CRNAs - a blessing or a curse.... we have created a monster

[ambiturner]

I’ve worked with some very dumb and dangerous providers in my career with a variety of credentials. I’ve also made my share of embarrassing mistakes myself.

While I agree that the team structure should always include a physician directing mid levels for complex cases, ultimately what I care about is whether you’re sharp and can do the job. I’ve had to can both physicians and CRNAs from my cardiac team.

Personally I think the promise of our AI systems coming online is precisely the democratization of knowledge and targeted clinical decision support that will make a larger number of providers with varied credentials able to make consultant level decisions at the point of care. if it means that we lose our hold on things and more providers are able to function at the level of physicians and our salaries come down… I’m ok with it. I just want patients to be safe.

Proceduralists seem to be in a decent spot because of the need to think fast and use your hands. I have seen some decent AI tools that can predict difficult airways and there’s some cool machine learning studies for post op pain, AKI etc.

Internal medicine on the other hand, at the least I think the job will be very different in the future. If you went to med school before the mid 2000s you probably remember having to memorize EVERYTHING because there was no way to look stuff up on the fly, other than a pocket reference. Memory was one of the most valuable traits in students. By the 2010s you could google symptoms or use up to date and now AI tools could probably create better differentials than seasoned clinicians. At the least I imagine the job will just be done differently in the future, hopefully such that there’s less administrative headache and is still satisfying.

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[CopaceticOne]

Really close

Proceduralists seem to be in a decent spot because of the need to think fast and use your hands. I have seen some decent AI tools that can predict difficult airways and there’s some cool machine learning studies for post op pain, AKI etc.

Internal medicine on the other hand, at the least I think the job will be very different in the future. If you went to med school before the mid 2000s you probably remember having to memorize EVERYTHING because there was no way to look stuff up on the fly, other than a pocket reference. Memory was one of the most valuable traits in students. By the 2010s you could google symptoms or use up to date and now AI tools could probably create better differentials than seasoned clinicians. At the least I imagine the job will just be done differently in the future, hopefully such that there’s less administrative headache and is still satisfying.

Simple IM is very guideline driven, aka “evidence based”. I would say easily 70% of my decision making in clinic or on wards would be with minimal thinking. As a matter of fact, the health system I worked in created order sets with empiric antibiotic choices based on what infection you were treating. No more needing to think about coverage spectrum / look at the local antibiogram.

When I left, I thought the interns were overall ignorant on Infectious Disease stuff because it had been so automated and they never had to think. But, the health system statistics for patient outcomes were much improved.

There’s always a price to pay - switch to a place without that and watch what happens. Physicians need to remember these are tools for the practice of medicine. Otherwise, we will be just like all of the noctors pretending to be us.

 

[nimbus]

Proceduralists seem to be in a decent spot because of the need to think fast and use your hands. I have seen some decent AI tools that can predict difficult airways and there’s some cool machine learning studies for post op pain, AKI etc.

Internal medicine on the other hand, at the least I think the job will be very different in the future. If you went to med school before the mid 2000s you probably remember having to memorize EVERYTHING because there was no way to look stuff up on the fly, other than a pocket reference. Memory was one of the most valuable traits in students. By the 2010s you could google symptoms or use up to date and now AI tools could probably create better differentials than seasoned clinicians. At the least I imagine the job will just be done differently in the future, hopefully such that there’s less administrative headache and is still satisfying.

Do people still carry these around? I haven’t seen one in a while.

 

[CopaceticOne]

Fo people still carry these around? I haven’t seen one in a while.View attachment 401538

I don’t recall seeing the newbies with physical copies. Most stuff is ebook / UpToDate for reference now. More common at my place was Pocket Medicine. Heck, I think there is even a Pocket Anesthesia.

When I was an intern I did think Washington Manual was more helpful in my learning because of using full sentences instead of a bunch of shorthand.

 

[aneftp]

Do people still carry these around? I haven’t seen one in a while.View attachment 401538

I had one. Haven’t. Seen in ages. I still keep my anesthesia and medical books from 25-30 years ago for some reason. Found a great need for them as my renovated kitchen sink was falling and I propped it up with the medical books till the contractors came back.

 

[NicholasPavona]

I had one. Haven’t. Seen in ages. I still keep my anesthesia and medical books from 25-30 years ago for some reason. Found a great need for them as my renovated kitchen sink was falling and I propped it up with the medical books till the contractors came back.

That's about all they're good for.