Can Anesthesiologists refuse to work a case for any reason?

[DrZzZz]

If the patient has that right, then anyone involved in their case has the right to object. There is no obligation to be an escort to someone's sure/probable demise at what amounts to the patient's own hand (JW etc). To suggest that there is no potential residual psychological effect on the persons involved is willfully ignorant of what we know about moral injury and psychological stress. If some are willing to take that on voluntarily or deny that is an issue for them, they can have at it.

I didn't suggest that health professionals don't have some ability to remove themselves from care in certain situations (does not apply in emergencies as others have stated). Personally, if a patient is making that call for themselves and I feel they really grasp the high possibility of death with their choices, I reluctantly will proceed after heavily documenting the conversation in the chart. I don't feel responsible for the outcomes of their poor choices as long as I did my job explaining the medical downsides of it.

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[chocomorsel]

do you allow your patients to get whatever type of anesthetic they want, if they understand the risks and benefits and consent to it?

your healthy patient wants GA for cataract with a tube, and is willing to take all the risks. etc

Wondering b/c ive told patients No before when they requested GA, especially for C sections.

Hell no. This ain’t Burger King.

 

[chocomorsel]

If the patient has that right, then anyone involved in their case has the right to object. There is no obligation to be an escort to someone's sure/probable demise at what amounts to the patient's own hand (JW etc). To suggest that there is no potential residual psychological effect on the persons involved is willfully ignorant of what we know about moral injury and psychological stress. If some are willing to take that on voluntarily or deny that is an issue for them, they can have at it.

Amen!

 

[chocomorsel]

One case I got written up for refusing about 15 years ago for was a PPTL. Patient had known and obvious difficult airway. Unpleasant experience with regional anesthesia in past and absolutely refused regional. I told her to come back in six weeks when a GA would be safer. Or take a spinal today.

And yet you got written up. By doing what was best for the patient. What a bunch of crock. Who wrote you up and what was the follow up?
The state of medicine in this country. SMH.

 

[chocomorsel]

I didn't suggest that health professionals don't have some ability to remove themselves from care in certain situations (does not apply in emergencies as others have stated). Personally, if a patient is making that call for themselves and I feel they really grasp the high possibility of death with their choices, I reluctantly will proceed after heavily documenting the conversation in the chart. I don't feel responsible for the outcomes of their poor choices as long as I did my job explaining the medical downsides of it.

It wasn’t you who suggested it. But good thing there are people like you. I won’t do it reluctantly at all unless it’s an emergency.

 

[Zekchar]

I never had a problem finding someone to switch an elective case. Refused to do a c section for the 5th child. 5% incidence of placenta accreta with each section. So 20% chance of section/hysterectomy. If you have never lived through one of these, they are a blood bath and require transfusions once a surgeon arrives to bail out the OBGyn. I could not live with myself letting the mother of 5 children bleed to death. She underwent an uneventful section/ tubal. I'm grateful it all worked out.

I will have to disagree here. I will even go further and say I would NOT want you as a partner in my group with this kind of sentiment.

1) It is the patient's right to object to blood as a Jehovah. You have no further say in this matter. A C-Section is a medical necessity in this case and is no longer elective.
2) You punting on this case forces someone else to have to deal with this nightmare. No that other anesthesiologist still cannot transfuse the patient and will have to deal with the same challenge that you would have.
3) Nobody wants the mother to die, including herself. Refusing this case is inappropriate.
4) You refusing to do this case is the same as a 50 year old anesthesiologist refusing to do a COVID intubation due to being high risk and insisting that the 35 year old colleague do it instead. You refusing to do this case is like declining to do a difficult airway awake intubation for a GA requiring case and insisting your partner do it instead.
5) Our job is difficult and some cases are harder than others. While you may weasel your way out of some cases and play the system, in the long run your partners will catch on and resent you. And they should since that's a cowardly move on your part.
6) I would not want you as a partner and as my backup.

 

[dannyboy1]

It was an elective repeat section and she was a Witness, sorry if I didnt make that clear. I only punted Witnesses for elective cases that could require transfusions. Not a carpal tunnel, etc. I never had a problem switching with an associate. Emergencies as I said earlier were different. I wouldn't call in a partner to do that.

This isn’t elective. The baby is in there and is gonna have to come out via c section. There is no option to not have the procedure. Elective is like knee replacement ....

 

[pjl]

I see anyone saying that they would refuse to care for an elective JW case, but would allow someone to be DNR in the OR as someone who is being a bit hypocritical. In my mind those are similar choices.
That said, I provide care for both those types of people, and have suffered the psychological toll of doing so.

