Only Surgeons should be cancelling (or transferring) cases

[anbuitachi]

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What are you talking about I cancel surgeries all the time. Even inappropriately booked “emergencies.”

Example: cancelled an elective radical neck due to patient having symptomatic severe AS. Surgeon tried to be slick and booked the case as an “emergency” the following Saturday. Guess who was on call? It was real awkward for the surgeon when I cancelled it again.

Once the patient eventually had their valve repaired we did the case. Patient did fine.

You don’t have to be a surgeon to understand when something is an actual emergency or not. My job is to care for the patient not please the surgeon.

That **** need to be escalated to hospital CMO. Ridiculous. Too many surgeons dont care about the PATIENT, they just want to operate.

 

[coffeebythelake]

What are you talking about I cancel surgeries all the time. Even inappropriately booked “emergencies.”

Example: cancelled an elective radical neck due to patient having symptomatic severe AS. Surgeon tried to be slick and booked the case as an “emergency” the following Saturday. Guess who was on call? It was real awkward for the surgeon when I cancelled it again.

Once the patient eventually had their valve repaired we did the case. Patient did fine.

You don’t have to be a surgeon to understand when something is an actual emergency or not. My job is to care for the patient not please the surgeon.

That is absolute bonkers and that surgeon should have their privileges revoked

 

[coffeebythelake]

This is malpractice. This patient’s quadriplegic future is 100% on that physician.

I would put 50% blame on the surgeon and 50% blame on the anesthesiologist for this. The surgeon I'm sure would tell the patient otherwise ("Surgery went great! But the anesthesia was screwed up")

 

[rakotomazoto]

Despite this being a thread started by a troll, there are still some solid lessons to glean from this extremely tragic case that happened in Walnut Creek. It seems like there was a decent effort at journalism with this case, much more than the average anesthesia/OR disaster. The article that I read for free online was quite lengthy and filled with relevant details.

In regards to the specific issue raised here, if you don't have the confidence to cancel a case under certain circumstances (intoxicated surgeon, obvious medical issues that could be optimized prior to elective surgery) then maybe this specialty isn't for you. I wasn't there, I am not even speculating on what I would or would not have done in this specific case, but I wholeheartedly disagree with the notion that we are at the whim and mercy of the surgeon and MUST do the case.

Talk to them like a colleague and remind them that it's bad for everyone when avoidable complications happen. Don't buy into this false dichotomy of surgeon versus an anesthesiologist. We are all there to take care of our shared patients. Keep everyone on the same team and make the right decision for the patient to the best of your ability. It's easy to get all inflammatory on the internet, but let's keep it decent out there in the real world.

 

[IMGASMD]

Often times I feel I am in the twilight zone. There’s the “board” answer, there’s the “right” answer, there’s the “practical” answer.

This is what I wrote from the other thread, answering which group of people I had the problem with.

“What does the patient need? Or what’s the best thing for the patient? Who cares, if it doesn’t fit my agenda, timeline or resources, I will still do whatever is according to my needs. I am guilt of that from time to time too. “

It’s so easy to say I can cancel cases because x, y and z. If it’s that simple, then it wouldn’t be on OSCE. What if your income (units) is based on whether you do the case or not? What if the surgeons income is based on that case? What if the surgery centers income is based on the shltty cases? (And you happened to own a share of the pie…)

I am not here to stir the pot…. Just want some of the younger colleagues know why having a good group and senior partners that actually back your up really make a huge difference.

 

[MirrorTodd]

If only surgeons can cancel cases, then why the **** is the aba testing my ability to say the words "I am cancelling this case" to a surgeon?

 

[IMGASMD]

If only surgeons can cancel cases, then why the **** is the aba testing my ability to say the words "I am cancelling this case" to a surgeon?

One can argue, which I am not.

They are saying “only” surgeon can cancel therefore you’re there to convince the surgeon to cancel.

 

[deleted87051]

Often times I feel I am in the twilight zone. There’s the “board” answer, there’s the “right” answer, there’s the “practical” answer.

This is what I wrote from the other thread, answering which group of people I had the problem with.

“What does the patient need? Or what’s the best thing for the patient? Who cares, if it doesn’t fit my agenda, timeline or resources, I will still do whatever is according to my needs. I am guilt of that from time to time too. “

It’s so easy to say I can cancel cases because x, y and z. If it’s that simple, then it wouldn’t be on OSCE. What if your income (units) is based on whether you do the case or not? What if the surgeons income is based on that case? What if the surgery centers income is based on the shltty cases? (And you happened to own a share of the pie…)

I am not here to stir the pot…. Just want some of the younger colleagues know why having a good group and senior partners that actually back your up really make a huge difference.

