Do you guys typically have admitting privileges?

[FutrrENT]

I just found out today from a good friend of mine that ER docs usually don’t. I knew there were a few places where they did not, but I assumed these were not the norm. Apparently, they are. So I’m a bit curious about you guys as well.

---

Members don't see this ad.

 

[IlDestriero]

I just found out today from a good friend of mine that ER docs usually don’t. I knew there were a few places where they did not, but I assumed these were not the norm. Apparently, they are. So I’m a bit curious about you guys as well.

No. Pain guys may though in some places. Where I am now, and where I did my residency and fellowship, they didn't. The patients were admitted through another service, and managed by the pain team.

 

[deleted126335]

I always assumed that med staff privileges included admitting privileges. Although, outside of a pain doc or critical care, I have never seen an anesthesiologist admit a patient. Anesthesia complications get admitted to other services.

 

[FutrrENT]

I always assumed that med staff privileges included admitting privileges. Although, outside of a pain doc or critical care, I have never seen an anesthesiologist admit a patient. Anesthesia complications get admitted to other services.

That's really surprising! I've never seen an anesthesia complication that required an admission, but I'm guessing it happens from time to time. Who is more equipped to handle anesthesia complications than anesthesiologists?

 

[BobBarker]

I'm having trouble seeing where it would be useful for an ER or Anesthesia doc to have admission privileges.. Excluding the EM/IM dual trained docs, of course.

 

[pgg]

CCM anesthesiologists? Some pain guys, I guess?

Not admitting patients is one of the perks.

 

[Apollyon]

I'm having trouble seeing where it would be useful for an ER or Anesthesia doc to have admission privileges.. Excluding the EM/IM dual trained docs, of course.

For a doc in the ED, it's a "push" issue - if I had them, I could admit to a service without having pushback or having to kiss someone's ass. They would have to take it, and like it.

The prior IM hospitalist group where I work had two docs that would NOT come in, but would try to block admissions - by phone. The care rendered by them sucked - I would NOT let a family member be mismanaged by them. It was idiotic to have some young person 2 years out of residency tell me over the phone that "I've never seen that happen" (ask anyone, including the more experienced anesthesiologists, about the stuff they've seen that they would have blown off or missed when they were fresh out) but not come in to evaluate the patients. This one hospitalist even had templated orders, beyond the preprinted checklist orders - there would be the preprinted orders, and numbers 1-4 or whatever. She would say "set #3", and that would have the preselected checked boxes, which she would order over the phone. When each hospitalists' admitting block of time was over, you couldn't even get ahold of them. If a patient of theirs expired, they might not find out until they came in 2 or 3 days later.

So, I don't have admitting privileges, and have to beg at times for colleagues to do the right thing for patients (had a dual boarded IM-Psych doc decline a consult because the patient was under-insured - wasn't even uninsured, but he said that this payor "never pays their bills"; he was not on-call, so I can't ding him for that).

 

[deleted126335]

That's really surprising! I've never seen an anesthesia complication that required an admission, but I'm guessing it happens from time to time. Who is more equipped to handle anesthesia complications than anesthesiologists?

periop MI or CHF - cardiology
change in mental status/CVA/new neurologic finding - neuro
carotid injury-vascular
aspiration-critical care, pulmonary
pneumothorax-general or CT surg

 

[Bertelman]

CCM anesthesiologists? Some pain guys, I guess?

Not admitting patients is one of the perks.

 

[seinfeld]

As anesthesiologists try and maintain our role as a perioperative physician I do not believe that congratulating ourselves on not wanting to be the attending physician on a patient helps our cause.

Having said that anyone with medical staff privileges, in most hospitals, can admit patients.

Personally beyond pain and critical care dont see why we would admit patients. Although a patient hospitalized for PONV, PAIN, or Pulm Complication post op doesn't exactly make a surgeon happy to have to deal with. The ASA would say that we should start admitting these patients to our service in an attempt to be a better perioperative doc.

 

[FutrrENT]

As anesthesiologists try and maintain our role as a perioperative physician I do not believe that congratulating ourselves on not wanting to be the attending physician on a patient helps our cause.

Having said that anyone with medical staff privileges, in most hospitals, can admit patients.