Every time I get stuck doing one of these cases for my partner, I think he is crappy and go over how many more months till he retires.

 

[Arch Guillotti]

I will have to disagree here. I will even go further and say I would NOT want you as a partner in my group with this kind of sentiment.

1) It is the patient's right to object to blood as a Jehovah. You have no further say in this matter. A C-Section is a medical necessity in this case and is no longer elective.
2) You punting on this case forces someone else to have to deal with this nightmare. No that other anesthesiologist still cannot transfuse the patient and will have to deal with the same challenge that you would have.
3) Nobody wants the mother to die, including herself. Refusing this case is inappropriate.
4) You refusing to do this case is the same as a 50 year old anesthesiologist refusing to do a COVID intubation due to being high risk and insisting that the 35 year old colleague do it instead. You refusing to do this case is like declining to do a difficult airway awake intubation for a GA requiring case and insisting your partner do it instead.
5) Our job is difficult and some cases are harder than others. While you may weasel your way out of some cases and play the system, in the long run your partners will catch on and resent you. And they should since that's a cowardly move on your part.
6) I would not want you as a partner and as my backup.

That was rough. I agree with all of it though.

 

[deleted682700]

Few times, I brought my concern to the chief of anesthesia and operating surgeon was with a new onset a fib with heart rate 130 for a permanent dialysis access. It was worked up and hospitalist and cardio got involved
corrected it and then had the surgery.

 

[Arch Guillotti]

Few times, I brought my concern to the chief of anesthesia and operating surgeon was with a new onset a fib with heart rate 130 for a permanent dialysis access. It was worked up and hospitalist and cardio got involved
corrected it and then had the surgery.

Why does the chief of anesthesia need to be involved?

 

[Angus Avagadro]

This isn’t elective. The baby is in there and is gonna have to come out via c section. There is no option to not have the procedure. Elective is like knee replacement ....

It was elective. 5th c scetion, came in from home. Its a long thread and you may have missed that. It was an easy switch with one of my associates. As you see from some of the above posters, some people have no problem with taking care of witnesses. I do, for elective cases with a good chance for transfusion.

 

[dannyboy1]

It was elective. 5th c scetion, came in from home. Its a long thread and you may have missed that. It was an easy switch with one of my associates. As you see from some of the above posters, some people have no problem with taking care of witnesses. I do, for elective cases with a good chance for transfusion.

Elective would mean you can do the surgery with the risk of bleeding or you can not do the surgery (as in a knee replacement where the patient can learn to live with the pain). This c section needs to happen, with the same risk of bleeding/death when it happens. What exactly is your argument? That the c section is too risky without the option of transfusion, therefore we should do the exact same procedure with a different anesthesiologist? How does that make sense?

 

[Angus Avagadro]

I will have to disagree here. I will even go further and say I would NOT want you as a partner in my group with this kind of sentiment.

1) It is the patient's right to object to blood as a Jehovah. You have no further say in this matter. A C-Section is a medical necessity in this case and is no longer elective.
2) You punting on this case forces someone else to have to deal with this nightmare. No that other anesthesiologist still cannot transfuse the patient and will have to deal with the same challenge that you would have.
3) Nobody wants the mother to die, including herself. Refusing this case is inappropriate.
4) You refusing to do this case is the same as a 50 year old anesthesiologist refusing to do a COVID intubation due to being high risk and insisting that the 35 year old colleague do it instead. You refusing to do this case is like declining to do a difficult airway awake intubation for a GA requiring case and insisting your partner do it instead.
5) Our job is difficult and some cases are harder than others. While you may weasel your way out of some cases and play the system, in the long run your partners will catch on and resent you. And they should since that's a cowardly move on your part.
6) I would not want you as a partner and as my backup.

We disagree. Gotta love the collegiality on an anonymous forum. Apparently I can disagree in an agreeable fsshion. I can refuse to accept the parameters someone places on me for an elective case. An emergency is different. There is a large congregation in our area and I have taken care of several JWs as emergencies on call. I have never refused to participate in anything like the false analogies you provide. Remember, I didn't refuse to do or cancel the case, I switched with a partner who was willing to do it. As far as being a partner, I'm pretty sure your sparkling " Go along to get along" personality would have excluded you from being one of my partners. You don't have to worry about me being one of yours, I've recently retired.

 

[Angus Avagadro]

Elective would mean you can do the surgery with the risk of bleeding or you can not do the surgery (as in a knee replacement where the patient can learn to live with the pain). This c section needs to happen, with the same risk of bleeding/death when it happens. What exactly is your argument? That the c section is too risky without the option of transfusion, therefore we should do the exact same procedure with a different anesthesiologist? How does that make sense?

