Machine to replace Anesthesiologists?

[narcusprince]

---

Members don't see this ad.

Why cant the sedasys be used as a tool similar to a pump. Open it up to all patients based on anesthesiolgist recommendation. Put a crna or aa in the room. Then providers have their hands free to watch the airway chart and ensure safe care of the patient. It should not replace us. Sure we could do this with a pump cheaper....

 

[Mad Jack]

But can it play sudoku?

Really though, this seems like more of a that to CRNAs than it is to anesthesiologists.

 

[Urzuz]

Chart during an EGD? Are you kidding me? THat is the last thing Im worried about during an egd or a colonocopy. THe patient requires your undivided attention almost all of the time. Screw the pump or the tubing!!. MY thumb is my pump. Were you in the room with joan rivers?

I don't follow -- care to elaborate? The way my scopes go is like this: get into the room. Patient gets into whatever position they have to be in for the procedure. I give them lidocaine, a small propofol bolus +/- some midazolam, and start a propofol infusion. Plane of anesthesia is established where the patient is breathing spontaneously and comfortable. Before scope goes in whatever hole it goes into, they get another tiny bolus. After scope is inserted the rest of the procedure usually isn't too stimulating unless they are mashing on the belly to turn corners in the colon here or there, but that is again usually resolved with tiny boluses of propofol and some comforting words. If by chance the patient goes apneic (extremely rare), I am there to give a gentle jaw thrust which usually stimulates them to breathe. If that isn't enough (never happened), I don't have qualms about telling my GI guys to remove the scope so I can mask. I am right there at the head of the bed, with a full drug cart next to me. If I look down to chart for 10 seconds, the patient is not in any danger. We also have alarms and monitors for a reason...or are you one of those ones that mutes all their alarms for fear of making the room more noisy, or annoying the surgeon/gastroenterologist? (As an aside, I do sincerely hope you use an ETCO2 monitor during these cases. I've heard of and seen some older anesthesiologists not doing this, which is flat out malpractice as far as I'm concerned...and as far as ASA guidelines are concerned as well). And if they need a general, they get a tube, not a heavy propofol infusion.

If you are so concerned about your patient going apneic and needing to mask or jaw thrust them at any given moment, maybe your thumb isn't as good as you think it is. By definition, an infusion will necessarily establish a more stable plane of anesthesia than your thumb will.

So, explain to me again, what's wrong with using a pump? And FYI, we did ALL of our scopes like this during training as well, at a large academic institution with patients as sick as you can get.

 

[Urzuz]

duplicate

 

[Urzuz]

Duplicate post

 

[Urzuz]

Duplicate post

 

[propadope]

But can it play sudoku?

Really though, this seems like more of a that to CRNAs than it is to anesthesiologists.

Your days are numbered. Pun intended

http://www.cbc.ca/radio/asithappens...tes-code-that-solves-sudoku-puzzles-1.3062091

 

[Peezy23]

...

 

[Wiscoblue]

Are you an MDA?

 

[IlDestriero]

Are you an MDA?

They didn't offer that degree at my school. Maybe it's a Caribbean thing?

 

[Wiscoblue]

It's an all MD group. I find it funny when docs refer to themselves as MDA. Maybe they've bought into the CRNA propaganda.

 

[Peezy23]

...

 

[psychbender]

I think the point Wiscoblue was making was in the use of the term "MDA," to distinguish yourself, rather than verbally distinguishing with your actual titles of anesthesiologist or doctor. I hate the term "MDA," as well as "ologist" to describe us, and never use either. I introduce myself to patients as Dr Psychbender, their anesthesiologist, and mention that I will be working with X, their nurse anesthetist. When talking to surgeons, I'll tell them which doctor and nurse will be doing their cases.

 

[Guy Caballero]

You may find it funny but it is very serious when you are jocking for contracts or taking meetings or "trial" periods at new ASCs to impress some Ortho guys and secure a contract with an excellent payor mix and there are CRNAs in the same building doing the same thing. As far as "CRNA propaganda" I have no clue what you mean but if you are so secure in whatever market you are in that you have no reason to distinguish yourself from CRNAs that want your contracts then please share your secret. As for the rest of us it is open season and we take this distinction very seriously.

^^Likely a new CRNA trolling. Doesn't yet know that the term MDA is made up and offensive to >90% of the anesthesiologists practicing. An anesthesiologist who went to medical school would know that there is no such thing as an MDA.

