How do you deal with "blame anesthesia"?

[kidthor]

Hi all - I've been having an uptick in "blame anesthesia" moments lately... and I'm wondering how you all deal with this issue both in a personnel and documentation sense?

A couple rough examples include:
-uncontrolled surgical bleeding blamed on coagulopathy and under-resuscitation (with normal coags/TEG, ongoing appropriate resus, etc)
-peripheral nerve blocks in the setting of prologed tourniquet time or nerve stretch intra-op with neuro issues post-op
-post op surgical patients with OSA who have obstructive issues two days down the line - blamed on "too much residual anesthesia"
-epidurals causing all manners of unrelated things post-op

And what do you do when post op notes blame you for complications that aren't definitively yours?

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[anbuitachi]

Hi all - I've been having an uptick in "blame anesthesia" moments lately... and I'm wondering how you all deal with this issue both in a personnel and documentation sense?

A couple rough examples include:
-uncontrolled surgical bleeding blamed on coagulopathy and under-resuscitation (with normal coags/TEG, ongoing appropriate resus, etc)
-peripheral nerve blocks in the setting of prologed tourniquet time or nerve stretch intra-op with neuro issues post-op
-post op surgical patients with OSA who have obstructive issues two days down the line - blamed on "too much residual anesthesia"
-epidurals causing all manners of unrelated things post-op

And what do you do when post op notes blame you for complications that aren't definitively yours?

It's super annoying but i correct them if i can..
One annoying thing is sometimes when I bring the patient to the PACu and patient complains of throat pain the nurse automatically blames it on anesthesia, without even learning about the case first. I've had this many times, even for MAC cases or cases where we had a small tube in but it was a EGD or laparoscopy... If i'm present i correct them. If i'm not and see it in a note and its ridiculous then i put in a note or call them

 

[dchz]

- "it indeed was a factor P deficiency that caused the bleeding, P for prolene"

-ask for all the back billing for all those residual anesthesia that you've provided

All kidding aside, I take any blame on me as an opportunity to examine and improve my practice. I have an attending that does cutting needle out of plane blocks, I don't know what is there to say the nerve block didn't cause the nerve damage. (It's one of the known sideffects)

But there is a professionalism issue of having post op notes blaming you. I would take the high road and speak to the note writer privately. Then moving up the chain prob all the way to hospital risk management.

Snarky rebuttals may take place from me after private conversations and nothing is corrected. Which may or may not include ad hominem attacks.

- "medical literature is plastered with evidence that epidurals do not cause back pain, but **** monkey is too busy trying to learn to tie basic knots and fling poop to be bothered with thinking like a doctor. "

I do not advise you actually write anything like the above on permanent record****

 

[Planktonmd]

Hi all - I've been having an uptick in "blame anesthesia" moments lately... and I'm wondering how you all deal with this issue both in a personnel and documentation sense?

A couple rough examples include:
-uncontrolled surgical bleeding blamed on coagulopathy and under-resuscitation (with normal coags/TEG, ongoing appropriate resus, etc)
-peripheral nerve blocks in the setting of prologed tourniquet time or nerve stretch intra-op with neuro issues post-op
-post op surgical patients with OSA who have obstructive issues two days down the line - blamed on "too much residual anesthesia"
-epidurals causing all manners of unrelated things post-op

And what do you do when post op notes blame you for complications that aren't definitively yours?

Unfortunately this is part of the job and it will always happen. Everyone tries to shift the blame to someone else and anesthesia is an easy target usually for many reasons.
When someone writes a note blaming you for a complication, the most important thing is to not get dragged into a debate on the medical record, ignore the note and simply write your own brief post-op note stating the facts. Don't add personal opinions, or criticism of others.

 

[kidthor]

One annoying thing is sometimes when I bring the patient to the PACu and patient complains of throat pain the nurse automatically blames it on anesthesia

That's a classic... I've had that with EGDs, ACDFs, rigid esophagoscopies for foreign body, bronchs, and thyroid surgeries.

 

[dannyboy1]

That's a classic... I've had that with EGDs, ACDFs, rigid esophagoscopies for foreign body, bronchs, and thyroid surgeries.

Honestly, who gives a fu(k. One of the side effects of ETT is a sore throat. ETT is indicated in the setting of general anesthesia in general and ENT surgeries in particular. You will not get sued for this. Nor will you get sued for back pain after an epidural. Accept it as part of the job, cash your paycheck and move on.