I guess you didnt read my reasoning above. In this case I can't abide a mother of 5 bleeding to death when a transfusion would easily save her. Her risk of placenta accreta and a section hyster is 20% and where I worked at the time, it would have been a 5 to 10 unit case with a general surgeon called in. It was non emergent and was an easy switch with an associate.

 

[ProwlerturnGas]

. You don't have to worry about me being one of yours, I've recently retired.
[/QUOTE]

This makes more sense to me now. I totally get it.

 

[zizzer]

I see anyone saying that they would refuse to care for an elective JW case, but would allow someone to be DNR in the OR as someone who is being a bit hypocritical. In my mind those are similar choices.
That said, I provide care for both those types of people, and have suffered the psychological toll of doing so.

Every time I get stuck doing one of these cases for my partner, I think he is crappy and go over how many more months till he retires.

Just to see where this goes, the difference to me seems to be that a DNR wish is generally based on the concept of futility, where the interventions to prolong life tend to include pain and suffering without substantial benefit. That seems to be a significant difference to somebody not in that situation who simply has a magical belief about blood transfusions. Now back to my comparison. Would you do a nonemergency VATS or airway surgery on somebody if they had some magical belief against pulse oximeters?

Another point to clarify: I don't think any of us are trying to say they don't have a right to make dumb decisions and refuse essential components like blood transfusions. Rather, the question is if we're obligated to perform non-emergency surgeries in an unsafe way based on ridiculous demands.

 

[Southpaw]

I guess you didnt read my reasoning above. In this case I can't abide a mother of 5 bleeding to death when a transfusion would easily save her. Her risk of placenta accreta and a section hyster is 20% and where I worked at the time, it would have been a 5 to 10 unit case with a general surgeon called in. It was non emergent and was an easy switch with an associate.

I don’t totally disagree with your reasoning. I feel ya. You’re right to want nothing to do with that case.

but it’s not completely elective. That baby is coming out whether today or a week(s) from now. And her being a JW, in your scenario and in your hospital, given your numbers, means she has a 20% chance of death. Or some number around there. What I do disagree with is you asking a colleague to take on that substantial risk and everything that comes along with that risk. I have no problem with you switching cases for patient/surgeon personality issues, or whatever, because presumably the surgical/anesthesia risk is low. But asking your partner to take the 1 in 5 death risk, and how that would play out in the OR, doesn’t seem fair to your colleague. Even if they seem cool with it. Congrats on your retirement.

 

[deleted697127]

I never had a problem finding someone to switch an elective case. Refused to do a c section for the 5th child. 5% incidence of placenta accreta with each section. So 20% chance of section/hysterectomy. If you have never lived through one of these, they are a blood bath and require transfusions once a surgeon arrives to bail out the OBGyn. I could not live with myself letting the mother of 5 children bleed to death. She underwent an uneventful section/ tubal. I'm grateful it all worked out.

Was there any evidence of placenta accreta Preop? Did you discuss this with the OB? Are they comfortable with the risk? I think you may be underestimating their ability to assess risk and probability of accreta. They’ve likely had a few months to think about this and consult with colleagues. Just like livers and pediatric hearts, these do better at high volume centers particularly with the amount of blood loss. It would be reasonable to recommend doing this case at a high volume academic center with the availability of IR for emergency embolization or even prophylactic Arterial balloon occlusion, +- emergency backup hyperbaric therapy but humor me....Did they bleed to death?

Ive heard statistics like the ones you’ve mentioned thrown around but i haven’t actually looked into the data deeply...certainly not deeply enough to challenge an Ob who assures me they are comfortable. Accreta is a spectrum and often found on path without clinical significance? Do 20% of 5th time c sections really need an emergency hysterectomy? What percent of these are we able to identify on imaging preop? What percent are only found intraop despite imaging that was not suspicious?

 

[Beeftenderloin]

Was there any evidence of placenta accreta Preop? Did you discuss this with the OB? Are they comfortable with the risk? I think you may be underestimating their ability to assess risk and probability of accreta. They’ve likely had a few months to think about this and consult with colleagues. Just like livers and pediatric hearts, these do better at high volume centers particularly with the amount of blood loss. It would be reasonable to recommend doing this case at a high volume academic center with the availability of IR for emergency embolization or even prophylactic Arterial balloon occlusion, +- emergency backup hyperbaric therapy but humor me....Did they bleed to death?