Personally beyond pain and critical care dont see why we would admit patients. Although a patient hospitalized for PONV, PAIN, or Pulm Complication post op doesn't exactly make a surgeon happy to have to deal with. The ASA would say that we should start admitting these patients to our service in an attempt to be a better perioperative doc.

My sentiments exactly. Unless the term “perioperative physician” encompasses just the immediate events before and after surgery.

 

[IlDestriero]

My sentiments exactly. Unless the term “perioperative physician” encompasses just the immediate events before and after surgery.

I'll save the admissions for the specialists. Pain can pick up admissions if they want. The kids "I" admit post op are almost always to the ICU for complications of the surgery or acute worsening of pre operative problems.
Pre op admissions are normally done by peds with heme, endocrinology, etc consulting to tune them up. I'm not sure how having my own service would help me provide a better service to the surgeons, patients, or the hospital. As it is, peds isn't complaining about the extra patients/revenue we're sending them.

 

[michigangirl]

No role for anesthesiologists to admit outside of pain docs and anesthesia intensivists who do CCM. As mentioned above, if my ex 26 weeker with chronic lung disease has acute bronchospasm during his elective umbilical hernia repair and can't get extubated, that's a worsening of a preop issue that isn't unexpected-- and can be handled by the pediatric ICU docs and followed by the surgeons. There are very few anesthesia related complications that there isn't a specialty service that is better equipped to deal with that complication-- that is usually a known possible complication because of a pre-op issue. Adding anesthesia to the admitting pool just gets complicated, means some anesthesiologist needs to staff the service for a certain amount of time to have some continuity (anyone interested?)

 

[Bertelman]

As anesthesiologists try and maintain our role as a perioperative physician I do not believe that congratulating ourselves on not wanting to be the attending physician on a patient helps our cause.

Having said that anyone with medical staff privileges, in most hospitals, can admit patients.

Personally beyond pain and critical care dont see why we would admit patients. Although a patient hospitalized for PONV, PAIN, or Pulm Complication post op doesn't exactly make a surgeon happy to have to deal with. The ASA would say that we should start admitting these patients to our service in an attempt to be a better perioperative doc.

I'm not sure I follow your response. You don't see why we would admit patients, yet you admonish me for a snarky high five. Which is it? Should we all voice our desire to admit patients, then bemoan the fact that we really shouldn't?

Part of being a "good perioperative physician", whatever that means, is understanding when another physician is capable of providing a better service. That's part of being ANY physician. I know I can treat an acute MI, and I will do so, but I'll get cardiology involved early and often, because that's what the patient really needs.

If I start admitting patients, that means I'll need to start rounding on patients, coordinating their care, discharging them home or to rehab, providing discharge prescriptions, and then seeing them 2 weeks later to see how they're doing.

...and oh yeah, I've got to be in the OR from 6:30 until 5:30. First and foremost, I am an anesthesiologist. I see no benefit of becoming a patient's primary physician on the floor, unless they have been admitted to the hospital to receive a continuous GA.

 

[FutrrENT]

I'm not sure I follow your response. You don't see why we would admit patients, yet you admonish me for a snarky high five. Which is it? Should we all voice our desire to admit patients, then bemoan the fact that we really shouldn't?

Part of being a "good perioperative physician", whatever that means, is understanding when another physician is capable of providing a better service. That's part of being ANY physician. I know I can treat an acute MI, and I will do so, but I'll get cardiology involved early and often, because that's what the patient really needs.

I’m probably speaking out of ignorance here, but are there no complications of anesthesia that don’t fall under someone else’s scope of practice? If I’m hearing you right, you’re saying that anesthesiologists have one job: to safely deliver anesthetics, and that an anesthesiologists scope of training and practice is very narrow. While I’m certainly no anesthesiologist myself, I think you’re wrong on this one.

When someone admitted to our service is becoming dyspneic, we don’t reflexively consult pulmonology. If a patient develops a severe infection, we only consult ID when we find that we can’t manage it ourselves (which is quite rare, I might add). If our patient has a low crit, we don’t run to the nearest phone to page hematology. We try to handle what we can, even as ENTs. I’d like to think that you guys, far more then us, have the extensive general medical knowledge to admit and manage patients who have complications -- be they cardiac or renal in nature -- that occur as a result of your treatment (i.e. the general anesthetic).

