "lifestyle") of a specialty as their number one priority in picking a field is simply "lazy". What if priorities 2, 3, and 4 reflect interest in the field, and a very busy and productive llfe inside or outside medicine? How can you call that person lazy?

I maintain that those who chose a residency BASED on those things you list are what I would call "lazy".

I value all those "lifestyle" things as well, but I've waited until after training to worry about it. As any other people in other specialties do.

As I've noted, my opinion is based on experience....my "lifestyle" minded co-resident screwed his buddies because he was lazy.

I trained residents for 5 years while in the Navy, and I've observed those who picked the specialty based on "lifestyle" and observed how their attitude screw their co-residents.

Like I said, anesthesia may be doing well right now because of the current medical/economic environment.

What happens if this changes???? What happens when the average gas passer will have to work 60 hour weeks with no vacation to make 150,000 per year......

Is one going to be happy and productive when one chose anesthesia because of "lifestyle"?

 

[Sugar72]

Ahhhh....I see.....a surgeon is an Internist/anesthesiologist/Intensivist/pulmonologist who has completed their training....is that what you are saying?

Hey wait a minute - are you guys talking about House MD....That show is great - a little unbelievable but good TV.

 

[Chief Resident]

Ahhhh....I see.....a surgeon is an Internist/anesthesiologist/Intensivist/pulmonologist who has completed their training....is that what you are saying?

No, I didn't say that. This is what I said:

What I'm saying is that a general surgeon (especially one with fellowship training in critical care/trauma) can do almost anything an anesthesiologist can and more (surgical intervention that an anesthesiologist can't). So in that sense a general surgeon is the "last line of defense" because he/she can take care of both medical and surgical problems, whereas an anesthesiologist is more confined to medical ones.

 

[proman]

Except that it's usually the surgeons who are the last line of defense.

I don't say that to dismiss what anesthesiologists do because what they do is important, but when the shi1t hits the fan it's usually the surgeon who steps up and runs the show.

Not at my hospital (private tertiary community with CRNAs/AAs and no anesthesiology residency). The CRNAs would almost never call the anesthesiologists (the respected ones did). Usually when the patient was doing poorly the surgeons would run the show by telling the CRNA to call their attending.

 

[militarymd]

Not at my hospital (private tertiary community with CRNAs/AAs and no anesthesiology residency). The CRNAs would almost never call the anesthesiologists (the respected ones did). Usually when the patient was doing poorly the surgeons would run the show by telling the CRNA to call their attending.

 

[Chief Resident]

Not at my hospital (private tertiary community with CRNAs/AAs and no anesthesiology residency).

That explains it.

 

[Noyac]

Except that it's usually the surgeons who are the last line of defense.

I don't say that to dismiss what anesthesiologists do because what they do is important, but when the shi1t hits the fan it's usually the surgeon who steps up and runs the show.

This is another example of a resident that has not yet entered the REAL world. In my humble experience in university hospitals, county hospitals, general hospitals, rural hospitals, trauma centers, surgery centers and plastic surgeons offices (damn I get around now that I think of it) when the **** hits the fan the OR community functions as a unit/team. If someone tries to control something that is not in their area of expertise then things go wrong. The surgeon takes care of the pathology and the anesthesia provider takes care of the physiology. No matter how trained the surgeon may be if he is trying to do my job (which he can't possibly do as well) then his task is lost an dthe patient will suffer. When the IVC is blasted to bits, it doesn't matter what that surgeon wants to do. If there is no volume in the patient, I say hold pressure/xclamp till I can get some fluids in him, then you can proceed. Therefore I am the 1st line of defense (just an example). So if you come out thinking you are the be-all end-all, well you will find the OR a rude environment. It is a team and from the scrub tech to the nurses to the Dr's and everyone else involved. Get it!

 

[toughlife]

I maintain that those who chose a residency BASED on those things you list are what I would call "lazy".

As I've noted, my opinion is based on experience....my "lifestyle" minded co-resident screwed his buddies because he was lazy.

I trained residents for 5 years while in the Navy, and I've observed those who picked the specialty based on "lifestyle" and observed how their attitude screw their co-residents.

Like I said, anesthesia may be doing well right now because of the current medical/economic environment.

What happens if this changes???? What happens when the average gas passer will have to work 60 hour weeks with no vacation to make 150,000 per year......

Is one going to be happy and productive when one chose anesthesia because of "lifestyle"?