Ive heard statistics like the ones you’ve mentioned thrown around but i haven’t actually looked into the data deeply...certainly not deeply enough to challenge an Ob who assures me they are comfortable. Accreta is a spectrum and often found on path without clinical significance? Do 20% of 5th time c sections really need an emergency hysterectomy? What percent of these are we able to identify on imaging preop? What percent are only found intraop despite imaging that was not suspicious?

I participated in a C-section on a high risk patient like this at a high volume center during med school. They actually put bilateral femoral artery sheaths in prophylactically so IR already had access in the event they did need embolization. Thankfully, didn’t end up needing to use them. Cool case.

That being said, it’s one thing to suggest a higher level of care, where services like this are available if a patient like this is coming in electively to your community hospital.

It’s another thing entirely to pawn all that headache, risk, and “moral injury” off on a colleague. Recognizing how hard it would be to lose a patient in a case like this, knowing what it would do to you emotionally and asking to put that pain on someone else is not collegial behavior. It’s selfish and disrespectful to those you work with. If it’s difficult for you, it’s difficult for everyone else. Part of doing this job involves navigating life and death situations in a complex and dynamic moral landscape. If that’s not your jam, go do scopes and cataracts somewhere. I really hate the term snowflake and all the play its been getting lately, but man...

 

[dhb]

what if your employer decide to put you in a difficult spot, which increases legal risk and possibly decrease care? can anesthesiologist decide to not do it other than quit. or will anesthesiologist be legally responsible for not doing the emergency case?

example: employer starts a level 1 trauma service and obviously will need anesthesiologist to be part of it. now all of a sudden, as a employee on call you now have to cover level 1 trauma, and busy OB service. anesthesiologists tell admin its not safe, but they continue the start of level 1 trauma anyway, they give salary fund to hire 1 additional anesthesiologist to cover. so i guess in this situation since the admin is deciding to move forward, all the responsibility falls on anesthesiology department to make this work? can the attendings even decide not to staff the trauma service without being legally responsible...

Enough JW stuff... can we go back to this question: what do you do when admin want's to start certain types of procedures the staff is not prepared to do and you think it's unsafe. Or if they let a surgeon operate on a day you have no one to staff his cases...

 

[deleted697127]

Enough JW stuff... can we go back to this question: what do you do when admin want's to start certain types of procedures the staff is not prepared to do and you think it's unsafe. Or if they let a surgeon operate on a day you have no one to staff his cases...

Negotiate. Depends on local competition and incentives. If I’m not salaried, I’m not doing anything for free.

 

[Arch Guillotti]

It’s another thing entirely to pawn all that headache, risk, and “moral injury” off on a colleague. Recognizing how hard it would be to lose a patient in a case like this, knowing what it would do to you emotionally and asking to put that pain on someone else is not collegial behavior. It’s selfish and disrespectful to those you work with. If it’s difficult for you, it’s difficult for everyone else. Part of doing this job involves navigating life and death situations in a complex and dynamic moral landscape. If that’s not your jam, go do scopes and cataracts somewhere. I really hate the term snowflake and all the play its been getting lately, but man...

Exactly!

 

[Angus Avagadro]

I don’t totally disagree with your reasoning. I feel ya. You’re right to want nothing to do with that case.

but it’s not completely elective. That baby is coming out whether today or a week(s) from now. And her being a JW, in your scenario and in your hospital, given your numbers, means she has a 20% chance of death. Or some number around there. What I do disagree with is you asking a colleague to take on that substantial risk and everything that comes along with that risk. I have no problem with you switching cases for patient/surgeon personality issues, or whatever, because presumably the surgical/anesthesia risk is low. But asking your partner to take the 1 in 5 death risk, and how that would play out in the OR, doesn’t seem fair to your colleague. Even if they seem cool with it. Congrats on your retirement.

Thanks. I agree
Our definition is a little different in so much as I basically was saying it wasn't emergent, she could go home and come back tomorrow or have come in the day before. Several of my partners felt the same way other posters here do and had no problem caring for the patient under her religious constraints. Could some, as you point out feel put upon? I suppose., and I'm grateful for their willingness to pitch in
. I guess I've seen or been involved with a few horrible situations and didn't want to participate in another. I really didn't think my response to the OP would have produced such lively comments.

 

[Angus Avagadro]

Was there any evidence of placenta accreta Preop? Did you discuss this with the OB? Are they comfortable with the risk? I think you may be underestimating their ability to assess risk and probability of accreta. They’ve likely had a few months to think about this and consult with colleagues. Just like livers and pediatric hearts, these do better at high volume centers particularly with the amount of blood loss. It would be reasonable to recommend doing this case at a high volume academic center with the availability of IR for emergency embolization or even prophylactic Arterial balloon occlusion, +- emergency backup hyperbaric therapy but humor me....Did they bleed to death?

