Can Anesthesiologists refuse to work a case for any reason?

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Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?

You don’t like the surgeon is not a good reason.

You know the person personally, as long as the patient is okay, you’re out of luck.

Cosmetic surgery? Really? That’s your cash cow. You don’t want to do it?!

D&E would be a better case to use the moral high ground.

It really depends on your practice and department.
 
Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?

You will be blacklisted and known as "that guy" if you dont have a good, solid reason.
 
If I cancelled for “any” reason I might get away with it once or twice. But eventually I’d be talking to administration and my contract would likely not be renewed.

For a good reason -no consent, further workup needed, something outside your typical scope of practice, etc.- yes, happens a couple times a year. Almost never goes further than my department unless a surgeon really pushes them then rarely a call from admin for justification. Everyone goes on with their day.

Questionable stuff like you mentioned. I could switch with a partner with little difficulty if need be. We do this occasionally.
 
I basically refused to do one case in my 13 years of anesthesia. The patient (adult, non special needs though clearly something is wrong with her) came in for a CT abdomen and "told" me that she was going to be mask induced and then have a CVL placed in her neck. No way I was going to do that. Fortunately for me the H&P was well over 30 days so she was cancelled anyways and never heard back from her again.

Honestly this is an odd question and not sure what you're trying to get out of this. Are you a student, resident, or attending? But anyways, as a physician, we can proceed however we think is safe and reasonable. If it is an unreasonable request or a cardiologist "clears" a patient that I don't agree with, then I'll stand up for what I feel is right.
 
This is nothing but a business. You go around canceling cases for no reason or disrupting or flow because you don't want to do a particular case, you will be removed. Unless you are some sort of superstar, the more demands you make, the higher chances you will be booted.
 
Remember that when you cancel a case for an arbitrary reason, you are reaching into the surgeon's and hospital/surgery center's wallet and ripping up money. That's what you are doing. It's the nuclear option, so you had better have a great reason and do it rarely or never.

A better approach is to share your concerns with the surgeon/team in a way that makes them want to cancel it. That way, they own the decision and don't hold it against you. I work in a small enough town that you are going to see the people you work with at Costco, at soccer games, birthday parties, school functions, etc. Why burn bridges and sour relationships unnecessarily?
 
Is this a meme? What happens if you're blacklisted or known as "that guy"?

No it isn't a meme. It is reality.

Be able to defend your reason for refusing to do a case or canceling a case. Even wishy washy medical reasons are scrutinized. Doing it on a whim because you don't like the surgeon is a sure way to get yourself mothballed (or if you dont want to work with someone you arrange for another anesthesiologist to take over well beforehand, probably with a lot of asskissing). This is true even in academic medicine. In PP doing **** like that is career suicide.
 
What medical conditions have you guys cancelled a case for? I have seen cases delayed for electrolyte optimization, INR reversal, or something of that sort. Surgeons have cancelled cases they wanted to add on but never really knew what the reason was other than maybe family or pt changed their mind. One of my attendings in residency got **** from surgeons because he refused to do an ICU trainwreck in florid heart failure, and they made him consult with a couple of other anesthesiologists who also agreed lol. I have turfed off a couple of cases to cardiac anesthesiologist where I felt was over my head because I am not familiar with the resources needed at a certain facility if shtf that would be better served by the specialist anesthesiologist who knows and can pull the resources necessary.
 
Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?
Sure. Why not?

In any group, the most intolerant person makes the rules. You just have to be that person. And have to be indispensable enough that they don’t replace you.

You know the waters you are swimming better than anyone here.
 
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Sure. Why not?

In any group, the most intolerant person makes the rules. You just have to be that person. And have to be indispensable enough that they don’t replace you.

You know the waters you are swimming better than anyone here.

If the OP is asking these questions, I dont think he/she is the one in the group making the rules
 
Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?


what kind ok question is this? Do you really think it's appropriate to cancel a case for for silly reasons? It's not easy for patients to take time off of work. Please don't feed the troll...
 
What medical conditions have you guys cancelled a case for? I have seen cases delayed for electrolyte optimization, INR reversal, or something of that sort. Surgeons have cancelled cases they wanted to add on but never really knew what the reason was other than maybe family or pt changed their mind. One of my attendings in residency got **** from surgeons because he refused to do an ICU trainwreck in florid heart failure, and they made him consult with a couple of other anesthesiologists who also agreed lol. I have turfed off a couple of cases to cardiac anesthesiologist where I felt was over my head because I am not familiar with the resources needed at a certain facility if shtf that would be better served by the specialist anesthesiologist who knows and can pull the resources necessary.