👍 I agree with the above and I pity those who want to do anesthesiology just so they can work 40hrs per week with 3-day weekends. Sadly, many of my classmates are delusional and think this will be the case in residency.

 

[VentdependenT]

This is another example of a resident that has not yet entered the REAL world. In my humble experience in university hospitals, county hospitals, general hospitals, rural hospitals, trauma centers, surgery centers and plastic surgeons offices (damn I get around now that I think of it) when the **** hits the fan the OR community functions as a unit/team. If someone tries to control something that is not in their area of expertise then things go wrong. The surgeon takes care of the pathology and the anesthesia provider takes care of the physiology. No matter how trained the surgeon may be if he is trying to do my job (which he can't possibly do as well) then his task is lost an dthe patient will suffer. When the IVC is blasted to bits, it doesn't matter what that surgeon wants to do. If there is no volume in the patient, I say hold pressure/xclamp till I can get some fluids in him, then you can proceed. Therefore I am the 1st line of defense (just an example). So if you come out thinking you are the be-all end-all, well you will find the OR a rude environment. It is a team and from the scrub tech to the nurses to the Dr's and everyone else involved. Get it!

Here here! Good post chap.

 

[militarymd]

That explains it.

As I mentioned before, many things in medicine are region dependent. I suppose where you practice (I assume as a resident), you may be the "last line of defense" for everything.

Where I've been, military tertiary training center where I attended in a combined MICU/SICU and in private practice at a community hospital, the surgeons call me to make the final decision on non-surgical issues....example....vent management, total body homeostasis issues, etc...

I freely admit that there is a lot of surgical issues that I know little about, and my surgical colleaques freely admit there are many non-surgical issues that they know little about...even though each of us know a bit about the other's area of expertise.

I suppose it is possible that you know everything and can do everything. You must be in the top 0.1 percent of the board certified trauma/critical care surgeons out there.

 

[jetproppilot]

What I'm saying is that a general surgeon (especially one with fellowship training in critical care/trauma) can do almost anything an anesthesiologist can and more (surgical intervention that an anesthesiologist can't). So in that sense a general surgeon is the "last line of defense" because he/she can take care of both medical and surgical problems, whereas an anesthesiologist is more confined to medical ones.

Geez, Dude, are you for real?

As the officer said in the movie Stripes, to the dude that said :

"MY NAME IS PSYCHO. IF YOU CALL ME FRANCIS, I'll KILL YOU."

Officer replies,

"LIGHTEN UP, FRANCIS."

Out of the academic i know more than you environment, its all about getting the case done with the patient in good shape.

99.9999% of general/orthopedic/ENT/neuro/GYN surgeons making their living at non-academic hospitals are not critical care gods. And even if they are (which there are a few, but like I said...few), they are all for making decisions based on sound clinical judgement...and most surgeons want to operate...thats it...operate... and if there is a non-surgical perioperative problem, they are looking at the anesthesiologist for guidance.

This isnt a whos-got-the-bigger-scrotum-contest, Slim.

Anesthesiologists in the OR are like Wolf in Pulp Fiction. We're here. And we take care of problems.

And nearly all private practice surgeons rely on that.

 

[jetproppilot]

I'm kind of disappointed by what I see you posting, Military. Ordinarily you seem to be a pretty reasonable guy. You maintain (correct me if I'm wrong) that anyone considering the hours/flexibility/stress (my idea of "lifestyle") of a specialty as their number one priority in picking a field is simply "lazy". What if priorities 2, 3, and 4 reflect interest in the field, and a very busy and productive llfe inside or outside medicine? How can you call that person lazy?

And GEEZ, what is this, LETS SLAM MILITARY MD WEEK?

Dudes smarter than me, you, and twenty other MDs combined.

And if I ever have the opportunity, I'd jump to work with the dude.

F uck you guys.

 

[blocks]

"Anesthesiologists in the OR are like Wolf in Pulp Fiction. We're here. And we take care of problems."





Jet, that aspect of anesthesiology practice is exactly why I chose this field. 👍

 

[VentdependenT]

And GEEZ, what is this, LETS SLAM MILITARY MD WEEK?

Dudes smarter than me, you, and twenty other MDs combined.

And if I ever have the opportunity, I'd jump to work with the dude.

F uck you guys.

Its also national cat litter inventors recognition week.

 

[Chief Resident]

I don't know why you guys are trying to turn this into a surgeon vs. gas pusher argument. I agree that anesthesiologists have their role, but to say that they are the "last line of defense" is misleading.