Ive heard statistics like the ones you’ve mentioned thrown around but i haven’t actually looked into the data deeply...certainly not deeply enough to challenge an Ob who assures me they are comfortable. Accreta is a spectrum and often found on path without clinical significance? Do 20% of 5th time c sections really need an emergency hysterectomy? What percent of these are we able to identify on imaging preop? What percent are only found intraop despite imaging that was not suspicious?

Thanks for some excellent points. This was long ago and was at a tertiary womens center. We did around 1,000 deliveries a month. The OB was concerned and she talked to me about it before I talked to my associate. I had been involved with a couple section hysters there and they were very bloody. A general surgeon needed to be called in. I know, you would think at a tertiary center an OB could handle it. It wasn't my experience. The best OBs I ever worked with were at a community hospital where I arrived 11 min after being paged, they were sewing the uterus. They did the section under straight local. The big city OBs were not nearly skillful enough to do that. As far as IR getting involved, I doubt at that time they would. The OB never mentioned or consulted them to my knowledge. As to the outcome, totally uneventful. So my angst in the end was unwarranted. Guess I should have focused more on the 80% success as opposed to the 20% complication.

 

[Angus Avagadro]

I participated in a C-section on a high risk patient like this at a high volume center during med school. They actually put bilateral femoral artery sheaths in prophylactically so IR already had access in the event they did need embolization. Thankfully, didn’t end up needing to use them. Cool case.

That being said, it’s one thing to suggest a higher level of care, where services like this are available if a patient like this is coming in electively to your community hospital.

It’s another thing entirely to pawn all that headache, risk, and “moral injury” off on a colleague. Recognizing how hard it would be to lose a patient in a case like this, knowing what it would do to you emotionally and asking to put that pain on someone else is not collegial behavior. It’s selfish and disrespectful to those you work with. If it’s difficult for you, it’s difficult for everyone else. Part of doing this job involves navigating life and death situations in a complex and dynamic moral landscape. If that’s not your jam, go do scopes and cataracts somewhere. I really hate the term snowflake and all the play its been getting lately, but man...

It would be selfish and disrespectful if my associate felt the way I do. From other posts, others dont feel the same way I do, so I'm not sure the moral injury or disrespectful comments are accurate.

 

[WholeLottaGame7]

It would be selfish and disrespectful if my associate felt the way I do. From other posts, others dont feel the same way I do, so I'm not sure the moral injury or disrespectful comments are accurate.

I think his points were valid. Unless your practice was full of psychopaths, having a young mother of 5 pass away from a potentially preventable cause is going to be emotionally traumatic even for those willing to accept her beliefs and run the risk. Your partners switched with you because they knew it needed to be done, not because they were psyched for the chance to watch someone die. I would not equate a willingness to do the procedure with any special ability to process the event, other than perhaps someone younger having less pre-existing burnout from seeing less bad outcomes.

It seems like the real issue is you were towards the end of your career, and tired of seeing bad stuff happen if you could avoid it. There's no shame in that, it probably happens to most people. One of the best peds anesthesiologists I know refused to take care of kids with severe pulmonary hypertension the last couple years of her career because she had a kid die in cath lab. I certainly didn't think any less of her. I will almost certainly hit that point in the future, also (another reason to be ready to retire early, if it comes to that).

If you're in a big group and the issue only comes up once or twice a year (or less), it's probably not that onerous. But as it becomes more frequent, say, once or twice a month, it's going to start to wear on everyone else, regardless of what they tell you. It seems like you got out before that point, so kudos to you.

 

[Beeftenderloin]

Thanks. I agree
Our definition is a little different in so much as I basically was saying it wasn't emergent, she could go home and come back tomorrow or have come in the day before. Several of my partners felt the same way other posters here do and had no problem caring for the patient under her religious constraints. Could some, as you point out feel put upon? I suppose., and I'm grateful

It would be selfish and disrespectful if my associate felt the way I do. From other posts, others dont feel the same way I do, so I'm not sure the moral injury or disrespectful comments are accurate.

Literally EVERYONE feels the way you do. Nobody wants to do this case. Nobody wants to watch a mother of 5 bleed to death in front of them. They do it because it’s a part of the very difficult job that we all signed up for. It sounds like retirement was the right call.

 

[vector2]

I inherited three COVID pts who were all vented > 12 days when I took over service this past month. During my week two of them died, one of them got trach/PEG’ed. The oldest was 64. Guess I should’ve just pawned them off on another intensivist who “doesn’t feel the way that I do.”

