Confused

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
N

NeuroKlitch

Full Member
5+ Year Member
Joined
Mar 23, 2017
Messages
139
Reaction score
38
Members don't see this ad.
So , I am on my surgery rotation right now , and it appears that there is 1 anesthesiologist, and multiple CRNA's at this hospital. We're only a few cases today , however everything was done by the CRNAs, and the anesthesiologist only popped his head in for a second to listen to the patients lung sounds after the pt was Intubated and then disappeared. . I attended practically every single case today. So what exactly to anesthesiologists do during their time in a setting like this ? Are they becoming phased out of medicine and more of administrators and managers over the CRNAs ? Not a troll. Was just very confusing . Thanks


Sent from my iPhone using SDN mobile
 
Side note. I think anesthesiology is amazing , as I love physiology and pharmacology. But if this is the future of the field , it seems like all the fun is left to others.


Sent from my iPhone using SDN mobile
 
U should check out cardiac surgeons next. It seems like the surgical PA crack open the chest. Harvest the veins in the legs and the cardiac surgeon only stays for 30-45 minutes and leaves again to join us Anesthesiologists in the break room to trade stocks at 930am opening bell

Our ER doc colleagues bring both the cardiac surgeons and the anesthesiologists Panera food from across the street as their Nps are evaluating most of the patients.

It's a good ole time as the radiologists join all of us by 10am for morning tea
 
NeuroKlitch said:
So , I am on my surgery rotation right now , and it appears that there is 1 anesthesiologist, and multiple CRNA's at this hospital. We're only a few cases today , however everything was done by the CRNAs, and the anesthesiologist only popped his head in for a second to listen to the patients lung sounds after the pt was Intubated and then disappeared. . I attended practically every single case today. So what exactly to anesthesiologists do during their time in a setting like this ? Are they becoming phased out of medicine and more of administrators and managers over the CRNAs ? Not a troll. Was just very confusing . Thanks


Sent from my iPhone using SDN mobile
Click to expand...

The anesthesiologist is there so if something goes wrong, the patient can sue a doctor instead of a nurse.
 
FFP said:
If s/he's not trolling, s/he's just described how many surgeons see us in the ACT "model".
Click to expand...

I have a question tho...

what is stopping a hard-working anesthesiologist from being in each of the rooms and not actually sitting in the lounge?

how many gas docs actually go into each room and keep an eye on each CRNA from not effing it up to actually be doing something?
 
DetectiveAlonzo said:
I have a question tho...

what is stopping a hard-working anesthesiologist from being in each of the rooms and not actually sitting in the lounge?

how many gas docs actually go into each room and keep an eye on each CRNA from not effing it up to actually be doing something?
Click to expand...

It really depends on the case. The super sick patients. U betcha I'm in the case.

The more mundane cases (the other 98% of the cases). I just make sure the case is on the way and patient is stable and I leave.

I tell people I don't get paid for the simple stuff. I get paid the the complicated situations.

If u doing bread and butter stuff every day. U likely are not going to see any difference between crna and MDs. And that's exactly what the AANA wants the public to know. There is no difference.

The highly complex cases done at tertiary care centers are well the MDs are always at.

Unfortunately as long as tough cases at rural hospitals get punted to urban centers. U will never know the difference between MD and Crna's
 
DetectiveAlonzo said:
I have a question tho...

what is stopping a hard-working anesthesiologist from being in each of the rooms and not actually sitting in the lounge?

how many gas docs actually go into each room and keep an eye on each CRNA from not effing it up to actually be doing something?
Click to expand...
I do (I rarely sit). But most times the surgeon is working, and does not notice my (at least) hourly presence (there are few cases that require my continuous presence). And during induction and emergence, God forbid to actually seem to direct/micromanage the CRNA, because that results in bad feelings from those, and they are contagious (you piss off one, you'll start noticing difficulties with others). So you stand there as the firefighter, ready to help the CRNAs when they frack up, trying to pick your battles and enforce the really important stuff (e.g. not extubating the morbidly obese in stage II). So what the surgeon sees is an anesthesia attending mostly just being physically present, maybe pushing drugs and giving some instructions, listening for breath sounds etc., but nothing like when supervising a resident. Unless they see you in a rare crisis situation, they don't see a big difference between you and the CRNA, because they don't see what's behind the curtains, they rarely hear when you discuss the plan (except when you have something to ask them to do differently - which they usually don't like) etc.