If I start admitting patients, that means I'll need to start rounding on patients, coordinating their care, discharging them home or to rehab, providing discharge prescriptions, and then seeing them 2 weeks later to see how they're doing.

Damn straight! You are physicians, and that’s what physicians do. If you wanted a cakewalk profession where you don’t have to deal with inpatients, you should have become a dermatologist or an ophthalmologist. Or better yet, you should have become a CRNA.

...and oh yeah, I've got to be in the OR from 6:30 until 5:30. First and foremost, I am an anesthesiologist. I see no benefit of becoming a patient's primary physician on the floor, unless they have been admitted to the hospital to receive a continuous GA.

I’m sorry man, but this argument is really weak. First and foremost, I’m an ENT. That doesn’t mean that any condition facing my patient that falls outside of otolaryngology ain’t my problem. Every other service in the hospital from vascular surgery to neurology that admits patients frequently manages conditions outside their main scope of practice. So why do you refuse to do it?

By the way, the surgeons you work with? We spend those hours in the OR too. Plus, we round on our patients before and after our OR hours. Our ENT service usually has 10 to 15 patients to round on each morning, most of them admitted to our service. I seriously doubt you guys would have to admit anywhere near that many patients, especially considering you guys do your job so well that complications requiring admission are apparently so rare.

I don’t care if this last statement gets me banned from this forum, but I’m going to say it anyway. It seems to me that what you really want for yourself is to do the work of a CRNA, but carry the title and pay of a doctor. Think about it. All you want to do is deliver anesthesia, and manage complications only when they occur during or immediately after the surgery. Beyond that? Your attitude is that you guys should ship them off to some other services.

 

[fakin' the funk]

Damn straight! You are physicians, and that’s what physicians do. If you wanted a cakewalk profession where you don’t have to deal with inpatients, you should have become a dermatologist or an ophthalmologist. Or better yet, you should have become a CRNA.

So...by your reasoning, dermatologists and ophthalmologists are not physicians either.

I become EXTREMELY wary of people when they start defining what a physician is as eerily similar to what it is that THEY do.

 

[fakin' the funk]

By the way, the surgeons you work with? We spend those hours in the OR too.

No, surgeons do not. Surgeons do not operate every day. Surgeons are not hands-on with patients in the OR >90% of their work day, every work day. We are. I have not ever seen a surgeon in the OR at 0600 while I am setting up for the first case and those to follow, and I have not seen a surgeon in the OR between emergence of one case and induction of anesthesia in the case to follow, that is, unless they were breathing down my neck to "speed along turnover".

Plus, we round on our patients before and after our OR hours.

In an academic setting, a surgical team has multiple team members, several of whom are EXCLUSIVELY outside of the OR taking care of those patients. In the worst case scenario, scribbling "AFVSS ADAT" is the end product and is not really all that demanding.

Our ENT service usually has 10 to 15 patients to round on each morning, most of them admitted to our service. I seriously doubt you guys would have to admit anywhere near that many patients, especially considering you guys do your job so well that complications requiring admission are apparently so rare.

NOW you're onto something. While you attempt to make a highly theoretical point about "what a physician does," you've missed the point that there are VERY FEW COMPLICATIONS FROM ANESTHESIA ALONE. Certainly not enough to warrant an "anesthesiology inpatient service" as you imagine one, and certainly not enough to entertain your arguments. And, in the situations that *I* have seen where an intraoperative or pertinent postoperative complication occurred, the anesthesiologist continued to operate in close consultative fashion until the complication was treated and resolved.

You won't know this because you're in ENT, but there are precisely two medical conditions which are "exclusive" to anesthesiology - malignant hyperthermia and pseudocholinesterase deficiency. Nearly every other perioperative complication, whether massive bleeding, surgical site infection, postoperative pneumonia, etc., has a basis in anesthesiology practice, but also has a primary surgical team (who, in the first place, requested anesthesia and incurred the surgical insult) to manage it.

Like it or not, there are specialties of medical practice that are essentially consultation ONLY - think radiology, pathology, dermatology, anesthesiology. That does not make individuals in those specialties "not physicians" as you would have it. And, like it or not, managing complications is not the only criterion for "being a physician," whatever that means.