 

[chocomorsel]

We disagree. Gotta love the collegiality on an anonymous forum. Apparently I can disagree in an agreeable fsshion. I can refuse to accept the parameters someone places on me for an elective case. An emergency is different. There is a large congregation in our area and I have taken care of several JWs as emergencies on call. I have never refused to participate in anything like the false analogies you provide. Remember, I didn't refuse to do or cancel the case, I switched with a partner who was willing to do it. As far as being a partner, I'm pretty sure your sparkling " Go along to get along" personality would have excluded you from being one of my partners. You don't have to worry about me being one of yours, I've recently retired.

Boouyah MoFos!!!!!
And the Mike drops!
That’s what I am talking about.
Don’t take no crap.

 

[deleted162650]

I inherited three COVID pts who were all vented > 12 days when I took over service this past month. During my week two of them died, one of them got trach/PEG’ed. The oldest was 64. Guess I just should’ve just pawned them off on another intensivist who “doesn’t feel the way that I do.”

What kinda shape were these people in pre-COVID?

 

[chocomorsel]

Thanks. I agree
Our definition is a little different in so much as I basically was saying it wasn't emergent, she could go home and come back tomorrow or have come in the day before. Several of my partners felt the same way other posters here do and had no problem caring for the patient under her religious constraints. Could some, as you point out feel put upon? I suppose., and I'm grateful for their willingness to pitch in
. I guess I've seen or been involved with a few horrible situations and didn't want to participate in another. I really didn't think my response to the OP would have produced such lively comments.

Lively is a nice way of putting it.
Let me spell out to you what all these folks are trying to tell you.
You suck.
But clearly you don’t give AF what they think.
Good on you.

 

[vector2]

What kinda shape were these people in pre-COVID?

Just regular obese people, all three with HTN and two also with DMII. No other serious PMH

 

[chocomorsel]

I inherited three COVID pts who were all vented > 12 days when I took over service this past month. During my week two of them died, one of them got trach/PEG’ed. The oldest was 64. Guess I should’ve just pawned them off on another intensivist who “doesn’t feel the way that I do.”

Seriously. I have much respect for you. You are always on my team.
But this is totally mean and unnecessary. It’s not the same thing. Not even close.
Covid patients mostly die. Young mothers mostly don’t.
And if you know that there are people who totally have no problem taking care of Jehovas witnesses, and you deeply have a problem with it, why not ask to switch?
Would you have a problem if this same person didn’t believe in abortion and asked a colleague to switch on an elective abortion case? It’s the same concept.
Some people have no problem with letting JW die because they refuse blood and if they tell you this and you have a problem morally, ethically, spiritually, why would asking to switch be a problem?
Someone on this board has already said
that they have no problem.
It’s not the same as saying, “I am not doing it, find someone else.” It’s actively loooking for somebody, sociopath or not, who has no qualms wirh it, and asking nicely to switch.

You all don’t know people like that in your practice?

 

[chocomorsel]

Literally EVERYONE feels the way you do. Nobody wants to do this case. Nobody wants to watch a mother of 5 bleed to death in front of them. They do it because it’s a part of the very difficult job that we all signed up for. It sounds like retirement was the right call.

Yeah, not true. Don’t speak for EVERYONE. Some people are just way more unbothered about certain cases than others.
We are all different.

 

[vector2]

Seriously. I have much respect for you. You are always on my team.
But this is totally mean and unnecessary. It’s not the same thing. Not even close.
Covid patients mostly die. Young mothers mostly don’t.
And if you know that there are people who totally have no problem taking care of Jehovas witnesses, and you deeply have a problem with it, why not ask to switch?
Would you have a problem if this same person didn’t believe in abortion and asked a colleague to switch on an elective abortion case? It’s the same concept.
Some people have no problem with letting JW die because they refuse blood and if they tell you this and you have a problem morally, ethically, spiritually, why would asking to switch be a problem?
Someone on this board has already said
that they have no problem.
It’s not the same as saying, “I am not doing it, find someone else.” It’s actively loooking for somebody, sociopath or not, who has no qualms wirh it, and asking nicely to switch.

You all don’t know people like that in your practice?

Angus went out of his way to highlight the “20% have accretas and require 10 prbcs” figure at his shop. No, it’s not the 40-60% mortality with severe COVID, but he is painting a pretty grim picture. Ultimately, a c-section is just not an elective case, same as taking care of an ICU COVID pt. The COVID pt needs advanced respiratory support one way or another. The csec pt is going to need that baby to come out one way or another. Either I take the responsibility because of my fiduciary duty as a physician or I dump it on someone else who I know is going to have some degree of misgivings no matter how “cool” they say they are with it.