Anesthesia is the wizard of Oz for most people not involved. Hence they don't know crap about what really happens, and it's mostly a matter of artistic impression on our part. It's a good specialty for people who could have made a career in sales, not so much for the introverted, thorough, anal ones. The latter should just friggin stay in internal medicine.
 
Last edited by a moderator:
FFP said:
I do (I rarely sit). But most times the surgeon is working, and does not notice my (at least) hourly presence (there are few cases that require my continuous presence). And during induction and emergence, God forbid to actually seem to direct/micromanage the CRNA, because that results in bad feelings from those, and they are contagious (you piss off one, you'll start noticing difficulties with others). So you stand there as the firefighter, ready to help the CRNAs when they frack up, trying to pick your battles and enforce the really important stuff (e.g. not extubating the morbidly obese in stage II). So what the surgeon sees is an anesthesia attending mostly just being physically present, maybe pushing drugs and giving some instructions, listening for breath sounds etc., but nothing like when supervising a resident. Unless they see you in a rare crisis situation, they don't see a big difference between you and the CRNA, because they don't see what's behind the curtains, they rarely hear when you discuss the plan (except when you have something to ask them to do differently - which they usually don't like) etc.

Anesthesia is the wizard of Oz for most people not involved. Hence they don't know crap about what really happens, and it's mostly a matter of artistic impression on our part. It's a good specialty for people who could have made a career in sales, not so much for the introverted, thorough, anal ones. The latter should just friggin stay in internal medicine.
Click to expand...

Appreciate it FFP. Always keeping it real.
 
aneftp said:
It really depends on the case. The super sick patients. U betcha I'm in the case.

The more mundane cases (the other 98% of the cases). I just make sure the case is on the way and patient is stable and I leave.

I tell people I don't get paid for the simple stuff. I get paid the the complicated situations.

If u doing bread and butter stuff every day. U likely are not going to see any difference between crna and MDs. And that's exactly what the AANA wants the public to know. There is no difference.

The highly complex cases done at tertiary care centers are well the MDs are always at.

Unfortunately as long as tough cases at rural hospitals get punted to urban centers. U will never know the difference between MD and Crna's
Click to expand...

I'd even argue that's not true. Just finishing my CA2 year but it's more the exception than the rule that I'll go into a crna room and not see at least 1 thing being done incorrectly. Took a moonlighting call this weekend and I walked in to relieve a crna who has literally having a conversation on the phone. Pt was an ASA 2 so he thought he could just sit back I guess. Anyway, patient was hypothermic, MAC 1.4 and paralyzed, BIS in the 20-30s.

The difference may not be enough to cause obvious morbidity and mortality but regardless of the procedure, I know who I want administering my anesthetic
 
d9sccr said:
I'd even argue that's not true. Just finishing my CA2 year but it's more the exception than the rule that I'll go into a crna room and not see at least 1 thing being done incorrectly. Took a moonlighting call this weekend and I walked in to relieve a crna who has literally having a conversation on the phone. Pt was an ASA 2 so he thought he could just sit back I guess. Anyway, patient was hypothermic, MAC 1.4 and paralyzed, BIS in the 20-30s.

The difference may not be enough to cause obvious morbidity and mortality but regardless of the procedure, I know who I want administering my anesthetic
Click to expand...

Let's say that the patient ended up being killed (god forbid)...

this would be UR fault?

WTF man.

Even if you could somehow get the jury to see that the CRNA was on their phone and had blatant disregard for the patient?

Did you not say anything to the CRNA?

like.. idk.. "Hey *******... do you not know wtf is going on to ur pateint? or what? You want me to lose my license that bad? Frickin' dipstick!"
 
FFP said:
Some people would disagree.
Click to expand...

Yah ... well... certain peeps are very sensitive and don't appreciate brutal honesty because they think life is all about ponies and rainbows and puppies and ****.

I appreciate hardened, straight-to-the-chase... no bull**** approaches to life in general.

Stop beating around the bush and I ain't got time to waste! Keep doing you FFP.
 
DetectiveAlonzo said:
Let's say that the patient ended up being killed (god forbid)...

this would be UR fault?

WTF man.

Even if you could somehow get the jury to see that the CRNA was on their phone and had blatant disregard for the patient?

