Limits of OR etiquette for anesthesiologists?

[RedRubberCath]

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So most anesthesiologists don't spend 100% of their time charting and looking at the monitors. Most of the anesthesiologists I've worked with spend their time either reading or chatting with the folks in the OR.
But today I was in with an anesthesiologist that spent an hour on his cell phone with some random customer service person, rambling on and on about getting an RMA # to return some electronic thing he bought. I thought it was sort of pushing the limits of etiquette.

What are the limits of etiquette with regards to "non-anesthesia" stuff in the OR? For example, is it ok to read JAMA? Newspaper? Playboy? 😛 Talking on the phone? Browsing the web? Etc.

Would be interested in hearing opinions 🙂

 

[Gimlet]

So most anesthesiologists don't spend 100% of their time charting and looking at the monitors. Most of the anesthesiologists I've worked with spend their time either reading or chatting with the folks in the OR.
But today I was in with an anesthesiologist that spent an hour on his cell phone with some random customer service person, rambling on and on about getting an RMA # to return some electronic thing he bought. I thought it was sort of pushing the limits of etiquette.

What are the limits of etiquette with regards to "non-anesthesia" stuff in the OR? For example, is it ok to read JAMA? Newspaper? Playboy? 😛 Talking on the phone? Browsing the web? Etc.

Would be interested in hearing opinions 🙂

I've talked to attendings that are of the opinion that reading anything but journal articles related to the case you're doing (or have coming up) is totally unprofessional. I'm sure for most anesthesiologists, the line can be drawn depending on the difficulty of the case/stability of the patient. Anything that would disrupt the work environment for others in the OR (like talking on a cell phone) would be totally un-cool in my book.

 

[usnavdoc]

So most anesthesiologists don't spend 100% of their time charting and looking at the monitors. Most of the anesthesiologists I've worked with spend their time either reading or chatting with the folks in the OR.
But today I was in with an anesthesiologist that spent an hour on his cell phone with some random customer service person, rambling on and on about getting an RMA # to return some electronic thing he bought. I thought it was sort of pushing the limits of etiquette.

What are the limits of etiquette with regards to "non-anesthesia" stuff in the OR? For example, is it ok to read JAMA? Newspaper? Playboy? 😛 Talking on the phone? Browsing the web? Etc.

Would be interested in hearing opinions 🙂

Is there a reason you posted this in other forums? The way you have it posted here is somewhat interesting but you are much more inflamatory/accusing in the other posting.

 

[ThinkFast007]

i think this is seen diffferently from different angles.

as medical students, I can see how we would think this is 'unprofessional'.

ON the other hand, i've rotated through PRIVATE hosps where I've seen plastic surgeons on their BLUETOOTH while in surgery. Never seen an anesthesiologist on a cell before.

I think if you are an attending its a didfferent perspective. These attendings for the most part work from what 7am-5pm or so. EVERYDAY. so when do these cats get time to do 'errands'? you cant call customer service for anywhere before 7 cuz theyre not open...after 5PM they are closed.

I think as long as you are not 'compromising' care...and you are a competent attending...dont see the problem as long as you are not LOUD and obnxious.

but yes, i do see how it can be a 'distraction'. good questions....not an attending yet.

 

[cdql]

It probably depends on what level you're at too. If you're just in your first year of residency, probably not a good idea to be bluetooth chatting while working.

If you're out in private practice and you're experienced enough, I don't see how it could hurt as long as you're not compromising patient safety or disturbing the surgeon.

That being said, if I were the patient who was going under anesthesia, I'd appreciate it if the doctor kept an eye on me the whole time 🙂

 

[jwk]

I think the OP about the MD on a cell for an hour during the case is unacceptable. Unfortunately, he probably fits the mold of the stereotypical anesthesiologist as portrayed on Grey's Anatomy - working crosswords, abandoning patients, etc.

There's a big debate on reading and other activities in the OR. Some think it's heresy, others think it actually keeps people a little more vigilant since they don't become mesmerized by their often routine cases. I know some that take their laptops right in the OR and surf the net or work on their stock portfolios - also a little over the top IMHO. I think any activity that changes your entire focus away from the patient is problematic. What those activities are remains open to debate.

 

[MechE]

Unfortunately, he probably fits the mold of the stereotypical anesthesiologist as portrayed on Grey's Anatomy - working crosswords, abandoning patients, etc.