 

[IlDestriero]

I still don't understand exactly what patients we should be admitting?
What are these complications that we should be admitting to our service and managing and than consulting the surgical team and other specialists to follow in a limited capacity?
MI? -> cardiology and the CVICU
CVA? -> neurology -> Neuro ICU
unstable NOS -> ICU team -> ICU
post op pain, surgical issues, surg complications -> surgical service +/- pain team consult +/- other consults.

What patients are we dumping on you? Patients that need to be pre admitted for tuning usually go to peds/medicine and get a consult to the appropriate service (pulm, heme, endocrine, etc for recs for their complex problems) We could probably manage these patients following the plan provided by the specialists, but why would we? If they were straightforward (ie diabetes), they wouldn't need a pre admission nor a specialist consult. I'm a pediatric anesthesiologist not a pediatrician, a pediatrician is best suited to admit complicated children and implement the required pre procedure plan. I don't see that as a dump, nor do they. They are in the best position to manage the patient's care.

 

[Bertelman]

I’m probably speaking out of ignorance here,

QFT

I'm not really sure I understand why an ENT is telling me how to do my job.

You pretty much summed it up when you said I have one job- to keep patients safe in the OR. Just for kicks, I'll go ahead and take care of them in the PACU, too. In return, I ask you to do only one thing- take care of their ears, nose and throat. I guess your scope of practice is just as narrow as mine. If you wish to fulfill the lofty ideal you have for me, I would ask you to continue taking care of your patient's anemia, dyspnea, etc. long after they are discharged. That's right, they can go ahead and follow up with you in your clinic for chest pain. Go ahead and manage their carvedilol, coumadin, sotalol, etc. Why wouldn't you want to do that? Ohhh, that's right, you rely on other physicians, too.

Since you seem so keen on telling me about these complications of general anesthesia, why don't you list them for me? If you can't generate such a list, you might want to back down from telling me what to do about it. I really don't care how you manage anemia, infection and dyspnea on your own service. I manage them in the OR whenever they pass my way. Same with renal failure, stroke, hemorrhage, etc. I would say my incidence of "complications unique to general anesthesia" is probably far less than your incidence of calling consults to other services.

There are countless physicians that don't set foot in a hospital. They work in a clinic, and only in a clinic. There are hospitalists who work in a hospital, and no where else. They don't get shit for not having a clinic, and I don't know why I'm getting shit for not rounding on the wards.The neurologists at my hospital do not admit patients. They only consult. The Orthos barely admit patients. Tell me why exactly I should feel guilty for not wanting to take care of patients on the ward? I will take care of whatever patient you bring my way, however I choose to treat my patients in the OR.

And don't even begin to call me a CRNA because I choose not to round on patients. You can't waltz around here throwing insults like that just because you've read a few threads about MD V. CRNA. You have no better understanding about what I do than I have about you. You have even less understanding of what a CRNA does, or how they view their job responsibilities.

 

[Bertelman]

Damn straight! You are physicians, and that’s what physicians do. If you wanted a cakewalk profession where you don’t have to deal with inpatients, you should have become a dermatologist or an ophthalmologist. Or better yet, you should have become a CRNA.

I'm all ears about your thoughts on EM. By this rich train of logic, you must think those guys really suck. They NEVER see inpatients. And I'm at a loss as to what's so loathsome about ophthalmologists. If I ever have the misfortune of suffering from a detached retina or some other ocular trauma, or cataracts for that matter, I'm gonna pray one of those guys is available for the OR, not rounding up on the wards. The internists is damn sure not going to restore my vision.

 

[seinfeld]

It seems to me that what you really want for yourself is to do the work of a CRNA, but carry the title and pay of a doctor.

This is at the crux of what i was really getting at. Be careful what you voice, people (congressman) may hear it differently.

 

[bullard]

QFT

I'm not really sure I understand why an ENT is telling me how to do my job.

I understand why. It's because he's not an ENT. He's a troll. I've been suspecting it for weeks. And on this thread, it's fairly obvious.

 

[Bertelman]

I understand why. It's because he's not an ENT. He's a troll. I've been suspecting it for weeks. And on this thread, it's fairly obvious.

I came to the same realization as I was finishing my response.