Believe me, getting handicapped into not giving blood by some idiot with magical thinking honestly enrages me. My reptile brain wants to tell them that they are undeserving of my compassion and the absolute miracle that is modern medicine. But part of living in a free society is allowing people to make stupid choices and not punishing them for it, no matter much they “deserve” it. Angus can wax all he wants about how he’s punting the case because he can’t take the moral anguish of losing a mother of 5. I’m just not buying it.

 

[Beeftenderloin]

Yeah, not true. Don’t speak for EVERYONE. Some people are just way more unbothered about certain cases than others.
We are all different.

Okay fine. Aside from a handful of sociopaths, NOBODY wants to do that case. Anyone who says they are “willing” to do that case is not excited about it. I promise you, regardless of what they may say, they don’t want to do it either. They’re doing it because they know that one way or another that woman needs care and since their colleague is unwilling to provide it they’re the one who has to step up, put their big boy pants on and do it.

 

[Arch Guillotti]

Okay fine. Aside from a handful of sociopaths, NOBODY wants to do that case.

Except for all the stone cold assassins around here. You know, the natural born killers.

 

[zizzer]

So what if somebody refused mechanical ventilation because God told them it was unnatural and wrong. Let's say it's a time-sensitive but not emergent case where neuromuscular blockade is indicated. It could be done without, but it puts the patient at higher risk. Would you do it?

Forget the specific details and focus on the main point. I could think of many more of these, "I believe God thinks (whatever) is forbidden" scenarios, some more challenging than others. The point is, if it's unacceptable for patients to dictate medical plans based on religion, why is blood transfusion for JW patients different?

Some of you are making the argument that it's their right to choose dumb things. I agree. I also think it's our right to insist on not practicing unsafe medicine for ridiculous reasons. I don't see that as punishing them because they could choose to have the surgery done right if they wanted to.

 

[coffeebythelake]

Yeah, not true. Don’t speak for EVERYONE. Some people are just way more unbothered about certain cases than others.
We are all different.

But you aren't one of those people who are unbothered by it. So why are you speaking for those other people? I think a quick look at the sentiment on this board shows that most (all?) of us here are bothered by it. Where the disagreement exist is whether we accept jt as part of our responsibilities as physicians, and do what we can in a difficult situation.

 

[chocomorsel]

But you aren't one of those people who are unbothered by it. So why are you speaking for those other people? I think a quick look at the sentiment on this board shows that most (all?) of us here are bothered by it. Where the disagreement exist is whether we accept jt as part of our responsibilities as physicians, and do what we can in a difficult situation.

Maybe I am. Maybe I am not.
Whatever the case, I can understand Angus's reasoning, empathize and understand why he/she would want to switch given the history he/she's given. about JW cases in the past.
I am the kind of person who would straight up say yes or no and mean it. Not feel pushed into a corner to take care of a patient I don't want to but feel obligated to simply because my partner asked, and was uncomfortable.

You all should try it.

d@Angus Avagadro if you hadn't found someone who agreed to do the case, would you have done it?

 

[vector2]

Maybe I am. Maybe I am not.
Whatever the case, I can understand Angus's reasoning, empathize and understand why he/she would want to switch given the history he/she's given. about JW cases in the past.
I am the kind of person who would straight up say yes or no and mean it. Not feel pushed into a corner to take care of a patient I don't want to but feel obligated to simply because my partner asked, and was uncomfortable.

You all should try it.

d@Angus Avagadro if you hadn't found someone who agreed to do the case, would you have done it?

I empathize with everyone who would want to punt that case to a colleague. Part of that empathy is understanding that I would not want someone to dump that case upon me and therefore I would take it upon myself to do that case if my number was up that day for OB.

 

[chocomorsel]

I empathize with everyone who would want to punt that case to a colleague. Part of that empathy is understanding that I would not want someone to dump that case upon me and therefore I would take it upon myself to do that case if my number was up that day for OB.

It's not a dump if someone asks. You are more than welcome to say no. What the hell is so hard about that? You say no, the next say no, everyone says no, then Angus is left holding the bag and puts on the big undies and goes to work.
What is the big deal? What's so hard about saying no if you feel you are being dumped on?

 

[vector2]

So what if somebody refused mechanical ventilation because God told them it was unnatural and wrong. Let's say it's a time-sensitive but not emergent case where neuromuscular blockade is indicated. It could be done without, but it puts the patient at higher risk. Would you do it?

Forget the specific details and focus on the main point. I could think of many more of these, "I believe God thinks (whatever) is forbidden" scenarios, some more challenging than others. The point is, if it's unacceptable for patients to dictate medical plans based on religion, why is blood transfusion for JW patients different?