There are plenty of reasonable medical reasons cases get cancelled for. Elective procedures shortly after strokes. Stopping DAPT 2 months after DES and trying to do an elective procedure. New onset A. Fib with rvr in holding at the surgery center in the guy that’s healthy cause he’s never seen a doctor.

Being the first guy in your group to do an ECT in a 600lb patient in my opinion requires discussing with your partners before unilaterally agreeing for your group to serially play with fire for questionable benefit.
 
Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?

There are several cases that I flipped to colleagues to do for various reasons: patient who was in a fender/bender with my daughter, contractor who I had a dispute with, etc.
The only one that I refused that was disruptive to the schedule was when I was on call, last case of the day (elective) was going to go late. Patient who had previously sued me. Surgeon asked if a colleague could stay late as opposed to inconveniencing the patient. Nobody was willing. The patient had zero issues.
 
what kind ok question is this? Do you really think it's appropriate to cancel a case for for silly reasons? It's not easy for patients to take time off of work. Please don't feed the troll...
I hope you don't really think I'm a troll, that's quite an insult.

With regard to the question, I never really said cancel the case, I meant refuse before any of it got started. That way there is no drama or money at risk from any party.
 
Whether it be that you don't like the surgeon, the patient was your childhood bully, you find cosmetic surgery immoral, etc..

Where is the line? When can you refuse to work a case, and how does it affect you?

Yup. I can refuse any case, any time. Just like I can refuse to show up to work, talk to my wife, pay my bills.

There will be consequences though, just like any of those other things.

At this point in my career, I could probably get away with flat out saying **** you for any reason I want to any of our surgeons or patients once, with no long term consequences. I would not advise that approach to any of my junior partners, and I am probably going to spend some time in a freaking meeting talking about it. I bet 3 times of telling surgeons to **** off (without a reason) would be the line.

If I am just pawning a case off on a partner because I know the person (or really any reason)?
Totally cool. I do that frequently for young teenage girls who are friends with my kids, having surgery which will expose them. I have taken care of a bunch of my partners’ social friends, or kids’ boyfriends or friends for the same reason. One of my partners won’t do Jehovah witnesses, which is no biggie. As long as the patient isn’t abandoned and someone cares for them, it is super reasonable to have it not be you.
 
I don't think I've ever "cancelled" a case. Postponed, on the other hand...

Wait, I take it back. There was the 90yo with severe dementia, stroke, and carotid body tumor with vascular compression that was scheduled for elective dental work. That was cancel cancelled. Even still, it's more of a "conversation" with the dentist and the granddaughter/HCPOA wherein I make them realize that them cancelling it is the smartest decision.
 
I don't think I've ever "cancelled" a case. Postponed, on the other hand...

Wait, I take it back. There was the 90yo with severe dementia, stroke, and carotid body tumor with vascular compression that was scheduled for elective dental work. That was cancel cancelled. Even still, it's more of a "conversation" with the dentist and the granddaughter/HCPOA wherein I make them realize that them cancelling it is the smartest decision.

Agree. I have never "cancelled" a case. However, I have "postponed the procedure pending further medical optimization", words matter.
 
Agree. I have never "cancelled" a case. However, I have "postponed the procedure pending further medical optimization", words matter.
I have cancelled a lot of cases over 10 years. Not soft calls, but obvious ones. Patients and families end up crying, but ultimately if it is obviously the right choice, just do it. They almost always understand after some discussion.

Soft calls are good ones to mention to patient and surgeon, present risks and alternatives and get some consensus.

But there are times where it is super obvious. Just take the ? Out of it and make a call.
 
I hope you don't really think I'm a troll, that's quite an insult.

With regard to the question, I never really said cancel the case, I meant refuse before any of it got started. That way there is no drama or money at risk from any party.

What level of training are you at? There’s always drama and money at risk.
 
What level of training are you at? There’s always drama and money at risk.
Agree, once a surgeon has decided to operate, anything slowing down their paycheck is a drama/money decision. Good thing we are doctors and that isn’t the primary driver for our decisions.
 
An attending while I was in residency refused to be the solo provider in any cases with fluoro or mask inductions as he didn't want to expose himself to any radiation or unnecessary vapor. No cancer history or anything else like this. Never gave us breaks during vascular or ortho cases. Always found someone else to do it for him. I always marvelled none of his colleagues called him out on this.
 