 

[Arch Guillotti]

I don't care if this last statement gets me banned from this forum, but I'm going to say it anyway. It seems to me that what you really want for yourself is to do the work of a CRNA, but carry the title and pay of a doctor. Think about it. All you want to do is deliver anesthesia, and manage complications only when they occur during or immediately after the surgery. Beyond that? Your attitude is that you guys should ship them off to some other services.

Dude relax.

Coming to this forum as a new user and picking fights with regulars is not the way to be welcomed around here.

 

[fakin' the funk]

Dude relax.

Coming to this forum as a new user and picking fights with regulars is not the way to be welcomed around here.

Flash forward 10 years. "FutrrENT" is throwing instruments in the OR and coming up in front of the supervisory board for anger management. Great start bro.

 

[beavis]

I understand why. It's because he's not an ENT. He's a troll. I've been suspecting it for weeks. And on this thread, it's fairly obvious.

My original gut feeling is proving true? His/her first post after joining was a CRNA/MD thread. I called him out, but eased up.

 

[WholeLottaGame7]

No, surgeons do not. Surgeons do not operate every day. Surgeons are not hands-on with patients in the OR >90% of their work day, every work day. We are. I have not ever seen a surgeon in the OR at 0600 while I am setting up for the first case and those to follow, and I have not seen a surgeon in the OR between emergence of one case and induction of anesthesia in the case to follow, that is, unless they were breathing down my neck to "speed along turnover".



In an academic setting, a surgical team has multiple team members, several of whom are EXCLUSIVELY outside of the OR taking care of those patients. In the worst case scenario, scribbling "AFVSS ADAT" is the end product and is not really all that demanding.



NOW you're onto something. While you attempt to make a highly theoretical point about "what a physician does," you've missed the point that there are VERY FEW COMPLICATIONS FROM ANESTHESIA ALONE. Certainly not enough to warrant an "anesthesiology inpatient service" as you imagine one, and certainly not enough to entertain your arguments. And, in the situations that *I* have seen where an intraoperative or pertinent postoperative complication occurred, the anesthesiologist continued to operate in close consultative fashion until the complication was treated and resolved.

You won't know this because you're in ENT, but there are precisely two medical conditions which are "exclusive" to anesthesiology - malignant hyperthermia and pseudocholinesterase deficiency. Nearly every other perioperative complication, whether massive bleeding, surgical site infection, postoperative pneumonia, etc., has a basis in anesthesiology practice, but also has a primary surgical team (who, in the first place, requested anesthesia and incurred the surgical insult) to manage it.

Like it or not, there are specialties of medical practice that are essentially consultation ONLY - think radiology, pathology, dermatology, anesthesiology. That does not make individuals in those specialties "not physicians" as you would have it. And, like it or not, managing complications is not the only criterion for "being a physician," whatever that means.

Winning!

But you forgot the subjective part of the SOAP note: LFFD (Looks Fine From Door).

 

[fakin' the funk]

My original gut feeling is proving true? His/her first post after joining was a CRNA/MD thread. I called him out, but eased up.

True. And, you're right...fire IS cool.

On the Beavis+Butthead DVD's that are available, do they all have the music videos cut out as some sort of copyright thing?

 

[FutrrENT]

I still don't understand exactly what patients we should be admitting?
What are these complications that we should be admitting to our service and managing and than consulting the surgical team and other specialists to follow in a limited capacity?
MI? -> cardiology and the CVICU
CVA? -> neurology -> Neuro ICU
unstable NOS -> ICU team -> ICU
post op pain, surgical issues, surg complications -> surgical service +/- pain team consult +/- other consults.

What patients are we dumping on you? Patients that need to be pre admitted for tuning usually go to peds/medicine and get a consult to the appropriate service (pulm, heme, endocrine, etc for recs for their complex problems) We could probably manage these patients following the plan provided by the specialists, but why would we? If they were straightforward (ie diabetes), they wouldn't need a pre admission nor a specialist consult. I'm a pediatric anesthesiologist not a pediatrician, a pediatrician is best suited to admit complicated children and implement the required pre procedure plan. I don't see that as a dump, nor do they. They are in the best position to manage the patient's care.

I’m not saying you’re dumping patients on anyone. Like I said, I already knew at very least that anesthesiologists rarely admitted patients. I just didn’t know that you guys never admit patients. Frankly, I’m surprised that you’re telling me that the scope of anesthesiology is so narrow that you guys feel it’s never necessary to admit patients.