Don't forget falling asleep during surgery. 🙄

 

[Idiopathic]

Im always uncomfortable talking during surgery when it isnt about the surgery or a patient. I also have a huge problem with docs who bring their laptops in and check stocks, surf the net, etc. while someone is paying them hundreds of dollars (thousands even) to monitor their care. I truly believe this is the mitigating factor in why many surgeons and other docs resent the anesthesia 'lifestyle', you know...work without really working, making more $$$ than the surgeon, often...when you bust out the laptop and start playing bejeweled or start checking stock quotes q5m, its a little out of hand, I dont care how mundane the case is.

 

[mysophobe]

I've seen plenty of anesthesiologists on their cell phones multiple times throughout the case, doing crosswords (that tends to be more of a CRNA thing though), and chatting it up with anyone that stops by.

The thing to note though, is somehow they always manage to know what's going on with the patient and have things under control. Personally, I don't care if you get a BJ during the case as long as you can manage the patient at the same time.

 

[cdql]

I've seen plenty of anesthesiologists on their cell phones multiple times throughout the case, doing crosswords (that tends to be more of a CRNA thing though), and chatting it up with anyone that stops by.

The thing to note though, is somehow they always manage to know what's going on with the patient and have things under control. Personally, I don't care if you get a BJ during the case as long as you can manage the patient at the same time.

hahaha...that would probably fall under the classification of "disturbing the surgeon"

 

[Gimlet]

The thing to note though, is somehow they always manage to know what's going on with the patient and have things under control.

Good point...I think a lot of people would be surprised by how cued in anesthesiologists are to their monitors when they are seemingly doing something else. You can tell a lot just from the beeps.

 

[mysophobe]

Yeah. Someone on this forum said it right when they said that the best anesthesiologist makes it look like he has a boring job, or something like that. If he has enough time to read or whatever, it's because he's well prepared and efficacious.

As far as disturbing the surgeon, as long as you let me watch, go at it.

 

[powermd]

Im always uncomfortable talking during surgery when it isnt about the surgery or a patient. I also have a huge problem with docs who bring their laptops in and check stocks, surf the net, etc. while someone is paying them hundreds of dollars (thousands even) to monitor their care. I truly believe this is the mitigating factor in why many surgeons and other docs resent the anesthesia 'lifestyle', you know...work without really working, making more $$$ than the surgeon, often...when you bust out the laptop and start playing bejeweled or start checking stock quotes q5m, its a little out of hand, I dont care how mundane the case is.

Are you sure this isn't just guilt you feel over having a job that would allow you time to 'chill out' during a case, while the surgeon sweats his nuts off on his feet all day?

Anesthesia is critical care, and I don't think I'm going too far out on a limb here by saying that how closely the patient needs to be monitored is variable. If everything is perfectly stable, and there is no expectation for that to change soon, then I don't see why the anesthesiologist must have his eyes glued to the CO2 curve.. or the HR... or the BP... or the vent monitor, etc. If the case is stable enough for you to turn around and draw up drugs for your next case, chart, etc.. it's stable enough to read a magazine, novel, check a stock quote- whatever you want to do, as long as you maintain the same situational awareness you would if you were doing a 'medical' task unrelated to directly monitoring the patient. I would also agree that keeping your mind active, however you like to do it, is BETTER for patient safety, than being lulled to sleep by beeping monitors.

 

[mysophobe]

Good point there. I agree 100%. It's so much safer to keep your brain active by doing something than to be falling asleep watching monitors. If crosswords keep you alert, do em.

 

[cloud9]

My cell phone ringing causes my MP3 to buzz and causes the TV to buzz and get wavy lines etc. from the signal transmission. Is there no concern about a similar occurrence around monitors in the OR (or floor for that matter). Granted my cell is a couple years old now, thus old tech, and the OR likely has better shielding on their electronics than I have on my MP3 and TV, but is really worth the risk when you have a patient's life on the line?

I guess I'm asking if there is any feedback/electrical interference between the phone transmitter and the equipment (or if the answer is definitive).

It seems poor form to take the chance.

 

[militarymd]

My cell phone ringing causes my MP3 to buzz and causes the TV to buzz and get wavy lines etc. from the signal transmission. Is there no concern about a similar occurrence around monitors in the OR (or floor for that matter). Granted my cell is a couple years old now, thus old tech, and the OR likely has better shielding on their electronics than I have on my MP3 and TV, but is really worth the risk when you have a patient's life on the line?

I guess I'm asking if there is any feedback/electrical interference between the phone transmitter and the equipment (or if the answer is definitive).

It seems poor form to take the chance.

Mayo actually did a study a few years back looking at cell phones in the OR.....It 's OK to use them.