Did you not say anything to the CRNA?

like.. idk.. "Hey *******... do you not know wtf is going on to ur pateint? or what? You want me to lose my license that bad? Frickin' dipstick!"
Click to expand...

its always the doctors fault. the lawyers will say "why did you let the CRNA talk on the phone? Clearly it's your lack of supervision."
 
NeuroKlitch said:
So , I am on my surgery rotation right now , and it appears that there is 1 anesthesiologist, and multiple CRNA's at this hospital. We're only a few cases today , however everything was done by the CRNAs, and the anesthesiologist only popped his head in for a second to listen to the patients lung sounds after the pt was Intubated and then disappeared. . I attended practically every single case today. So what exactly to anesthesiologists do during their time in a setting like this ? Are they becoming phased out of medicine and more of administrators and managers over the CRNAs ? Not a troll. Was just very confusing . Thanks


Sent from my iPhone using SDN mobile
Click to expand...

No, you are not confused. Doctors, in general, are getting phased out of medicine. Anesthesiology is just the pioneer in phasing out doctors. PAs and NPs are pushing for independent practice in many states...at least the states that haven't granted them independent practice already. We will all be "providers" in the big, happy family that is American healthcare.
 
GravelRider said:
No, you are not confused. Doctors, in general, are getting phased out of medicine. Anesthesiology is just the pioneer in phasing out doctors. PAs and NPs are pushing for independent practice in many states...at least the states that haven't granted them independent practice already. We will all be "providers" in the big, happy family that is American healthcare.
Click to expand...

Americans solution to saving money from our expensive healthcare. Put less qualified people in charge of your health! Soon it will be college students with a Bachelor of science degree taking care of you. hehe
 
anbuitachi said:
Americans solution to saving money from our expensive healthcare. Put less qualified people in charge of your health! Soon it will be college students with a Bachelor of science degree taking care of you. hehe
Click to expand...

haha we already have nurses for that ...

don't know how much worse it can get.
 
DetectiveAlonzo said:
Let's say that the patient ended up being killed (god forbid)...

this would be UR fault?

WTF man.

Even if you could somehow get the jury to see that the CRNA was on their phone and had blatant disregard for the patient?
Click to expand...
Yes. It's called "failure to supervise". There have been similar cases. The doc gets most of the blame, even if not present, because the system is set up so that patients still think that they are cared for by doctors, they are billed by doctors, and these big healthcare cancers systems are all there just to help the docs do their jobs. Plus the malpractice attorneys will go for the juicy target, even if there is no merit in it, because one never knows how the jury decides... Merit has nothing to do with winning a case.

Rock, hard place, rock, hard place, rock...?
 
Last edited by a moderator:
For those of you that work in the ACT model, do you typically have some kind of remote monitoring so you can at least view the patients vitals?
 
FFP said:
Yes. It's called "failure to supervise". There have been similar cases. The doc gets most of the blame, even if not present, because the system is set up so that patients still think that they are cared for by doctors, they are billed by doctors, and these big healthcare cancers systems are all there just to help the docs do their jobs. Plus the malpractice attorneys will go for the juicy target, even if there is no merit in it, because one never knows how the jury decides... Merit has nothing to do with winning a case.

Rock, hard place, rock, hard place, rock...?
Click to expand...


This is absolute bull****.

If I am blessed to end up in gas, I will be on my CRNAs ass like white on rice and if they have a problem with it or ask me why...

I'm simply tell them..

So YOU don't kill the patient.
 
d9sccr said:
For those of you that work in the ACT model, do you typically have some kind of remote monitoring so you can at least view the patients vitals?
Click to expand...
If the anesthesia record is computerized. That's not always the case in smaller hospitals.
 
DetectiveAlonzo said:
This is absolute bull****.

If I am blessed to end up in gas, I will be on my CRNAs ass like white on rice and if they have a problem with it or ask me why...

I'm simply tell them..

So YOU don't kill the patient.
Click to expand...

Make sure you join a group where you have total hiring/firing power, and don't work for an AMC.
Also make sure the group isn't impotent when it comes to them. You wouldn't believe the crap some of these groups tolerate from them.
 
FFP said:
If the anesthesia record is computerized. That's not always the case in smaller hospitals.
Click to expand...

Which EMRs have this feature? We use Cerner and Epic, but to my knowledge, they aren't set up for this, at least at our institution.
 
d9sccr said:
For those of you that work in the ACT model, do you typically have some kind of remote monitoring so you can at least view the patients vitals?
Click to expand...