 

[IlDestriero]

I’m not saying you’re dumping patients on anyone. Like I said, I already knew at very least that anesthesiologists rarely admitted patients. I just didn’t know that you guys never admit patients. Frankly, I’m surprised that you’re telling me that the scope of anesthesiology is so narrow that you guys feel it’s never necessary to admit patients.

That's because you obviously don't understand our job, or how we function. As noted above, we're consultants. Procedurialists consult us to provide anesthesia and analgesia safely and efficiently. It does include some preop and post op care, but that's it.
IR does procedures on patients and doesn't admit them, they go back to the primary service, ICU, or Peds. I think that's ridiculous.
I've never admitted a patient in over 10 years. Why would I?
You still haven't explained who YOU think we should be admitting and managing primarily.

 

[FutrrENT]

QFT

I'm not really sure I understand why an ENT is telling me how to do my job.

You pretty much summed it up when you said I have one job- to keep patients safe in the OR. Just for kicks, I'll go ahead and take care of them in the PACU, too. In return, I ask you to do only one thing- take care of their ears, nose and throat. I guess your scope of practice is just as narrow as mine. If you wish to fulfill the lofty ideal you have for me, I would ask you to continue taking care of your patient's anemia, dyspnea, etc. long after they are discharged.

That’s not a good comparison. What I am proposing is that anesthesiologists handle complications that occur while under your care in the hospital, just as we do. That’s what every other service does. And it certainly doesn’t extend into the time of “long after they are discharged”. Services don’t discharge patients until their anemia, dyspnea, or whatever else has been addressed, or until the patient has been restored to baseline, or at very least, treated well enough for the patient to leave the hospital. Managing something on an inpatient is entirely different than managing conditions long-term.

That's right, they can go ahead and follow up with you in your clinic for chest pain. Go ahead and manage their carvedilol, coumadin, sotalol, etc. Why wouldn't you want to do that? Ohhh, that's right, you rely on other physicians, too.

Because I’m an ENT. I don’t know anywhere near as much about cardiovascular physiology and pathology or renal physiology and pathology or pulmonary physiology and pathology as you guys do. Basically, I’ve always looked at anesthesiologists as being cardiologists, pulmonologists, nephrologists, and neurologists rolled into one, but focusing on these areas in relation to anesthesia. ENT’s and other surgeons (usually) don’t have that kind of medical knowledge. Am I mistaken here?

Since you seem so keen on telling me about these complications of general anesthesia, why don't you list them for me? If you can't generate such a list, you might want to back down from telling me what to do about it.

I cannot. Then again, I never said I could. I’m just having a hard time believing that you are not equipped to admit and manage patients who don’t do so well after a surgery.

I really don't care how you manage anemia, infection and dyspnea on your own service. I manage them in the OR whenever they pass my way. Same with renal failure, stroke, hemorrhage, etc. I would say my incidence of "complications unique to general anesthesia" is probably far less than your incidence of calling consults to other services.

Just in the OR and PACU? Never for an extra day or two beyond that? Never?

There are countless physicians that don't set foot in a hospital. They work in a clinic, and only in a clinic.

They work in a clinic because they don’t deal with the kinds of touch-and-go situations you guys deal with.

There are hospitalists who work in a hospital, and no where else. They don't get shit for not having a clinic, and I don't know why I'm getting shit for not rounding on the wards.The neurologists at my hospital do not admit patients. They only consult. The Orthos barely admit patients. Tell me why exactly I should feel guilty for not wanting to take care of patients on the ward? I will take care of whatever patient you bring my way, however I choose to treat my patients in the OR.

But orthopedists and neurologists typically do admit patients from time to time. Maybe I’m wrong here, but I thought that anesthesiologists aren’t simply there to make it so that patients don’t feel pain during surgery, rather, they allow patients to endure surgeries that would otherwise kill them! If that’s the case, I’d assume that managing patients for a day or two post-operatively on an anesthesiology service would be quite reasonable.

And don't even begin to call me a CRNA because I choose not to round on patients. You can't waltz around here throwing insults like that just because you've read a few threads about MD V. CRNA. You have no better understanding about what I do than I have about you. You have even less understanding of what a CRNA does, or how they view their job responsibilities.