I’m 100% productivity based. No single case is worth a crappy outcome even if it’s an all day case. Cancelled, then plan B, go have Brunch, take my dog to the Beach.

 

[IMGASMD]

I’m 100% productivity based. No single case is worth a crappy outcome even if it’s an all day case. Cancelled, then plan B, go have Brunch, take my dog to the Beach.


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I am saying it’s a more nuanced conversation than just who gets to cancel the case. I know we all hate talking in hypotheticals.

But let’s say you’re 10 years younger.
You haven’t made partner yet.
Being handed a “questionable” case, in pre-op, 10 mins before starting.
The surgeon says, if you can’t do this, I will have to talk to your senior partner.
To twist the knife. You’re 300k in debt, and supposedly making partner in two months.

Does this happen? Probably not as dramatic as in movies. I’m also not talking about Walnut Creek.

I have a price, you have a price too. (Much higher limit than mine…)

 

[deleted87051]

I am saying it’s a more nuanced conversation than just who gets to cancel the case. I know we all hate talking in hypotheticals.

But let’s say you’re 10 years younger.
You haven’t made partner yet.
Being handed a “questionable” case, in pre-op, 10 mins before starting.
The surgeon says, if you can’t do this, I will have to talk to your senior partner.
To twist the knife. You’re 300k in debt, and supposedly making partner in two months.

Does this happen? Probably not as dramatic as in movies. I’m also not talking about Walnut Creek.

I have a price, you have a price too. (Much higher limit than mine…)

Most surgeons are reasonable. They don’t want problems any more than we do. In my experience, they cancel more cases than we do. Total knee patient shows up with a pimple or ingrown hair near the incision. Cancelled. Cabg patient has p2y12 assay showing slight residual antiplatelet activity. Cancelled. As a group, we don’t cancel a lot of cases, but when we do, it’s rare to get any pushback. The typical response is, “Is the next patient here yet?”

We are also self insured so you’re less likely to make partner if you recklessly proceed with cases that shouldn’t proceed.

 

[IMGASMD]

Most surgeons are reasonable. They don’t want problems any more than we do. In my experience, they cancel more cases than we do. Total knee patient shows up with a pimple or ingrown hair near the incision. Cancelled. Cabg patient has p2y12 assay showing slight residual antiplatelet activity. Cancelled. As a group, we don’t cancel a lot of cases, but when we do, it’s rare to get any pushback. The typical response is, “Is the next patient here yet?”

We are also self insured so you’re less likely to make partner if you recklessly proceed with cases that shouldn’t proceed.

Your group sounds like a upstanding bunch of physicians.

I can assure you, I’ve worked with as$hoIes.

 

[Beeftenderloin]

I am saying it’s a more nuanced conversation than just who gets to cancel the case. I know we all hate talking in hypotheticals.

But let’s say you’re 10 years younger.
You haven’t made partner yet.
Being handed a “questionable” case, in pre-op, 10 mins before starting.
The surgeon says, if you can’t do this, I will have to talk to your senior partner.
To twist the knife. You’re 300k in debt, and supposedly making partner in two months.

Does this happen? Probably not as dramatic as in movies. I’m also not talking about Walnut Creek.

I have a price, you have a price too. (Much higher limit than mine…)

I’d beat him to it and run it by a senior partner. Let them know my concerns and ask point blank what they would do and if I’m going to get thrown under the bus if I cancel or are you going to have my back? Not so much to determine if I should or shouldn’t cancel (assuming I felt strongly enough it was the right move). More so to know if I should start looking for another job. They’re not the only game in town and the market is still 🔥. Not saying that would for sure be enough to leave, but definitely enough to start looking.

 

[BobLoblaw78]

Half of all anesthesiologists are below average. Should the dolts among us refuse to do anything but cataracts and lumps and bumps in a cushy ASC?

Which half do you feel you belong in? You are unnecessarily insulting half the profession and calling them dolts. It sounds almost like you are familiar with the environment but not an actual anesthesiologist. And the comment about cushy ASC just sounds like jealousy. I am guessing you aren't an anesthesiologist or you're one who has to take whatever job was offered while getting pushed around by surgeons.