As for whether it is ok socially or not.....Here's my observation....someone who's been in practice for 10 years ..in anesthesia (crna supervision, solo, with residents/SRNAs and as an ICU attending).

We will start with safety. I will give you that no matter what you do...even if you fall asleep....patients are going to be safe....state of the art monitors...other people in the room ...overall safety of anesthesia....

So assuming that everyone is safe, then why is it that people (surgeons, nurses, patients ) have perceptions that some anesthesiologists are better than others....why is it that certain MDs frequently have requests from surgeons / staff while others get the...."I guess its ok that so and so is sleeping my grandmother"???

It comes down to some of the things I have listed before in being a good private attending....I tried to find the link to the post, but I couldn't find it.

In essence, it boils down to perception....how people perceive you independent of your ability or skills.

Reading "car and driver" or surfing the web during a case makes people perceive you in a certain way....standing, watching, paying attention makes the same people perceive you in another way....

Which way would you like to be "perceived"? I know how I would like to be perceived.

Does it matter how you are perceived? I believe so....when a patient does do poorly...and the lawyers start sniffing around....they ask the nurse.."how does dr so and so behave during cases that he attends?" and the nurse responds "DR so and so usually surfs @big titties .com during the case"....I wonder what the jury will think about that?

Anyways...what do the other private attendings out there think? Jet, UT, Noyac?

 

[rn29306]

Mil is right. It's all about perception.

I rarely sit during cases. I can see the monitor actually easier sitting down than standing, but that's just my personal opinion. Then why stand? It allows me to see what is going on during the case and an experienced ear easily detects a change in the monitor for HR or sat, even by a couple of heartbeats a minute or a one digit change in sat. Many times the surgeon looks at us just to see if we are paying attention, something ingrained I'm sure by slackers before me. A surgeon that sees I am paying innate attention to what's going on, looking over the drape, watching what he is doing, is much more comfortable with the delivery of anesthesia than simply looking up and seeing a sloping blue drape and nobody staring back. Thus, the surgeon is much less likely to make snidearse comments about the delivery of anesthesia. I can tell if a resident or surgeon is camping out on a patient's body part and can easily tell if that notch in the ETCO2 was made by an attempted breath by an unparalyzed patient or if they are pressing on the abdomen. I can see when they are about finished, rather than sitting on my rear and hearing staples being banged in and having a full MAC of forane on board.

Just my two cents. Private practice is probably quite routine and sitting is OK because private practice docs are routine in their timing and proficiency. Teaching hospitals are quite different for many variables.

 

[toughlife]

Is there a reason you posted this in other forums? The way you have it posted here is somewhat interesting but you are much more inflamatory/accusing in the other posting.

Yeah RedRubberCath left this post about anesthesiologists in the general residency forum.

http://forums.studentdoctor.net/showthread.php?p=3515559#post3515559

 

[Skrubz]

if i'm scheduled for an interesting case, sometimes i'll bring in an article or two about it and try to read it during the day. haven't gotten to the point of bringing in a textbook yet, probably because it seems most of my attendings frown on CA-1s reading in the OR... i hear it gets more lax as a CA-2 (and with some attendings, you need to have a text handy in order to answer their questions and earn your lunch break...).

as for sitting, it all depends on the case and the time of day. obviously the first 20-30 minutes post-induction is busier (for me at least) with positioning, extra lines, antibiotics and whatnot. but once the surgeons have started and if the patient is stable, i'll take the opportunity to sit down for a little. i do get up every so often and peer over the drapes (even if nothing is going wrong) just to see how the surgery's progressing. and if the patient is trying to die on you (like the 2 year old s/p SB transplant in active rejection/abdominal sepsis), then the entire case becomes a little frenetic.

 

[Idiopathic]

Are you sure this isn't just guilt you feel over having a job that would allow you time to 'chill out' during a case, while the surgeon sweats his nuts off on his feet all day?

Anesthesia is critical care, and I don't think I'm going too far out on a limb here by saying that how closely the patient needs to be monitored is variable. If everything is perfectly stable, and there is no expectation for that to change soon, then I don't see why the anesthesiologist must have his eyes glued to the CO2 curve.. or the HR... or the BP... or the vent monitor, etc. If the case is stable enough for you to turn around and draw up drugs for your next case, chart, etc.. it's stable enough to read a magazine, novel, check a stock quote- whatever you want to do, as long as you maintain the same situational awareness you would if you were doing a 'medical' task unrelated to directly monitoring the patient. I would also agree that keeping your mind active, however you like to do it, is BETTER for patient safety, than being lulled to sleep by beeping monitors.