Many of you seem to point to your ability to manage patients beyond the OR as one of the main differences between anesthesiologists and CRNAs -- which I believe it is. Now you’re telling me that you don’t manage patients much beyond the OR. Just in the PACU for a few hours. Did I summarize your position correctly?

 

[IlDestriero]

That's not a good comparison. What I am proposing is that anesthesiologists handle complications that occur while under your care in the hospital, just as we do. That's what every other service does.

What complications are we causing again? A sore throat?

Many of you seem to point to your ability to manage patients beyond the OR as one of the main differences between anesthesiologists and CRNAs -- which I believe it is. Now you're telling me that you don't manage patients much beyond the OR. Just in the PACU for a few hours. Did I summarize your position correctly?

Anesthesiologists, as physicians, have a far better understanding of the problems that our complicated patients have. (disease states, physiology, etc.) There's no question about that, though others would like you to believe differently. I still don't understand what that has to do with creating an anesthesia service to manage past or future surgical patients. That sounds like the role of a hospitalist. I'm not a hospitalist. I'm a Consultant in Anesthesiology. You can call me 24/7 and I can evaluate your patient, make recommendations for necessary pre procedure studies, recommend outside consultants, recommend a strategy to tune them up prior to surgery, etc. or we can go blazing into the OR emergently and I'll wing it myself taking things as they come. When the surgery is over, they go to the PACU or ICU. If they go to the ICU, there is an ICU team to manage them. If they had a serious complication, we follow their progress in the ICU. If they go to the PACU, and they are stable, they go to the floor, and back to your service. Their anesthesia is over, as is, almost always, our role in their care. We do follow up the next day to look for anesthetic complications. If we discovered a problem, we would insure that it was followed up on appropriately, however they would likely still remain on your service. Why would they be my patients when their anesthetic washed out of their system a couple hours after surgery? If your patient is anemic from his tumor excision, its a surgical complication, not an anesthesia complication. That's just one example. Since you don't give any examples of these anesthesia complications that we should be managing on our service, I'm just guessing.

 

[beavis]

True. And, you're right...fire IS cool.

On the Beavis+Butthead DVD's that are available, do they all have the music videos cut out as some sort of copyright thing?

Not sure why, but my sister was disappointed when I bought her the DVDs for Christmas

 

[fakin' the funk]

That’s not a good comparison. What I am proposing is that anesthesiologists handle complications that occur while under your care in the hospital, just as we do. That’s what every other service does. And it certainly doesn’t extend into the time of “long after they are discharged”. Services don’t discharge patients until their anemia, dyspnea, or whatever else has been addressed, or until the patient has been restored to baseline, or at very least, treated well enough for the patient to leave the hospital.

FutrrENT, I don't appreciate your slanty apostrophes and quotation marks.

 

[michigangirl]

What complications are we causing again? A sore throat?



Anesthesiologists, as physicians, have a far better understanding of the problems that our complicated patients have. (disease states, physiology, etc.) There's no question about that, though others would like you to believe differently. I still don't understand what that has to do with creating an anesthesia service to manage past or future surgical patients. That sounds like the role of a hospitalist. I'm not a hospitalist. I'm a Consultant in Anesthesiology. You can call me 24/7 and I can evaluate your patient, make recommendations for necessary pre procedure studies, recommend outside consultants, recommend a strategy to tune them up prior to surgery, etc. or we can go blazing into the OR emergently and I'll wing it myself taking things as they come. When the surgery is over, they go to the PACU or ICU. If they go to the ICU, there is an ICU team to manage them. If they had a serious complication, we follow their progress in the ICU. If they go to the PACU, and they are stable, they go to the floor, and back to your service. Their anesthesia is over, as is, almost always, our role in their care. We do follow up the next day to look for anesthetic complications. If we discovered a problem, we would insure that it was followed up on appropriately, however they would likely still remain on your service. Why would they be my patients when their anesthetic washed out of their system a couple hours after surgery? If your patient is anemic from his tumor excision, its a surgical complication, not an anesthesia complication. That's just one example. Since you don't give any examples of these anesthesia complications that we should be managing on our service, I'm just guessing.

 

[hoyden]

FutrrENT :

All you want to do is deliver anesthesia, and manage complications only when they occur during or immediately after the surgery

EXACTLY. And that is why I am an Anesthesiologist, not an ENT 😀