 

[anbuitachi]

Honestly, who gives a fu(k. One of the side effects of ETT is a sore throat. ETT is indicated in the setting of general anesthesia in general and ENT surgeries in particular. You will not get sued for this. Nor will you get sued for back pain after an epidural. Accept it as part of the job, cash your paycheck and move on.

who gives a fk if you get sued. it's part of life as is death. accept it and move on

 

[coffeebythelake]

Honestly, who gives a fu(k. One of the side effects of ETT is a sore throat. ETT is indicated in the setting of general anesthesia in general and ENT surgeries in particular. You will not get sued for this. Nor will you get sued for back pain after an epidural. Accept it as part of the job, cash your paycheck and move on.

there's plenty of ignorance out there about what we do. i correct them when i can especially if it is so obviously wrong.

 

[Southpaw]

Hi all - I've been having an uptick in "blame anesthesia" moments lately... and I'm wondering how you all deal with this issue both in a personnel and documentation sense?

A couple rough examples include:
-uncontrolled surgical bleeding blamed on coagulopathy and under-resuscitation (with normal coags/TEG, ongoing appropriate resus, etc)
-peripheral nerve blocks in the setting of prologed tourniquet time or nerve stretch intra-op with neuro issues post-op
-post op surgical patients with OSA who have obstructive issues two days down the line - blamed on "too much residual anesthesia"
-epidurals causing all manners of unrelated things post-op

And what do you do when post op notes blame you for complications that aren't definitively yours?

Maintain good communication with the surgeon regarding labs and the resuscitation. If they throw you under the bus, they’re a dick, and you move on with your life. You can’t fix their personality disorder.

Blocks - if you have issues with certain surgeons (tourn. time too long, blaming post op issues on you) stop offering their patients blocks.

The ‘blame anesthesia’ mentality I found more prevalent in residency with residents who just didn’t know better. I still see it occasionally, but it’s rare in private practice in my opinion, unless it’s either warranted (no one is perfect) or the surgeon is just an ***hole.

If by epidural you mean OB, then you can’t fix that. Everyone, and I mean literally everyone, on the OB floor is ****ing nuts.

 

[San Marzano]

If by epidural you mean OB, then you can’t fix that. Everyone, and I mean literally everyone, on the OB floor is ****ing nuts.

This was so true at my last job too. Why is this such a universal thing? The hormones maybe?

 

[2Fast2Des]

You mean when the patient moves and the MDsurgeon says they're waking up that's not true? Or if the surgeon blames me that the diaphragm moves with ventilation and asks if I could stop it I should comply?

 

[dhb]

Maybe Twiggidy can insert a gif of Jules screaming "Does he look like a bit..ch!"

 

[Psai]

Sounds like you need a new job where the surgeons aren't *****s

 

[sigrhoillusion]

My favorite is reading the surgery notes.

Anesthesia Type: LMA

LMA? What? That's it? I've been doing this all wrong...

 

[VisionaryTics]

I have one simple request: keep the blood pressure low enough so that a single RBC traverses the coronary and renal circulation every few minutes.

If you gas monkeys can't handle that, don't get upset when we blame you for horrific intraoperative hemorrhaging.

Also no gas, that causes bleeding. No Toradol. No propofol. Keep the patient deep enough so they don't do move a micron during the procedure, but you can't use paralytic because I'm monitoring nerves. But they need to be able to awake immediately when the intern throws his last stitch after his two hour closure which we said would take 10 minutes. And please stop futzing around before the procedure putting on EKG leads and stuff, you're just wasting time.

 

[deleted126335]

When you get to the FU point in life, or your job becomes less valuable to you for whatever reason you get to give it back. Of course once you do it once or twice, word spreads and the surgeons stop being a$$holes to you. But not to your colleagues.

 

[coffeebythelake]

When you get to the FU point in life, or your job becomes less valuable to you for whatever reason you get to give it back. Of course once you do it once or twice, word spreads and the surgeons stop being a$$holes to you. But not to your colleagues.

I ****ing screamed at a urology resident the other day for their stupid antics. OR full of people. I don't think I'm at the FU part of my career yet, and Id like to think it was out of character. But I was soooo mad. I think they are afraid of me now.

 

[Psai]

I ****ing screamed at a urology resident the other day for their stupid antics. OR full of people. I don't think I'm at the FU part of my career yet, and Id like to think it was out of character. But I was soooo mad. I think they are afraid of me now.

I've been at the fu portion of my career for a while now.

 

[Consigliere]