Crap Bad Anesthesiologists Say

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soorg

soorg

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"When am I being relieved?"

"I can't do this colonoscopy without a capnogram.”

"I'm the only one who knows how to do this surgeon's cases. Schedule me with him."

"I'm so stressed."

"I need 45 minutes to get consent."

"When am I being relieved?"

"Anesthesia is very dangerous."

"Someone will be with you the entire time. Just not me."

"This patient can't have an endoscopy in an ASC! He has a stent!"

"These nurses are so annoying."

"When am I being relieved?"

"This patient needs a stress test before he can have cataract surgery."

"It's the resident's fault."

"No one pushes propofol like me."

"I should've done pain."

"When am I being relieved?"

"This is the way I do it."

"I'm canceling the case. This 21 year-old has no clearance."

"I want to wait eight hours. The patient was chewing gum at 6:00 am."

"I don't get paid enough."

"When am I being relieved?"

“Anesthesia gets blamed for everything."

"I can't take over this case-the antibiotic time wasn't documented!"

"I need a documented echo before I can do a spinal."

"A hysterectomy isn't a 100% guarantee the hCG will be negative."

"When am I being relieved?"
 
soorg said:
"When am I being relieved?"

"I can't do this colonoscopy without a capnogram.”

"I'm the only one who knows how to do this surgeon's cases. Schedule me with him."

"I'm so stressed."

"I need 45 minutes to get consent."

"When am I being relieved?"

"Anesthesia is very dangerous."

"Someone will be with you the entire time. Just not me."

"This patient can't have an endoscopy in an ASC! He has a stent!"

"These nurses are so annoying."

"When am I being relieved?"

"This patient needs a stress test before he can have cataract surgery."

"It's the resident's fault."

"No one pushes propofol like me."

"I should've done pain."

"When am I being relieved?"

"This is the way I do it."

"I'm canceling the case. This 21 year-old has no clearance."

"I want to wait eight hours. The patient was chewing gum at 6:00 am."

"I don't get paid enough."

"When am I being relieved?"

“Anesthesia gets blamed for everything."

"I can't take over this case-the antibiotic time wasn't documented!"

"I need a documented echo before I can do a spinal."

"A hysterectomy isn't a 100% guarantee the hCG will be negative."

"When am I being relieved?"
Click to expand...
Did I train you?

I don't think they paid me enough for that one either.
 
Crap really, really bad anaesthesiologists say...

"Yeah, it looks like you're having an allergic reaction but it's fine. It's not anaphylaxis and we're behind schedule so you'll be ok. Don't worry about it."

Anaphylaxis about 10-15 minutes later...now "behind schedule" was on some dark street corner steroids.
 
"OMG, they opened the wrong instruments!! I'll have to wake the patient up before he gets too hypotensive!!"

"Your surgeon is excellent. I would go to him/her."
 
When I make a mistake, my attending barks at me: "do you think this is easy!? Do you think a nurse can do this!?"

It's usually after something relatively inconsequential, like not putting on the ToF during induction. I don't think highly of his methods
 
cockblockandrun said:
Actually, I believe in capnogram for all my EGD's and colon cases. For me, its a standard monitor just like a pulse ox and blood pressure. No capnogram= no anesthesia.
Click to expand...

I'm with you.

The main reason I believe in it, is that the ASA Standards for Basic Anesthetic Monitoring also believe in it.

"During moderate or deep sedation the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment."

I don't think the "nature of the equipment" that "precludes the use of capnography" would include that it was there, but was electively not used.
 
For EGDs, without question. For colons, don't care (although 99% of the places I work have it.) My hand feeling them breathe is good enough.
 
Crap bad Drs. in general say:

"I don't feel comfortable with . . ."

Remember, that's just code for " I don't know what the F I'm talking about."
 
SaltyDog said:
Crap bad Drs. in general say:

"I don't feel comfortable with . . ."

Remember, that's just code for " I don't know what the F I'm talking about."
Click to expand...

While I would agree that this is used as a cop out at times, I have seen and heard of some egregious care in the community setting. The statement below comes to mind.

"Massive mediastinal mass with SVC compression and pericardial invasion. What's the big deal?"
 
SaltyDog said:
Crap bad Drs. in general say:

"I don't feel comfortable with . . ."

Remember, that's just code for " I don't know what the F I'm talking about."
Click to expand...

So how do you suppose us Bad doctors phrase this instead? I am not afraid to admit that I am not comfortable with certain things. I am not superwoman, and not all training programs are created equal.
 
chocomorsel said:
So how do you suppose us Bad doctors phrase this instead? I am not afraid to admit that I am not comfortable with certain things. I am not superwoman, and not all training programs are created equal.
Click to expand...


You go to your more experienced partner and say, "I haven't done X before, can you help me/show me how?" Or you make it a point to be in the room when one of your partners is doing X procedure.

We've recently had issues with people who can't/won't/refuse-to-learn lumbar drains for thoracic aortic stent grafts. All learning does not stop at the end of residency. The point is to keep learning and gain experience so you become comfortable.
 
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SaltyDog said:
Crap bad Drs. in general say:

"I don't feel comfortable with . . ."

Remember, that's just code for " I don't know what the F I'm talking about."
Click to expand...

Having heard various versions of both statements numerous times, I will still go for those any day over the "I don't feel comfortable with (blah) but :shrug: well, YOLO!" :whistle: kind of physician.
 
cockblockandrun said:
Actually, I believe in capnogram for all my EGD's and colon cases. For me, its a standard monitor just like a pulse ox and blood pressure. No capnogram= no anesthesia.
Click to expand...
If u read the ASA 2011 standard. There is a little wiggle room for not using capnogram. Read it closely. It's very clear cut they give an "opt out" for some facilities that don't routinely have capnogram available.

