Feeling like a doctor?

[Houseness]

I was talking to an anesthesiologist attending once. He's a great guy and LOVES his job. When I asked him what he thought the downside to the practice was, among the whole CRNA thing, he said he sometimes felt like he wasn't a "real" doctor. Granted, he said that when he did intubations in the ER and critical care work, it's a little different, but here was his point:

In the OR, the surgeons don't help set up and many times, don't do anything afterwards. That is, only a few surgeons accompany the patient to the PACU and only a few surgeons accompany the patient from pre-op to surgery. The anesthesiologist moves the patient and does what the surgeon prefers.

Second, the surgeon has everything set up for him by the nurse. That is, all the instruments and any needs of comforts are set up. He doesn't even help clean. The nurses do that. However, this attending receives complaints from the nurses all the time when his residents didn't put this away, or didn't clean that up. Sometimes, pain guys come in to do interventional procedures and even they get everything set up for them and then cleaned up after them, but not the Anesthesia people.

So as he said, he sometimes feels like he is lower on the totem pole when it comes to interaction with house staff.

Further, when on call, he feels like he's doing pretty much what a CRNA is now capable of (though that's not that big of a deal).

What do you all think? I figure this phenomenon would be different everywhere depending on the cultures of the hospitals, but it's just an example.

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[2ndyear]

I'd say I went through this for about a week at the beginning of (this) my CA-1 year. In other fields, you write the order and that's it. Someone gives the med or whatever. Someone sets up the procedure for you, etc. In anesthesia, we do everything. Now I realize why. If my room is set up for me, the first thing I do is take everything down and do it my way. Make sure the machine works. Checks and double checks, that's safety. If a patient comes with an IV from the floor or ER, I put my own in anyways. I know what size is appropriate, where it should be, and how to secure it so it won't come out. The reason we do everything ourselves is that the stakes are so high, if there is a simple error the patient dies plain and simple. When it's your butt on the line, you take the time and do it right.

If you're worried about not feeling enough like a doctor, spend a night on call at a busy hospital with the anesthesia team. Other doctors call all the time when they can no longer handle their situations. Sometimes it's respiratory arrest, sometimes cardiac. I've managed vents in the unit, put in IV's in baby's because no one else could, and stuck big neck lines in. You're the last line of defense for a lot of situations across the whole hospital, and when someone's in tough shape trying to die, people look to you to save them.

One last random thing. Echo. Doctors read echo, plain and simple. Anesthesiologists do echoes, and these will only become more prevalent in the future.

 

[nitecap]

Id agree with the above poster. Dont think it is a CRNA issue. really witness Anesthesiologists role a busy OR suite knocking a huge board out that without a great leader this doesnt get down.

Look face it surgery is mosts hospitals money maker. That is what funds just about all of the facilities other programs ect. Anesthesia is a much lower mney maker for the facility. So they are gonna get whinned and dined by hospital administration and the hospital is gonna do what ever it takes to retain their good surgeons that do the alot of money making cases. Anesthesia needs the surgeon as well for if they are not working then alot of times anesthesia is not working.

Im no MD but I have never heard any anesthesia attending or resident at that say they didnt feel like a doctor. On the contrary I witness them more times than not maybe thinging they are a more specialized MD that thinks they are better than your average IM, FP guy or what not.

Really dont understand how a CRNA can make a MD not feel like a MD. I mean MD's that employ NP's and PA's alike basically have those midlevels seeing 60% of the pt load. Half the time you go to your IM for a cough or cold and may only see the NP or PA. The PA is on call for that MD at nite unless things go terribly wrong ect and more consultation is needed. Having theses midlevels increases the amt of patients they can see, increases their productivity and many times increases their income while increasing their down time. really while working in a large CT ICU I rarely saw many of the top dog CT surgeons write an other progress note besides the initial post op one if anything besides their dictation. They merely breeze over the PA's note and sign off. Some of these surgeons employ up to 3 PA's. Doubt they think its taking away from them being a MD.