I thought the post was about OR etiquette? The situations I described are in bad form, regardless of whether or not they are safe. They do not shine a favorable light on our profession either. With everybody worried about the 'perception' of the role of anesthesia in surgery, the last thing we should be encouraging is focusing on things other than the task at hand.

 

[militarymd]

I thought the post was about OR etiquette? The situations I described are in bad form, regardless of whether or not they are safe. They do not shine a favorable light on our profession either. With everybody worried about the 'perception' of the role of anesthesia in surgery, the last thing we should be encouraging is focusing on things other than the task at hand.

I'm not worried about it....It is just the reality of working in a team environment.

 

[Ruban]

Good replies.

 

[Idiopathic]

I'm not worried about it....It is just the reality of working in a team environment.

Well, your own concern (and mine) aside, there have been an awful lot of posts about said perception.

 

[DD214_DOC]

i think this is seen diffferently from different angles.

as medical students, I can see how we would think this is 'unprofessional'.

ON the other hand, i've rotated through PRIVATE hosps where I've seen plastic surgeons on their BLUETOOTH while in surgery. Never seen an anesthesiologist on a cell before.

I think if you are an attending its a didfferent perspective. These attendings for the most part work from what 7am-5pm or so. EVERYDAY. so when do these cats get time to do 'errands'?

The same time everyone else does them -- on your break. Normal people work 8-5 you know.

 

[Noyac]

When the surgeon or someone else calls my name in the OR I usually say "What, was I snoring again?"

Really though, Mil is right IMHO. It's all about the perception. Most people, even the surgeons, have no clue as to what anesthesia is like. They think it is easy (w/c it is usually) b/c we make it look easy even when its not. At least the ones of us that are perceived as being good or better than the others make it look easy.

This is my routine. I induce the pt, do my positioning and other ancillaries, do some charting and stand at the drapes during the start of the case. I converse with the surgeon mostly (how'd you do in the basketball bracket? I saw your boys team won last evening. etc.) cause the circulator is usually busy. As the case gets more involved I let them concentrate on the task so that they don't delay the case and they keep moving along. I sit back, catch up on charting, answer pages, set up my next case, etc. I don't talk on my cell (it doesn't get reception in the OR), I don't have a laptop, I do read from time to time. I read anesthesia CME's, biking mags, skiing mags, etc. As the case is winding down I stand and carry on the conversation. Many times I stand and watch the whole case. It just depends.

I don't think reading or doing other activities is necessarily bad practice if you are vigilant and courteous. As you get more time in the OR you learn to pickup subtle sounds. Beeps change tone, BP cuff cycles, suctions goes quite 😱 , and on and on. Its like flying a plane (so I've heard. Jet?) you need to pay attention to many things at once without losing track of any.

 

[RedRubberCath]

Yeah RedRubberCath left this post about anesthesiologists in the general residency forum.

http://forums.studentdoctor.net/showthread.php?p=3515559#post3515559

Wow, thanks for outing me! I really must have been trying to keep that on the down-low, given how I posted it in a PUBLIC FORUM! I swear, sometimes the worst thing about anesthesia is that it ISN'T competitive enough, allowing low-IQ types such as yourself to enter the field. I sincerely hope that the higher-end gas residency progs I'll be applying for will weed out people like you.

So ANYWAY, it seems like there still isn't a real consensus on what is and isn't ok in the OR. I will make a new post with a poll so we can get some numbers.

 

[Gimlet]

Wow, thanks for outing me! I really must have been trying to keep that on the down-low, given how I posted it in a PUBLIC FORUM! I swear, sometimes the worst thing about anesthesia is that it ISN'T competitive enough, allowing low-IQ types such as yourself to enter the field. I sincerely hope that the higher-end gas residency progs I'll be applying for will weed out people like you.

So ANYWAY, it seems like there still isn't a real consensus on what is and isn't ok in the OR. I will make a new post with a poll so we can get some numbers.

Toughie's comment was probably because your other post on the Gen Residency forum sounded more like you were inviting people to flame the field in general. Personally, I don't care if people want to talk sh** about anesthesiology (keeps the competition down 😀 ), but the field gets a bad enough rap as it is from other doctors and from TV shows like Gray's Anatomy that portray anesthesiologists in a lazy/incompetent light.

 

[ThinkFast007]

The same time everyone else does them -- on your break. Normal people work 8-5 you know.

so ur telling me in the 30 min break you can do all this? are you kidding me? hey anesthesiology has got it's perks my friend. if you are tight then I think doing a 'little' stuff on the side that keeps you stimulated is OK. NOtice the word 'little'. I agree that friggin yelling at yoru stockbroker for 2 out of 3 hours of case is excessive. But no one's arguing that point.