Some of you are making the argument that it's their right to choose dumb things. I agree. I also think it's our right to insist on not practicing unsafe medicine for ridiculous reasons. I don't see that as punishing them because they could choose to have the surgery done right if they wanted to.

Your logic is sound if we were talking about a totally elective procedure. Again- this baby is coming out one way or another, and it's assault to give her blood against her will.

 

[vector2]

It's not a dump if someone asks. You are more than welcome to say no. What the hell is so hard about that? You say no, the next say no, everyone says no, then Angus is left holding the bag and puts on the big undies and goes to work.
What is the big deal? What's so hard about saying no if you feel you are being dumped on?

You know it's more complicated than a yes or no. Or at least it is in my gig. There are all kinds of nuances vis a vis seniority, being seen as a "team player" etc. An "ask" is not always an "ask"

But even if Angus is a senior partner asking another senior partner, what are the odds that the doc on the receiving end is absolutely delighted from a logistic or moral standpoint to receive that case? Anyone who says yes to that case is being dumped on, willing participant or otherwise

 

[coffeebythelake]

So we've heard from anesthesiologists who don't like to do these cases and have no qualms punting them

And we've heard from anesthesiologists who don't like to do these cases and hate it when they receive the punted cases

But we have yet to hear from this mythical group of anesthesiologists who actually want to do these cases and would gladly accept the punt...

Just saying...

 

[Angus Avagadro]

Maybe I am. Maybe I am not.
Whatever the case, I can understand Angus's reasoning, empathize and understand why he/she would want to switch given the history he/she's given. about JW cases in the past.
I am the kind of person who would straight up say yes or no and mean it. Not feel pushed into a corner to take care of a patient I don't want to but feel obligated to simply because my partner asked, and was uncomfortable.

You all should try it.

d@Angus Avagadro if you hadn't found someone who agreed to do the case, would you have done it?

I absolutely would do the case of I could not find someone to switch. Fortunately, I found someone to switch with. I have taken care of JWs for emergencies before. As I said it was an scheduled elective repeat c section. She came in from home, not in labor. She could have gone home and had the case done in the am. If it was emergent, I would have done it. Some comments here remind me of a gang initiation where they beat the pi$$ out of you before you can join. Fortunately, in this case it all worked out for everyone involved. I have had an extraordinary career and really don't require validation from anyone. We are all different and I can appreciate some of the insights offered here. That said, I can and will continue to sleep well, despite any disagreement. Hopefully this thread will continue in a collegial fashion. Maybe time for another case?

 

[chocomorsel]

So we've heard from anesthesiologists who don't like to do these cases and have no qualms punting them

And we've heard from anesthesiologists who don't like to do these cases and hate it when they receive the punted cases

But we have yet to hear from this mythical group of anesthesiologists who actually want to do these cases and would gladly accept the punt...

Just saying...

This is also my understanding as parental decision-making based on religion is completely nullified in life or death situations such as transfusions. The child did not choose religion... They are a child and do not understand the implications and can't be sacrificed because of their crazy parents. This was repeated ad nauseum in ethics questions and by our legal/ethics lectures in school.

As an aside, I guess I'm a sociopath because I really couldn't care less if a religious person dies from totally avoidable medical problems due to whatever flavor fairy tale they believe instead of all the other fairy tales. It's a waste of money and I think they are *****s but it's not my life. They have their right to die in this country. The only reason I would ever care is if this decision making affects someone dependent on said preventably dead person such as children.

There seems to be one.
And there are like 20 or so of us regulars on this board. I highly doubt we represent the thousands of docs out there who don’t partake in this board.

 

[chocomorsel]

@Angus Avagadro, there are some bullies on this board. People who aggressively try to put each other down. They get a kick out of it I guess.
Glad you have thick skin and don’t care nor need any validation.
I am not special enough to think that you suck enough not to be my partner.

 

[Angus Avagadro]

@Angus Avagadro, there are some bullies on this board. People who aggressively try to put each other down. They get a kick out of it I guess.
Glad you have thick skin and don’t care nor need any validation.
I am not special enough to think that you suck enough not to be my partner.

LOL! That's very sweet of you to say. I played hardball with the big boys for many years , these folks aren't so much. The intellectual lightweights who do the things you mentioned only diminish themselves. I'm very comfortable in my own skin and breadth of experience. I must say I dont care so much for the agressive discusion with the personal attacks within this group. But it appears many have been here for over a decade and it seems to work for them. I find it more agitating than stimulating. I'll stick it out for awhile to see if things improve or I get desensitized. Thanks for the kind words.