I can remotely view patient vitals, vent parameters (measured airway pressures, rate, etc), and gases (o2, co2, volatile, etc), as well as anything charted like meds or fluids. The only thing I can't easily do is look at the patient or surgery in progress and I'm guessing in a few years we will have cameras in each room allowing me to remote view anywhere at any time.
 
d9sccr said:
Which EMRs have this feature? We use Cerner and Epic, but to my knowledge, they aren't set up for this, at least at our institution.
Click to expand...
I haven't see Cerner's anesthesia module yet (if it exists), but it works great in Epic. You just open the anesthesia record and you can watch the vitals, anesthesia machine data, documentation etc. live, exactly like Mman says.. You need to be in the correct context (i.e. anesthesiology, not other specialties).

If I were CMS, I would impose that all places that bill medical direction have this level of technology by 2020.
 
Last edited by a moderator:
FFP said:
Anesthesia is the wizard of Oz for most people not involved. Hence they don't know crap about what really happens, and it's mostly a matter of artistic impression on our part. It's a good specialty for people who could have made a career in sales, not so much for the introverted, thorough, anal ones. The latter should just friggin stay in internal medicine.
Click to expand...
This is not unique to anesthesia at all. In private practice, this pertains to nearly every specialty. Perception is reality.
 
FFP said:
I haven't see Cerner's anesthesia module yet (if it exists), but it works great in Epic. You just open the anesthesia record and you can watch the vitals, anesthesia machine data, documentation etc. live, exactly like Mman says.. You need to be in the correct context (i.e. anesthesiology, not other specialties).

If I were CMS, I would impose that all places that bill medical direction have this level of technology by 2020.
Click to expand...

Yay. Now AMCs and hospitals will be able to justify higher supervision ratios...for the same or less pay, of course.
 
GravelRider said:
Yay. Now AMCs and hospitals will be able to justify higher supervision ratios...for the same or less pay, of course.
Click to expand...

CMS and insurance companies are the ones dictating supervision ratios.

I actually listened to a presentation from some guy at Mayo (I think) that mentioned they have an anesthesiologist supervise RNs giving sedation in all sorts of different locations by sitting in a control room with a bunch of TV screens so he can remotely "watch" them all and provide instructions via phone. Sounded kinda crazy but something similar probably not too far off in the future of OR cases for us (although I truly hope not).
 
Ezekiel2517 said:
This is not unique to anesthesia at all. In private practice, this pertains to nearly every specialty. Perception is reality.
Click to expand...

And it's not really about sales at all. It's learning to distinguish what matters from what doesn't in real life so you can get your s*** done fast with minimal fuss.
 
FFP said:
I haven't see Cerner's anesthesia module yet (if it exists), but it works great in Epic. You just open the anesthesia record and you can watch the vitals, anesthesia machine data, documentation etc. live, exactly like Mman says.. You need to be in the correct context (i.e. anesthesiology, not other specialties).

If I were CMS, I would impose that all places that bill medical direction have this level of technology by 2020.
Click to expand...

It does and we use it at two hospitals. It's not really better or worse than Epic, just different. They each have their strengths and weaknesses.

Thanks for the response regarding the EMRs.

Do you guys have the ability to view patients on iphone or iPad or something so you can be in another room doing a difficult airway or whatever while keeping an eye on a critical patient?
 
d9sccr said:
It does and we use it at two hospitals. It's not really better or worse than Epic, just different. They each have their strengths and weaknesses.

Thanks for the response regarding the EMRs.

Do you guys have the ability to view patients on iphone or iPad or something so you can be in another room doing a difficult airway or whatever while keeping an eye on a critical patient?
Click to expand...
You can run Epic over Citrix, which can run on the iPad.
 
Here we can view vitals, gas data, drugs given (if charted), any comments written by whoevers in the room. We do also have cameras but they aren't that useful since it's small . I think it's mainly used to see if a room is taken or not
 
You must log in or register to reply here.

Similar threads

P
Local Anesthetics are confusing
Replies
15
Views
3K
Mman
M
A
pHTN confusion question
Replies
42
Views
3K
deleted9493
D
A
Confused about prelim/transitional and advanced anesthesia spots
Replies
28
Views
15K
parcus
P
B
confused about anesthesia
2 3 4
Replies
167
Views
20K
GA8314
G
H
A-line--confusion about damping, ringing, and natural frequency
Replies
6
Views
2K
fakin' the funk
fakin' the funk
Top