 

[blocks]

The role is to keep the patient alive and well, regardless of what the surgeon is doing.

 

[jetproppilot]

I don't know why you guys are trying to turn this into a surgeon vs. gas pusher argument. I agree that anesthesiologists have their role, but to say that they are the "last line of defense" is misleading.

You are the one pushing that argument, Slim. Not me.

 

[lvspro]

surgeon vs. gas pusher

In this context, it would be butcher vs gas pusher
😀

 

[VentdependenT]

Give it up man. Who are you trying to convince here? We know the truth but if it makes you feel better just keep on truckin with that attitude.

When that 75 yr old granny in for the total hip codes on the table I'll have to curl up in the corner and ask you to take over. You are the last line of defense. I'll even turn off my magic gas for you.

With the reflexes of a tiger and the knowledge of all things medical I'm sure you'll assuage our fears and bring the situation under complete control. Not only will ya stablize the pts cardiovasuclar status but you'll crack the chest open and swap out the fat embolized lungs. All while screaming at the OR nurse, hitting on the third year medical student, and telling the anesthesiologist to turn off his "beeps."

 

[jetproppilot]

What I'm saying is that a general surgeon (especially one with fellowship training in critical care/trauma) can do almost anything an anesthesiologist can and more

And you say we're turning this into a surgeon vs anesthesiologist war?

Gimme a f ukking break.

I've never been in a sparring contest with a general surgeon. And I'm not gonna start with you, Chief.

Out here in the real world, the general surgeon and I are on the same team.

 

[pmichaelmd]

from a surgeon. I suppose that stereotypes do exist for a reason. As has been noted in previous posts, we as anesthesiolgists (and anesthesiologists-in-training) have to get used to that kind of attitude. I don't mean to imply that we have to accept it, but we have understand that most other medical professionals will have little idea of what we do on our side of the blood-brain barrier.

I recently had an orthopedist joke with me "why do you bother doing anesthesia? A nurse can do what you do." He also went on to say that entering anesthesia was expected of me because only somebody who is lazy and/or unintelligent would enter a "nursing" field. There was also something about my having been a flight surgeon in the past...funny thing is, he came to our hospital and nearly died on the table while he was being attended by an anesthesia provider who was not a medical doctor (is that PC enough??). The reason he came off of that table is not because the orthopedist or non-medical anesthetist recognized his arrhythmia but because a medically-trained specialist in anesthesia happened to be checking on the room and ran the code. Surprisingly, the orthopod who was operating on the orthopod did not assume control of the code...I'm guessing his knowledge of ACLS would have included using IV bone paste and he knew it.

We may not get as much respect up front but when the shi t hits the fan we can take comfort in knowing that we helped saved that particular life. The best revenge is that this orthopod, with all of his arrogance, knows who saved his @ss and I'm guessing that he will be asking for an anesthesiologist the next time he gets his knee done.

Sorry for the ramble but I couldn't resist 👍

PMMD

No, I didn't say that. This is what I said:

 

[Chief Resident]

Out here in the real world, the general surgeon and I are on the same team.

True. But the one with the scalpel is the team captain. 😉

 

[maximuum]

I wouldn't listen much to what Chief Resident says. I saw on another board that he/she is only a medical student.

 

[VentdependenT]

True. But the one with the scalpel is the team captain. 😉

Welcome to my ignore list your royal hindass

3 in one week. not bad.

 

[blocks]

True. But the one with the scalpel is the team captain. 😉

Or the one that needs the scalpel to define him is light in his loafers.

 

[Chief Resident]

Or the one that needs the scalpel to define him is light in his loafers.

Or the one who couldn't cut it as a surgeon did the next thing that would at least let him be in the OR.

You need to lighten up. Perhaps you didn't see the 😉 in my other post. You guys are way too sensitive.

 

[Chief Resident]

I recently had an orthopedist joke with me "why do you bother doing anesthesia? A nurse can do what you do."

There is something to be said about that. I've seen CNAs run entire cases without much (if any) input from the anesthesiologist.

 

[jetproppilot]

from a surgeon. I suppose that stereotypes do exist for a reason. As has been noted in previous posts, we as anesthesiolgists (and anesthesiologists-in-training) have to get used to that kind of attitude. I don't mean to imply that we have to accept it, but we have understand that most other medical professionals will have little idea of what we do on our side of the blood-brain barrier.