An attending while I was in residency refused to be the solo provider in any cases with fluoro or mask inductions as he didn't want to expose himself to any radiation or unnecessary vapor. No cancer history or anything else like this. Never gave us breaks during vascular or ortho cases. Always found someone else to do it for him. I always marvelled none of his colleagues called him out on this.
That guy was a genius!
 
Jehovah's Witness for non emergent surgery with potential for heavy blood loss. Would have someone else do the case. Hemipelvectomy, liver resection etc. Plenty of people would allow them to bleed to death, I would not.
 
Jehovah's Witness for non emergent surgery with potential for heavy blood loss. Would have someone else do the case. Hemipelvectomy, liver resection etc. Plenty of people would allow them to bleed to death, I would not.


Agree. Would not even contemplate taking them to OR unless they sign waiver to give blood. Occurred twice during residency( both signed waiver).
 
Agree. I have never "cancelled" a case. However, I have "postponed the procedure pending further medical optimization", words matter.

I second this. Words matter a lot. Documentation is important and quite often overlooked.

I personally have canceled 2 cases in my career. Both were for clinical reasons. I also recognize that I am the gatekeeper. Multiple functions of the hospital cannot function without my facilitation, but if my facilitation is overly burdensome they will replace me. It's a balance and ultimately I think that Jehovah's and abortion cases are the only ones where we can take ethical stands.

At the end of the day I am a cog in the system but I also have to sleep at night. Do that which allows you to best sleep at night.
 
Agree. Would not even contemplate taking them to OR unless they sign waiver to give blood. Occurred twice during residency( both signed waiver).
On more than one occasion I have seen the family called in to say goodbye to Grandma when the QRS is widening, only to then demand she be transfused. I would switch assignments for elective cases.For on call emergencies, I would not ask a colleague to come in. I would make the patient shake my hand and tell me under no circumstances to give them blood. I then promised it will take a court order and a sheriff bigger than me to transfuse you. I actually took care of the hemipelvectomy patient on a fri, as I was on call the weekend and could not find anyone to switch on short notice. They passed on sat. It still troubles me.
 
I second this. Words matter a lot. Documentation is important and quite often overlooked.

I personally have canceled 2 cases in my career. Both were for clinical reasons. I also recognize that I am the gatekeeper. Multiple functions of the hospital cannot function without my facilitation, but if my facilitation is overly burdensome they will replace me. It's a balance and ultimately I think that Jehovah's and abortion cases are the only ones where we can take ethical stands.

At the end of the day I am a cog in the system but I also have to sleep at night. Do that which allows you to best sleep at night.
What's the deal with jehovas? Why does this keep coming up?
 
On more than one occasion I have seen the family called in to say goodbye to Grandma when the QRS is widening, only to then demand she be transfused. I would switch assignments for elective cases.For on call emergencies, I would not ask a colleague to come in. I would make the patient shake my hand and tell me under no circumstances to give them blood. I then promised it will take a court order and a sheriff bigger than me to transfuse you. I actually took care of the hemipelvectomy patient on a fri, as I was on call the weekend and could not find anyone to switch on short notice. They passed on sat. It still troubles me.

There was a Jehovah's pt in ICU that refused transfusion when family around, but he would ask to be transfused without their knowledge after they left the room so he wouldn't die... But many if not most Jehovah's I've had have no idea what the fluids\products we have. No idea what cell salvage, albumin, etc or anything is. All they do is refuse... Legally we can't be charged with their demise if they bleed to death and their family decides to change their mind, right?
 
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What's the deal with jehovas? Why does this keep coming up?

Had one Jehovah we used experimental hemoglobin thing on trial from FDA in the ICU because she and family absolutely refused prbc. Regardless of the fact that she was suffering from respiratory failure and reintubations because of her decompensated state due to the anemia among the multiple issues she had. Had to limit blood draws and use pediatric blood tubes when we did to limit blood iatrogenic loss. In that aspect Jehovah's pts push the science of blood saving techniques, if there is a positive in that aspect....
 
There was a Jehovah's pt in ICU that refused transfusion when family around, but he would ask to be transfused without their knowledge after they left the room so he wouldn't die... But many if not most Jehovah's I've had have no idea what the fluids\products we have. No idea what cell salvage, albumin, etc or anything is. All they do is refuse... Legally we can't be charged with their demise if they bleed to death and their family decides to change their mind, right?
That was the understanding our hospital operated under. Of course you can be sued for anything, but our lawyers felt we would prevail in court.
 