 

[chmd]

I think the point Wiscoblue was making was in the use of the term "MDA," to distinguish yourself, rather than verbally distinguishing with your actual titles of anesthesiologist or doctor. I hate the term "MDA," as well as "ologist" to describe us, and never use either. I introduce myself to patients as Dr Psychbender, their anesthesiologist, and mention that I will be working with X, their nurse anesthetist. When talking to surgeons, I'll tell them which doctor and nurse will be doing their cases.

I talked to a periop nurse re: mda being garbage. She said she thought that the "a" was added to distinguish us from the rest of the non specialist type docs -- meaning an indication of superiority of sorts.

 

[Khaan]

I wouldn't think there is any threat to Anesthesiologists or CRNAs. When things go wrong they can go really wrong and require quick critical thinking with a human touch that I simply believe machines cannot achieve (a personal opinion).

 

[Peezy23]

...

 

[Peezy23]

...

 

[Peezy23]

...

 

[Peezy23]

...

 

[Twiggidy]

no CRNA, AA, or machine, can intubate, do lines, do blocks, or know physiology of critical patients better than me......mic drop

 

[Guy Caballero]

You know I joined SDN because of the seemingly "intelligent" Convo on this site. But whoever the hell you are to suggest I am a CRNA is just pissing me off. Who in the hell do you think you are? EVERY anesthesiologist in
my group in Colorado Springs refers to themselves as an MD Anesthesiologist. If you had half a brain you would know that CRNAs are not credentialed in the springs and that is the way we like it. So my 4 years of medical school my 2 years of general surgery and my 3 years of anesthesiology residency qualify me as a CRNA just because your idle mind doesn't understand the dynamic of MY market in the springs?? Sit down because you sound like a clown and your insult is just pissing me off. If you dont have anything productive to say keep your comments to yoursel. CRNA trolling??? WTF ever. I trained in General surgery under David Feliciano and I had direct contact to Paul Barash and the likes during my entire anesthesia residency. Can you put that together???? Where did I train??? Give me a break

Sorry to anger you. New posters using the term MDA are generally CRNA's trolling. Sorry if that was not accurate in your case. If you didn't know that the term is offensive to many anesthesiologists, you do now. BTW, I never asked anything about where you trained, but please give Paul my regards.

 

[Consigliere]

And one more thing genious...

LOL! There's something so funny about someone trying to diss someone else's intelligence then mispelling "genius."

 

[Peezy23]

...

 

[Consigliere]

no CRNA, AA, or machine, can intubate, do lines, do blocks, or know physiology of critical patients better than me......mic drop

This very well may be true but I got news for ya' fella - a lot of people really don't care. To many out there, you are a glorified, overpaid intubating-line placing-block doing-physiology knowing monkey.

 

[Consigliere]

So you have never mispelled anything while using a small phone keypad and rushing from the lounge to start a case? yeah ok...

I never rush, sir.

 

[Twiggidy]

This very well may be true but I got news for ya' fella - a lot of people really don't care. To many out there, you are a glorified, overpaid intubating-line placing-block doing-physiology knowing monkey.

Oh I know this first hand and at some points have even been told by a surgeon, "The only reason you're here is to keep the blood pressure normal." But this monkey is better at monkey-ing than any nurse monkey, monkey assistant, or machine monkey.

But on this forum, I'm preaching to the choir. No hosptial admins likely trolling this place.....maybe.

 

[Peezy23]

...

 

[chmd]

And one more thing genious... Of course every anesthesiologist that trained knows we are all MD/DO. THE PEOPLE THAT HOLD THE CONTRACTS AND THEREFORE HOLD THE $$$. HOWEVER DON'T. SO IN THIS MARKET WITH CRNAs KNOCKING CONSTANTLY AT THE DOOR TO SLIP INTO ONE OF THESE ASCs IN TOWN MDA IS NEEDED TO EDUCATE THE LESS INFORMED GI ASC BUSINESS MANAGER. Had enough yet??

You're really bringing down my enjoyment of this forum. Are you in cahoots with "legit boss"?

Congrats on passing your boards recently.

 

[Consigliere]

So this guy is Captain Anesthesiology. Well I just woke a patient uo got em to the PACU got to Pre-op, consent signed, placed a femoral catheter and a single shot pop-sciatic and had the patient in the room 15 minutes to the dot after exit time from the OR on the last case...so yeah...I rush

Big f_ucking deal. The only question I have is: what took you so long? You'd be looking for another job if you worked at my place, pops.