I recently had an orthopedist joke with me "why do you bother doing anesthesia? A nurse can do what you do." He also went on to say that entering anesthesia was expected of me because only somebody who is lazy and/or unintelligent would enter a "nursing" field. There was also something about my having been a flight surgeon in the past...funny thing is, he came to our hospital and nearly died on the table while he was being attended by an anesthesia provider who was not a medical doctor (is that PC enough??). The reason he came off of that table is not because the orthopedist or non-medical anesthetist recognized his arrhythmia but because a medically-trained specialist in anesthesia happened to be checking on the room and ran the code. Surprisingly, the orthopod who was operating on the orthopod did not assume control of the code...I'm guessing his knowledge of ACLS would have included using IV bone paste and he knew it.

We may not get as much respect up front but when the shi t hits the fan we can take comfort in knowing that we helped saved that particular life. The best revenge is that this orthopod, with all of his arrogance, knows who saved his @ss and I'm guessing that he will be asking for an anesthesiologist the next time he gets his knee done.

Sorry for the ramble but I couldn't resist 👍

PMMD

My hat is off to you, Sir/Sirette, and all dudes/dudettes in the military for preserving our lives as we know it from the terrorist mother fu kkers.

Thank you.

My most memorable work-relationships are with orthopedists...guess muscle head dudes think alike....yeah, we sparred back and forth...

Me, with the..

"Know the difference between a carpenter and an orthopedic surgeon?"

"A carpenter knows at least TWO antibiotics."

And the orthopedic dude with his...

HEYYY! Bill!! How was Snow Mass? Geez, are ya gonna work for THREE WEEKS STRAIGHT?"

Affectionate banter. We both know our place. And we respect each other. Ya'll in training who gain erections from i=know-more-than-you-when-s hit-hits-the-fan have not-even close to a clue.

I tell you, from experience (even though many dudes, albeit non-real-world-dudes-who-post-on-this-board-like-they-are-experienced-dudes), Dr Dodson, Mr. 800K-a-year orthopedist dude,

knows his place and stands back when a non-orthopedic problem arises.

Not a pretentious statement. Just the truth. ALL ortho dudes (notice I said ALL) want to come in, put in their joint/pin, and leave.

And if theres a perioperative problem, they're looking for WOLF.

 

[jetproppilot]

Or the one who couldn't cut it as a surgeon did the next thing that would at least let him be in the OR.

You need to lighten up. Perhaps you didn't see the 😉 in my other post. You guys are way too sensitive.

Geez.

An FBI profiler would nail you as a 5'6" white male, 165lbs, plays video games incessantly, and couldn't pick up a chick in an all-female prison.

 

[Chief Resident]

Geez.

An FBI profiler would nail you as a 5'6" white male, 165lbs, plays video games incessantly, and couldn't pick up a chick in an all-female prison.

No need to project your identity onto others.

 

[pmichaelmd]

There is something to be said about that. I've seen CNAs run entire cases without much (if any) input from the anesthesiologist.

To get into this flame war, but I'll just leave it be. We all have our place and are good at what we do (presumably). I would no more lean over the curtain and tell you how long to make your incision than expect you to look over the curtain and understand why I shouldn't bring a baseline hypertensive with an avg. preop SBP of 170 to a SBP of 90 just to decrease the bleeding. Forget about discussing MAPs.

We should all know our place and only get into trouble when we try to exceed our capabilities. The wise ones are those that know their limits. I can say this as I initially trained in FP and watched those guys run cardiac stress tests 👎

PMMD

 

[pmichaelmd]

Many thanks to you, JPP, as well as MilMD, Noyac, UTSW, and the other practicing anesthesiologists who grace this board with post-residency wisdom. I do more lurking than contributing but certainly appreciate all you guys put forth.

I did enjoy my time in the military but am now happily a civilian CA-2. 🙂

Goodnight and cheers to all.

PMMD

My hat is off to you, Sir/Sirette, and all dudes/dudettes in the military for preserving our lives as we know it from the terrorist mother fu kkers.

Thank you.

My most memorable work-relationships are with orthopedists...guess muscle head dudes think alike....yeah, we sparred back and forth...

Me, with the..

"Know the difference between a carpenter and an orthopedic surgeon?"

"A carpenter knows at least TWO antibiotics."

And the orthopedic dude with his...

HEYYY! Bill!! How was Snow Mass? Geez, are ya gonna work for THREE WEEKS STRAIGHT?"

Affectionate banter. We both know our place. And we respect each other. Ya'll in training who gain erections from i=know-more-than-you-when-s hit-hits-the-fan have not-even close to a clue.