We all know the reasoning the ASA put the capnogram "standard" into place in 2011. Cause there were (are) rogue non anesthesia providers ( mostly GI docs) essentially giving essentially general anesthesia (choose your overdose of cocktails GI docs employ for their conscious sedation). Those non anesthesia providers aren't trained like us and most simply don't know when air is moving or isn't moving. That's the real reason they put in the standard. But there is an opt out clause so it's not a iron clad "standard" for GI procedures involving general/deep sedation.
 
OK well maybe I should have explained what I meant seeing as everyone took "I'm not comfortable with. . ." in a different direction than intended. I'm not saying that one has to be cavalier, or an expert at every single procedure/type of case to not be considered a bad anesthesiologist/doctor. I was referring to those who use "I'm not comfortable" as part of their clinical reasoning/medical decision making. For example, Dr. Orthopod adds on a ORIF distal radius in a pt who's been on Plavix up until the day before yesterday. He's not overly concerned about surgical bleeding, but asks your thoughts on a block. Saying "I'm not comfortable blocking a pt only 2 days off Plavix" is something a weak Dr. says. A good consultant would say something like "For either a ICB or SCB I'm very close to the vessels with my needle tip, and I don't think it's a good idea for that reason, but I'm willing to to check a platelet inhibition assay and if it's normal I'll talk to the pt about it." See the difference. It wouldn't fly to answer a question on your oral boards with "I'm not comfortable with . . ." and it shouldn't fly when speaking to physician colleagues regardless of specialty. We are experts, we are consultants, we need to act and sound like it.
 
SaltyDog said:
Crap bad Drs. in general say:

"I don't feel comfortable with . . ."

Remember, that's just code for " I don't know what the F I'm talking about."
Click to expand...

Anesthesiologists who say "I don't like that you said 'I'm not comfortable with...'.".
 
nimbus said:
Saying "I'm not comfortable blocking a pt only 2 days off Plavix" is something a weak Dr. says. A good consultant would say something like "For either a ICB or SCB I'm very close to the vessels with my needle tip, and I don't think it's a good idea for that reason, but I'm willing to to check a platelet inhibition assay and if it's normal I'll talk to the pt about it." See the difference. It wouldn't fly to answer a question on your oral boards with "I'm not comfortable with . . ." and it shouldn't fly when speaking to physician colleagues regardless of specialty.
Click to expand...

The part in Bold type bothers me. Leaving it open to chance and not your own decision making is not my thing.

How about "No, because I don't want to"?
 
urge said:
The part in Bold type bothers me. Leaving it open to chance and not your own decision making is not my thing.

How about "No, because I don't want to"?
Click to expand...

That's just as chicken**** an answer as "I'm not comfortable." I think "No, bleeding risk is too high for this block in this pt" would be perfectly reasonable and not make you sound like a nurse.
 
SaltyDog said:
That's just as chicken**** an answer as "I'm not comfortable." I think "No, bleeding risk is too high for this block in this pt" would be perfectly reasonable and not make you sound like a nurse.
Click to expand...
I don't need to give explanations. Maybe you do, but not me.
 
Carbocation1 said:
Meaning the surgeon gets his way or you do?
Click to expand...
Me but it's not really a question of "getting one's way or not." It's always a patient safety issue and if there's a good reason for not doing something, I won't do it. End of story.
 
Consigliere said:
Me but it's not really a question of "getting one's way or not." It's always a patient safety issue and if there's a good reason for not doing something, I won't do it. End of story.
Click to expand...
It's terrible form to do a case that a partner said no to. But if a surgeon came to me and said "Your partner said they won't do this case just because. Can you take a look?" First I wouldn't believe them because we wouldn't hire someone that terrible, and then once confirmed I'd take a look and turn it down or do it. Then I'd tell the boss you're a f@ck up that's going to cost us business and we better start interviewing.
 
Not to mention, I'd suggest to the chair that we formally apologize for the JV handling of the situation. Whether the case was appropriate or not.
 
Pooh & Annie said:
Not to mention, I'd suggest to the chair that we formally apologize for the JV handling of the situation. Whether the case was appropriate or not.
Click to expand...
What's your point? Is there one?
 
SaltyDog said:
"For either a ICB or SCB I'm very close to the vessels with my needle tip, and I don't think it's a good idea for that reason, but I'm willing to to check a platelet inhibition assay and if it's normal I'll talk to the pt about it."
Click to expand...

So someone sucks at ultrasound and hits the subclavian with a 22g (or 25 if ur trying to be careful).. Does the patient die?
 
Hawaiian Bruin said:
"This patient is obese. We'll need a Glidescope."

"You can't give muscle relaxant until you prove you can ventilate."

"Deep extubation is dangerous."

"I need to see an EKG before we proceed with this outpatient knee scope. Why? To have a baseline."
Click to expand...
I wish I could like this more than once.
 
Pooh & Annie said:
Not to mention, I'd suggest to the chair that we formally apologize for the JV handling of the situation. Whether the case was appropriate or not.
Click to expand...
There are two types of anesthesiologists: the ones who play fetch like a dog and the ones who don't play games.

Not hard to tell in which camp people fall.

I'm perfectly happy not playing games.
 
Pooh & Annie said:
Because that's a childish, unprofessional, bush league response for a "consultant" or any other doctor-to-doctor interaction. Unless it's your buddy from med school or something.
Click to expand...
Sounds like you are still walking around spewing out answers you memorized for your oral board.

Grow up.

The only explanations you have to give now are when you get sued for screwing up.

I'm not in the habit of screwing up.
 
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