Also you speak of a MD helping to move the pt over. Many times thatMD may be protecting his airway and if lost may turn into major issues. And of course you have to check your machine because that is what they controll. In witnesing a ton of codes on floors and ICU's I would rather an anesthesiologist run the code by far more that IM, FP, Radiology, OB, GYN, derm, ID, GI, GU, even plastics. They seem to think quicker when quick desicion making is needed stat, They have way more exp. with airway mgmt, they are more calm when shiznit hits the fan b/c many experience this daily.

Witnessed a pg woman code not to long ago and both OB attendings and 2 OB residents freaked out and totally lost composure. The ER nurse that responded to the code was way more competent than both of these physicians with extensive training. Thank goodness anesthesia was there to pull things together and get her back. So to say an Anesthesiologists would not feel like a MD. Not sure how, being that I see them deal with far more crucial and critcal things requiring fast on site desicion making on a daily basis than many other specialties do.

 

[KluverBucy]

well said nitecap. nuff said.

 

[Misterioso]

I have heard this also, that anesthesiologists don't always feel like real physicians. More so now with CRNA's taking over more of their ground. But I've heard this also for other specialties who don't do also what physicians have traditionally done: diagnose and treat. Anesthesiologists and some other specialties don't do this in the traditional sense. But it's important to realize that anesthesiologists can do certain things better for the patients than other doctors can.

 

[YouDontKnowJack]

I spoke with an anes'logist recently in the OR.
He was overflowing with things to say about how good his hours are, how he gets to pick whether he wants to do an operation, how good the money is..... and he loves how he just gets to sit there on his ass and read magazines.

I think he couldn't care less about not 'feeling like a doc'

 

[Misterioso]

.....and he loves how he just gets to sit there on his ass and read magazines.

I don't know if this was unintended or not, but that statement reinforces the lazy stigma that others here have been trying to move away from.

 

[YouDontKnowJack]

I don't know if this was unintended or not, but that statement reinforces the lazy stigma that others here have been trying to move away from.

well it is the truth most of the time. He and I were just chatting the whole time through the operation. he occasionally checked the machine and changed the iv fluid.

 

[timtye78]

Stigmas are overrated-whether its a stigma about 'feeling like a doctor or not', 'lazy,' 'lifestyle specialties', 'md vs do' etc.

to he11 with people's stigmas, do what you like to do, and you CAN always do something different if you need to. Dont pick your work based on what 'others will think."

 

[supahfresh]

I don't know if this was unintended or not, but that statement reinforces the lazy stigma that others here have been trying to move away from.

you may be able to sit around and read magazines in the ambulatory setting when your patients are healthy. Try doing that in a heart or liver case. I personally hate the easy cases with a passion. All I can do is try a new airway technique and then read to ensure I get something educational out of the case.

 

[lateness]

you may be able to sit around and read magazines in the ambulatory setting when your patients are healthy. Try doing that in a heart or liver case. I personally hate the easy cases with a passion. All I can do is try a new airway technique and then read to ensure I get something educational out of the case.

its true, but you cant always be doing difficult long complicated cases, all the time, i have friends who tell me that after years they like a variety of cases, espcially including healthy cases so that they know the outcome, i guess it depends on if you think about it like years from now, also

 

[VolatileAgent]

this thread is valueless.

 

[chicamedica]

Actually i kinda like the fact that anesthesiologists get to implement their own orders. In medicine, for example, orders have to go through like at least 3 parties to finally get to the patient. Heck, on medicine things would take so long and the human error factor was multiplied by the number of hands the order has to exchange, that sometimes, i'd just rather go do it myself (and often one is compelled to, when something crucial just doesn't get done).

As for having to clean up, after many a time of being impatient with having to "wash dishes" after chem or bio lab, i have realized that part of being a scientist IS cleaning up after yourself, cause you cant do experiments if all your equipment is dirty or contaminated. I extrapolate that to anesthesiology. Working in a mess is impossible/potentially disastrous, and if you dont make your work space ideal for yourself, who will? It's funny how in med school (at least where i was), with the exception of anatomy lab, it was almost like it's taboo to get your hands dirty. Micro "lab" involved a group of 5 students WATCHING the TA do the experiment .

 

[2ndyear]

I worked with an orthopaedic surgeon who used to schedule like 8-10 shoulder cases in one day. Right after he finished, he'd grab a mop and help clean the OR to get ready for his next case. Always left for the day by 4 pm too!