There was a Jehovah's pt in ICU that refused transfusion when family around, but he would ask to be transfused without their knowledge after they left the room so he wouldn't die... But many if not most Jehovah's I've had have no idea what the fluids\products we have. No idea what cell salvage, albumin, etc or anything is. All they do is refuse... Legally we can't be charged with their demise if they bleed to death and their family decides to change their mind, right?
Yeah some of them aren’t all that serious when the preacher guy and the family aren’t around!
 
Yeah some of them aren’t all that serious when the preacher guy and the family aren’t around!

During residency, we had a trauma patient who was intubated and unable to consent. His family and Jehovah’s Witness people showed up and adamantly said he refuses blood. Thankfully he didn’t need any. But when he woke up he said, “I don’t believe in that crap.”
 
During residency, we had a trauma patient who was intubated and unable to consent. His family and Jehovah’s Witness people showed up and adamantly said he refuses blood. Thankfully he didn’t need any. But when he woke up he said, “I don’t believe in that crap.”

Thats ****ed up
 
During residency, we had a trauma patient who was intubated and unable to consent. His family and Jehovah’s Witness people showed up and adamantly said he refuses blood. Thankfully he didn’t need any. But when he woke up he said, “I don’t believe in that crap.”
Thats ****ed up

In an emergency situation can we go by what family says if the patient themselves can't verbalize what they want? Unless there is an advance directive that states that, I'm not sure I would hold back transfusion if I got an emergency case with an unresponsive pt who would need blood to survive with no documentation of their wishes. What if the family doesn't want the individual to survive so they claim Jehovah's witness, you never know lol
 
In an emergency situation can we go by what family says if the patient themselves can't verbalize what they want? Unless there is an advance directive that states that, I'm not sure I would hold back transfusion if I got an emergency case with an unresponsive pt who would need blood to survive with no documentation of their wishes. What if the family doesn't want the individual to survive so they claim Jehovah's witness, you never know lol

Ethics and Risk should be involved in such decisions
 
In an emergency situation can we go by what family says if the patient themselves can't verbalize what they want? Unless there is an advance directive that states that, I'm not sure I would hold back transfusion if I got an emergency case with an unresponsive pt who would need blood to survive with no documentation of their wishes. What if the family doesn't want the individual to survive so they claim Jehovah's witness, you never know lol
Interesting dilemma. Let them sue me. I would rather be the guy that saved the patient than the guy who let the patient die. Perhaps there is some case law here. Ethics involvement sounds great but these things can happen pretty quickly.
 
Interesting dilemma. Let them sue me. I would rather be the guy that saved the patient than the guy who let the patient die. Perhaps there is some case law here. Ethics involvement sounds great but these things can happen pretty quickly.

Would be an interesting court case... Where the surviving person with a good outcome sues the doctor for saving their life when they could have been left for dead haha
 
Would be an interesting court case... Where the surviving person with a good outcome sues the doctor for saving their life when they could have been left for dead haha

Can they sue you for committing them to eternal damnation??

What sort of punitive damages would be talkin’ for something like that? What might a jury award as pain/suffering for having to endure the flames of hell!?
 
On more than one occasion I have seen the family called in to say goodbye to Grandma when the QRS is widening, only to then demand she be transfused. I would switch assignments for elective cases.For on call emergencies, I would not ask a colleague to come in. I would make the patient shake my hand and tell me under no circumstances to give them blood. I then promised it will take a court order and a sheriff bigger than me to transfuse you. I actually took care of the hemipelvectomy patient on a fri, as I was on call the weekend and could not find anyone to switch on short notice. They passed on sat. It still troubles me.
So did the blood save Grandma? Sounds like the point of no return at that point. Total BS.
 
Had one Jehovah we used experimental hemoglobin thing on trial from FDA in the ICU because she and family absolutely refused prbc. Regardless of the fact that she was suffering from respiratory failure and reintubations because of her decompensated state due to the anemia among the multiple issues she had. Had to limit blood draws and use pediatric blood tubes when we did to limit blood iatrogenic loss. In that aspect Jehovah's pts push the science of blood saving techniques, if there is a positive in that aspect....
Take them away from their husbands. Question them away from their families. They often change their minds and be honest about death and tell them you won’t let anyone find out about it.

The men in that denomination tend to be very controlling of their families and wives.
 
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