Doing What's Right Despite a PIA Surgeon

[DrZzZz]

As a graduating resident, question for you all.

Case that would clearly benefit from some elective procedure, be it a peripheral block or epidural, and surgeon pushes back for a BS reason. For example, "I don't want it (the procedure) to slow us down".

How much, if at all, do you argue with the surgeon for the patient? It's an elective procedure, totally not required for the surgery, but will clearly benefit the patient. Is it not worth the argument? Do you consent to do said procedure post-op if needed?

For now, I don't rock the boat. I'll mention it to my attending and let them decide, but that's going to be me in a few short weeks. Just looking for your opinions. Thanks.

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[HomeSkool]

Educate your surgeons, give them crap if they think what's right for the patient is contingent on what's convenient for the surgeon, plan ahead to get block patients brought back early, consent for postop rescue blocks, and never ever forget that you're a consultant and not the primary provider.

 

[anbuitachi]

As a graduating resident, question for you all.

Case that would clearly benefit from some elective procedure, be it a peripheral block or epidural, and surgeon pushes back for a BS reason. For example, "I don't want it (the procedure) to slow us down".

How much, if at all, do you argue with the surgeon for the patient? It's an elective procedure, totally not required for the surgery, but will clearly benefit the patient. Is it not worth the argument? Do you consent to do said procedure post-op if needed?

For now, I don't rock the boat. I'll mention it to my attending and let them decide, but that's going to be me in a few short weeks. Just looking for your opinions. Thanks.

Honestly, ive never seen even a single attending of mine push for a block if the surgeon said no (sadly).

However, I think you can just say it's part of your anesthetic so you can go ahead and block since it's an academic center if they dont have any reason. Personally i hate it when a surgeon tries to dictate our care.

 

[deleted171991]

Personally i hate it when a surgeon tries to dictate our care.

You are in the wrong specialty, buddy. Get used to it.

And while I agree that I am a consultant outside the OR, in the OR I am the primary attending for anesthesia. As in the buck stops with me when about the anesthetic plan, and that includes everything that happens on my side of the blood-brain barrier (e.g. fluids). I will try to keep the surgeon happy, as much as possible, but not if it hurts the patient.

It's co-management, so one'd better be on good terms with the surgeon, for the patient's sake.

 

[dannyboy1]

As a graduating resident, question for you all.

Case that would clearly benefit from some elective procedure, be it a peripheral block or epidural, and surgeon pushes back for a BS reason. For example, "I don't want it (the procedure) to slow us down".

How much, if at all, do you argue with the surgeon for the patient? It's an elective procedure, totally not required for the surgery, but will clearly benefit the patient. Is it not worth the argument? Do you consent to do said procedure post-op if needed?

For now, I don't rock the boat. I'll mention it to my attending and let them decide, but that's going to be me in a few short weeks. Just looking for your opinions. Thanks.

If it’s something like an epidural or block I would go with the flow for now. Remember you are brand new to the practice and hospital. Establish yourself as safe, pleasant, and reliable. Once the surgeons get to know you you will have an easier time with these situations.

 

[abolt18]

As a graduating resident, question for you all.

Case that would clearly benefit from some elective procedure, be it a peripheral block or epidural, and surgeon pushes back for a BS reason. For example, "I don't want it (the procedure) to slow us down".

How much, if at all, do you argue with the surgeon for the patient? It's an elective procedure, totally not required for the surgery, but will clearly benefit the patient. Is it not worth the argument? Do you consent to do said procedure post-op if needed?

For now, I don't rock the boat. I'll mention it to my attending and let them decide, but that's going to be me in a few short weeks. Just looking for your opinions. Thanks.

I've only seen 2 of my attendings push back, and they basically said "look, your patient is going to hurt, a lot. Neither of us wants that for her. I know you say we don't have time, but look, we've got everything ready and the block would have been done by now if we hadn't stood here talking about it. Give me 5 minutes and our patient will be better off for it."

I've only seen it on a couple occasions, and it was specifically when the surgeon "didn't want to wait" and there was no other good reason.

 

[Man o War]

For me it depends what it is. If it’s a monitor or intervention/access I think I might need for intraop care, I’m going to do it. I’ll be damned if I’m getting caught with my pants down in the middle of a crap situation because some surgeon was bitching at me for putting an extra line in.
Or anesthetic type in certain patients. GIs were the worst about wanting us to do unsafe stuff on obese patients.
I find these arguments occur less as you get to know them and and they get to know you. Also, pick your battles but never compromise safety/preparedness.

 

[vector2]

Multimodal (including a bit of ketamine and/or methadone) has become so good that I honestly don't push the regional issue unless general is clearly unsafe for the patient. Just the other day my colleague had a patient on plavix with CHF and bad CAD refusing revascularization. Surgeon wanted to do bilateral LE debridements/amps. Pt was a little guy, so surgeon got told pt is only getting one side blocked and then getting a mg or two of versed. He can come back tomorrow to do the other leg. End of story.

 

[ryanjmy]

As others have said go with the flow until you are established. Nobody wants to hear how they are doing things wrong from the newby. You're probably even going to get pushback from old guys in your group that don't want to bother with blocks.

There's no reason a peripheral block should slow them down. If you have proper support and skills it shouldn't take longer than 5 mins and can be done in the preop area. If you don't have ancillary support eventually you can talk to administration. Every sentence should contain the phrase opioid epidemic and/or eras.

Epidurals are a little more tricky. That requires an acute pain service. Your partners aren't going to like getting called in the middle of the night because a pump is beeping.

 

[Consigliere]

Don't sweat that, pal. Believe me, in just a few short years, you'll look at blocks as just more work and will be happy when you don't have to do them.

 

[T-burglar]

Don't sweat that, pal. Believe me, in just a few short years, you'll look at blocks as just more work and will be happy when you don't have to do them.

If you are salaried .

If my total knee days lost all the associated block units I’d never voluntarily do a day of knees again