I tell you, from experience (even though many dudes, albeit non-real-world-dudes-who-post-on-this-board-like-they-are-experienced-dudes), Dr Dodson, Mr. 800K-a-year orthopedist dude,

knows his place and stands back when a non-orthopedic problem arises.

Not a pretentious statement. Just the truth. ALL ortho dudes (notice I said ALL) want to come in, put in their joint/pin, and leave.

And if theres a perioperative problem, they're looking for WOLF.

 

[jetproppilot]

We should all know our place and only get into trouble when we try to exceed our capabilities. The wise ones are those that know their limits.

PMMD

DUDES DUDETTES IN TRAINING,

if you take ONLY ONE THING AWAY FROM SDN ANESTHESIA,

this is it.

👍

 

[HP11]

This is not a flame as I'm applying to ortho myself. But, as my preceptor/mentor who is an orthopedist likes to say:

"orthopods have a heart of a lion, the claws of an eagle, and the brain of a chicken."

 

[svaefinga]

Guys you are so funny, to read this is really entertaining especially practicing outside the US where nurses are not allowed to run any cases at all. It doesn't matter who thinks he was the last line of defence as long as I get the patient alive and stable out of the OR.

 

[militarymd]

Geez.

An FBI profiler would nail you as a 5'6" white male, 165lbs, plays video games incessantly, and couldn't pick up a chick in an all-female prison.

ha ha ha ha ha ha

 

[militarymd]

Try hasn't even taken Step 1 yet:

http://forums.studentdoctor.net/showpost.php?p=2998325&postcount=18

even better

 

[pmichaelmd]

Is it troll season already 'round here??

Try hasn't even taken Step 1 yet:

http://forums.studentdoctor.net/showpost.php?p=2998325&postcount=18

 

[Gimlet]

Is it troll season already 'round here??

Yep, based on a quick look at his post history it looks like he got tired of bashing D.O.s and felt the need to come in here and try to stir things up. Chief Resident: it's obvious you aren't interested in anesthesiology, so why are you here?

 

[Chief Resident]

Chief Resident: it's obvious you aren't interested in anesthesiology, so why are you here?

I am becoming interested in finding a good lifestyle residency. Anesthesiolology is one of the residencies which provides that, along with other residencies that I've looked into like family med and psychiatry.

 

[blocks]

That's a pretty disparate group of fields. If you are looking for lifestyle, why didn't you include Radiology and Derm, the ultimate lifestyle residencies?

What's the matter, Chief, something lacking?

 

[Chief Resident]

That's a pretty disparate group of fields. If you are looking for lifestyle, why didn't you include Radiology and Derm, the ultimate lifestyle residencies?

As I said those are the residencies I've looked into so far. Derm and rads may be other specialties I'd be interested in maybe looking into.

 

[militarymd]

Hey Chief,

As a student, how do you know who does what and is in charge of what?

You should be figuring out how to do a H&P and learning how not to piss people off.

You never know who you may run into in your future.

 

[Chief Resident]

Hey Chief,

As a student, how do you know who does what and is in charge of what?

What do you mean exactly, Col. Frank Fitts?

You should be figuring out how to do a H&P and learning how not to piss people off.

How am I pissing people off? I responded to somebody boasting that anesthesiologists are the last line of defense and people jumped all over it.

You never know who you may run into in your future.

Is that another one of your threats Col. Fitts, like your threat about meeting people in dark alleys? Between you wanting to "meet" men in alleys and jetproppilot bragging about how he abuses female residents to make them cry......well we get the picture to put it mildly.......

 

[VentdependenT]

Try hasn't even taken Step 1 yet:

http://forums.studentdoctor.net/showpost.php?p=2998325&postcount=18

Infuriatingly ridiculous.

Get ready for a lifetime of professional and resultant personal disillusionment holmes. My apologies to your future coworkers who will have to endure your inevitable intolerable temper tantrums. There are more like you out there. I just want to find the mold thats cranken you guys out and break it.

 

[Chief Resident]

Infuriatingly ridiculous.

Get ready for a lifetime of professional and resultant personal disillusionment holmes. My apologies to your future coworkers who will have to endure your inevitable intolerable temper tantrums. There are more like you out there. I just want to find the mold thats cranken you guys out and break it.

Dude chill that was like a month ago, I already took the test and probably scored high enough that in combination with my awesome grades I can have my pick of residencies.