If these guys werent confident on what they were doing, i dont think they would do these other things. I'm sure these attendings realize it's their license on the line if something screws up.

Ever talked to a CA1 about this matter. most of the guys i've talked with say they were scared SHI TLESS about doing other things during the case. Let me ask you something. after you learned how to ride a bike and got good at it, did you still have to keep lookign down at teh pedals and so forth? Hopefully not. Same thing, once you are good/confident at something you can multitask A LITTLE BIT.

before Idio comes on here and starts twisting my words...I'm not saying that once you get good at something you can 'slack off'. Vigilance is the cornerstone of anesthesia and I think these anesthesiologists who do this know what they are doing.

my two cents.

 

[RedRubberCath]

Yeah, I posted it in General too 'cause ultimately, the people who judge our etiquette are not anesthesiologists. So even if all of us in the anesthesia forum are like "yeah, I surf porn on the net all day and it's cool," others might disagree. But the other thread has turned into an expo of how incredibly dysfunctional surgeons can be! 😱

Toughie's comment was probably because your other post on the Gen Residency forum sounded more like you were inviting people to flame the field in general. Personally, I don't care if people want to talk sh** about anesthesiology (keeps the competition down 😀 ), but the field gets a bad enough rap as it is from other doctors and from TV shows like Gray's Anatomy that portray anesthesiologists in a lazy/incompetent light.

 

[Gimlet]

But the other thread has turned into an expo of how incredibly dysfunctional surgeons can be! 😱

Hahaha, true... 👍 Gotta love surgeons.

 

[toughlife]

Wow, thanks for outing me! I really must have been trying to keep that on the down-low, given how I posted it in a PUBLIC FORUM! I swear, sometimes the worst thing about anesthesia is that it ISN'T competitive enough, allowing low-IQ types such as yourself to enter the field. I sincerely hope that the higher-end gas residency progs I'll be applying for will weed out people like you.

So ANYWAY, it seems like there still isn't a real consensus on what is and isn't ok in the OR. I will make a new post with a poll so we can get some numbers.

Relax genius. Just watch the way you say things if you don't want to get flamed. Go ahead and "impress" everyone with your "extremely high IQ" and "competitiveness". 🙄 Oh, and I already matched so asked me if I care about being weeded out. 😉

 

[Idiopathic]

before Idio comes on here and starts twisting my words...I'm not saying that once you get good at something you can 'slack off'. Vigilance is the cornerstone of anesthesia and I think these anesthesiologists who do this know what they are doing.

I actually agree with you. If patient care isnt affected and outcomes/costs are the same, I dont care what the doc does during the case...keeping in mind, I would rather not have to tell one (as a 4th year student) that his patient has been apneic for 2 minutes or so, just to see him, without looking up, give the ambu-bag a squeeze.

Vigilance in the face of monotony is extremely difficult to pull off, and that is the true test of the profession, I think, not how well you handle yourself in stressful situations, but how you deal with the rote, "only 0.01% have complications" type cases. Certainly doesnt mean you cant read the paper, etc, during, but I think that even you would agree with me that it hurts the profession.

I mean, what is the one thing other students/docs comment on, when you tell them what you are doing for a career? "Oh, hate to work?" or "Need more time on your palm pilot?" Would be nice to keep that idea down.

 

[ThinkFast007]

hey rubber-

what's your poison? are you going into anesthesiology? surgery? what?

 

[Ruban]

hey rubber-

what's your poison? are you going into anesthesiology? surgery? what?

I'm about 90% anesthesia right now (currently finishing up MS3 year). I'm rotating in surg now and it's definitely not my thing, although I do respect their work a lot. But standing up for hours on end is just painful. I still haven't gotten a good answer to "Why don't surgeons use chairs?"

 

[ThinkFast007]

I'm about 90% anesthesia right now (currently finishing up MS3 year). I'm rotating in surg now and it's definitely not my thing, although I do respect their work a lot. But standing up for hours on end is just painful. I still haven't gotten a good answer to "Why don't surgeons use chairs?"

was actulaly talking to "RUBBERCATH" or whatever his name is...the OP

 

[Ruban]

was actulaly talking to "RUBBERCATH" or whatever his name is...the OP

Doh! Saw the title ("yo rub") and automatically responded

 

[ThinkFast007]

Doh! Saw the title ("yo rub") and automatically responded

its all good.... i guess we can excuse a future anesthesiologist 👍

as long as you are a die hard conservative!! 😀