identity theft

[manthatssick]

Did you know that the ASA thinks you are "stealing" thier services?

Your ASA has long been fighting
these scope-of-practice issues that are
brought forward each year by the nurse
anesthetists. Yet they are not the only
ones in the medical community who are
trying to steal our identity. We have
to look no further than the emergency
rooms, the endoscopy suites and the
cardiac catheterization laboratories to
find other examples of theft of identity
from anesthesiologists. In the ERs of
America, emergency physicians are using
propofol to induce unconsciousness for
the brief period of time it takes to set​

fractured bones.
http://www.asahq.org/Newsletters/NL Portal/april09.html

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[SoCuteMD]

If you knew anything about the field, you'd know it's not an ER but an ED.

Thanks for the heads up.

 

[dchristismi]

*MY* ASA??

Hm, actually, that would be MY ACEP and AAEM. And SAEM, for that matter.

ASA is what we give to chest painers.







Can I get an "F?"

 

[Dwindlin]

I think only the first line was actually written by the OP. The portion starting with "Your ASA..." is copy/pasted from the ASA newsletter the OP links at the end of the quote.

 

[Doctor Bob]

In the ERs of America, emergency physicians are using propofol to induce unconsciousness for the brief period of time it takes to set fractured bones.

I'd much rather do this myself with a competent nurse or midlevel, than wait around for an anesthesiologist to be free to come down and then wait while they did their own pre-sedation workup, only to have them watch over the patient for 5 minutes during the procedure... and then bill the patient for another provider.

Not that I don't like anesthesiologists... I just think that would slow down the ED.

 

[SoCuteMD]

Also, as far as anesthesiology - don't you have bigger things to worry about? I mean, the ED would be a small part of your income. The OR, however, is being infiltrated by nurses who insist (and seem to convince many people) that they can do your job just as well as you can. Shouldn't you work on reclaiming your own territory first?

 

[xaelia]

I'm going to stop doing rectal exams and let Gastroenterology and Colorectal Surgery fight it out for turf in the ED.

 

[docB]

This is actually an important topic and it seems to come up every few years.

Here's how this usually goes down:

The anesthesiologists are continually fighting with the CRNAs. Every now and then the debate swings to "who should be allowed to do certain things." The certain things are usually listed as give certain drugs (ie. propofol, etomidate, etc.), do procedural sedation etc. The gas groups then start to push for restrictions on everyone else's ability to do these things and it spills over from the nurse vs. doctor arena to a gas vs. everyone else situation.

Hospitals, Joint Commission, CMS, etc. start to sniff around about the alarms being raised by the anesthesiologists. The first question that gets put back to the gas crowd is "Why shouldn't they be able to do it?" The gas answer is always "Because they can't manage the airway or the other systems if there's a problem."

At that point we as EPs are usually able to excuse ourselves from the issue and the fight continues between gas and the others who do procedural sedation like cards, GI, ortho and so on. It then gets brought up that the cost and manpower requirements of having an anesthesiologist go to every sedation is prohibitive. At that point the hospitals and CMS turn against the gas guys as they don't want anything that increases costs.

Then the usual proposal by gas is that they not actually do the sedations but that they should be "available" and be contacted by phone before any sedation is done and that they should be able to bill for the sedation (which is done by someone else). At that point everyone laughs and the whole thing dies out because what it really amounts to is that the anesthesiologists really want to license the use of procedural sedation.

We will really not have anything to worry about until they are as a whole specialty willing to field a deep enough call panel with a low enough cost to respond to every sedation and until they can produce convincing data that each group they want to strip of the abiltiy to sedate is unable to provide sedation without an acceptable margin of sefety.

 

[beyond all hope]

The good news is that procedural sedation is so safe with so few adverse outcomes (note: getting hypoxic for a few seconds is not a real adverse outcome unlike what JHACO thinks) that gas doesn't have the political umph to take over.

EPs are doing good and safe sedation all over the country. If there's ever a reported rash of bad outcomes, you can guarantee gas will try to get in. Then we'll have to go back to doing unofficial sedations, such as large doses of opiates and benzos separately for 'agitation'. Those suck.

Propofol and Ketamine rock!

Who's ever had a real bad outcome from sedation? Not me. Never even heard of it from any of my fellows. Sure, I've had to sternal rub a few, narcan a few, give a little IVF or antiemetics to a few.

My last Ketamine kid wanted to go back to the 'happy place' after I rebroke his arm in order to straighten his 60 degree angulated greenstick forearm fracture.