 

[bashwell]

You're really bringing down my enjoyment of this forum.

True, sadly. Often someone's reaction tells us more about them than it does about the person they're criticising. IQ is important but so is EQ (though I don't know if I quite like the designation of EQ as EQ, but I just mean emotional stability, equanimity, maturity, that sort of thing).

 

[Consigliere]

So this guy is Captain Anesthesiology.

BTW, I'm a general. General anesthesia.

 

[deleted171991]

 

[Twiggidy]

Im over here like this....🙂

 

[Peezy23]

...

 

[Twiggidy]

. Drops mic. I'm done

 

[Twiggidy]

You guys have certainly made my day more fun 🙂

 

[Consigliere]

Difference is My blocks actually work. I should have known not to jar with someone that supports the Philadelphia Eagles. That right there shows me all I need to know about your character. Get some Broncos in your life. And stop placing subcutaneous catheters and billing for an actual block
. Drops mic. I'm done

(Picks mic up and places it under Peezy's mouth) - "Why did you quit your cardiothoracic surgery residency? Didn't have the nuts to finish? Never mind, the question is rhetorical; I already know the answer."

Peace out!

 

[psychbender]

And no one introduces themselves to patients as "Hi I am your MDA today". that sounds ridiculous. If you actually READ what I posted you would note that I said this distinction is used in my practice when JOCKING FOR CONTRACTS. i.e. on PAPER with business managers and owners of ASCs to clearly define who they are dealing with BECAUSE the CRNAs here have been known to draft letters to ASCs and NEVER mention anything other than "ANESTHESIA PROVIDER" when describing themselves.

I'm going to come back to this, ignore all of the chest thumping and mic dropping. If you are putting in proposals that your groups has X number of MDAs available for the contract, why not replace "MDA" with a better title like, "doctor." I am being absolutely serious here, there is no reason for you to use their denigrating term for us in business negotiations (or ever). If the CRNA group tries to be vague with using the "anesthesia provider" term when discussing manpower, be very obvious by stating that you have X number of actual doctors with your group. Harp on it, and point out that you don't know what you're actually getting with the CRNA group that hides its staffing behind imprecise language (are they solo CRNAs, or do they hire one or two anesthesiologists to "supervise" them?). Or are you suggesting that the business managers and owners of ASCs won't understand that your doctors are actual anesthesiologists, but totally get MDAs?

 

[Guy Caballero]

Peezy reminds me a little bit of when Barry Friedberg dropped by the forum to say "Hi." The one post after another style. The constant "I'm better than you are" banter. All that is missing is the overuse of the emoticons.

 

[Peezy23]

...

 

[Gastrapathy]

These are all good points. Without breaching confidentiality clauses because these are ongoing negotiations: This is more of an actual credentialing issue with the hospital allowing pts that should be coming to the hospital to go to these ASCs. The GI docs are actually in breach of contract because of the fact that they hire the CRNAs and take pts to their own ASCs essentially competing with us for Anesthesia billing, which is not allowed via our exclusive contracts with the hospital. It is a loophole the GI guys have found. The DOJ was notified and doesn't seem to care much so the next step is going to the actual hospital board. I had a discussion with one of the memebers of the credentialing committee and when I stated I was an anesthesiologist at the hospital she asked "Are you a doctor or a nurse". Like I stated before, CRNAs are not even allowed to work in this hospital so this question utterly annoyed me but this is what we are dealing with. So to be able to push the point that the hospital and the GI guys are in breech of contract we are forced to communicate in terms that they actually seem to understand. As you may see this is a sticky situation with a lot more layers than I am allowed to expose

I can't believe someone is dumb enough to share his location (Colorado Springs) and that his group complained about a contracting dispute with GI to the DOJ. But since you did, it's now quoted for posterity. You must be the very first irreplaceable physician on earth.

Or a varsity troll.

Sending cases to an ASC isn't a loophole. It's a basic part of GI practice management. Guess there are some CRNAs around after all. If it was my GI group and you filed a federal complaint against me, I'd be looking to get you replaced.

 

[Gastrapathy]

Lol, too late killer. But the sudden erasing of posts...is this real or just another masterstroke for the supertroll?!??

There are only 2 groups in Colorado Springs. What will they think of this? You do realize that they could just walk right? Take their patients to other hospitals, leave that ED uncovered. Probably wouldn't need to give more than a months notice.