OR etiquette..

[2Fast2Des]

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some OR questions/randomness..

As a resident, what is the best way to introduce yourself to OR staff? i.e. techs, scrubs, circulators. As Dr so and so? or as first name? To attendings and residents obviously as first name

Or best, after introducing yourself, everyone decides to address you as what you are giving the patient "Anesthesia!"

Is there a way you guys respond or don't when addressed as Anesthesia? I've been tempted to just ignore them and their request or reply back "Yes (Circulator/Scrub Tech/Surgery/surgeon)" but I feel like that would cause hostility, not that I should care since they obviously don't about us. Its hard enough to ask them for help (few instances where they start draping right over my head and trying to push me out of the way while I'm placing the A-line or getting extra PIV's for bigger cases) or start huffing and puffing if we take a bit longer because of a difficult start, but all the hours slotted for the surgery ignores our part. Sometimes for the laparoscopic surgeries they decide to overinflate the belly and I'm fighting high peak pressures and I request them to turn down the insufflation if possible and either no response, or they say yes and the OR nurse doesn't do it, or when I do it, they run over and turn it back up and say how dare anesthesia.

Even intraop if pt bucks/moves sometimes, OH GOD PT IS WAKING UP. or I DEMAND ZERO TWITCHES, 1 IS TOO MUCH! I've had ortho PA's complain that the pt was moving (aka the toes starting to wiggle) when they were wrapping the leg with ace bandage at the end of TKA when the pt's spinal was starting to wear down . My eyes able to look at the back of my skull hearing that statement hahaha

 

[Planktonmd]

Welcome to the rest of your career... You are "anesthesia" until you achieve enough political credit.
You made an "intelligent" choice to go to this specialty and you ignored all the red flags, so now you have to accept your predicament and be a good "anesthesia".

 

[Robotic Wis-Hipple]

Yup.

Just raise the blood brain barrier to just above eye level and embrace it.

But introduce yourself to OR staff by your first name and say you're a resident. It's just easier. And half of them are going for DNPs anyway and because they see you rarely you may as well be an intern to them, so there's no good capital to gain by calling yourself Dr.

 

[wickedskillz]

Treat others with respect and gain competency so that you know what you're doing, and people will respect you. Unless you're able to learb every circulator nurse's name, don't expect they'll learn yours. Focus more on learning to be better and don't worry about this stuff, annoying though it may seem. The respect will come.

 

[jthedestroyr]

some OR questions/randomness..

Even intraop if pt bucks/moves sometimes, OH GOD PT IS WAKING UP. or I DEMAND ZERO TWITCHES, 1 IS TOO MUCH! I've had ortho PA's complain that the pt was moving (aka the toes starting to wiggle) when they were wrapping the leg with ace bandage at the end of TKA when the pt's spinal was starting to wear down . My eyes able to look at the back of my skull hearing that statement hahaha

1) I put my attending and my name on the dry erase board before cases with dr j (resident). They refer to the surgery residents as doctors, but I don't push this. It's weird, everywhere outside the OR including pacu I've never had someone call me by my first name, except the OR. Maybe it's because we spend so much time in the OR and America tends to stress informality, many of these people just don't think twice about it. It's not that big of a deal to me.

2) PA tried to do that to me, I turned the gas off and said anesthesia machine is out of coins, you better hurry. Of course, I'm not going to punish a patient for a slow PA. Always have Mac high enough to prevent recall but a small dose of propofol if they're moving too much to regain control and provide a nice reminder to hurry up.

3) twitches: see propofol trick. my institution also has suggamadex which our staff encourages us to use. Sometimes a small dose of propofol cures a frustrated surgeon. After all, many like to blame everything but themselves when things are going bad, including that one twitch must be the reason the patient isn't relaxed enough to do whatever they're attempting to do. There are always a few surgeons like this.

 

[BobBarker]

You don't really need to talk to the OR staff. Our university hospital actually had a written policy that the OR staff would not help anesthesia with induction.

 

[jthedestroyr]

You don't really need to talk to the OR staff. Our university hospital actually had a written policy that the OR staff would not help anesthesia with induction.

That's crazy, we have some excellent nurses that will help hold mask while I'm putting on monitors, pull stylet, hold cricoid etc. now, not all, but a good portion will. It's actually very nice and helpful.

 

[AdmiralChz]

3) twitches: see propofol trick. my institution also has suggamadex which our staff encourages us to use. Sometimes a small dose of propofol cures a frustrated surgeon. After all, many like to blame everything but themselves when things are going bad, including that one twitch must be the reason the patient isn't relaxed enough to do whatever they're attempting to do. There are always a few surgeons like this.

Hah, we have a particularly heinous surgeon who blames everything on anesthesia (and quite nastily) - some attendings have gone as far to label flush syringes as rocuronium and push 5 mLs in view of the surgeon. 3 minutes later - "Now I can finally see what I'm doing!"

 

[jthedestroyr]

Hah, we have a particularly heinous surgeon who blames everything on anesthesia (and quite nastily) - some attendings have gone as far to label flush syringes as rocuronium and push 5 mLs in view of the surgeon. 3 minutes later - "Now I can finally see what I'm doing!"

Never done the flush trick, but im going to add that to my arsenal.

We have one nortious for saying, "i dont care if your silly twitch monitor says no twitches i still see movement." Then, if you actually did paralyze within 10min state theyre done, closing now.

 

[ZzzPlz]

These surgeons should buy stock in sugammadex

 

[deleted162650]

Hah, we have a particularly heinous surgeon who blames everything on anesthesia (and quite nastily) - some attendings have gone as far to label flush syringes as rocuronium and push 5 mLs in view of the surgeon. 3 minutes later - "Now I can finally see what I'm doing!"

If he is really that douchy then I would for sure push saline and then when he exclaims how much better that is loudly announce that you just pushed saline. Let him and everyone else know just how full of sheet he is. Maybe keep that one in your back pocket until your last week of residency.

 

[Planktonmd]

Maybe keep that one in your back pocket until your last week of residency.

Exactly!

 

[pjl]

Exactly!

Hour, not week.


Sent from my iPhone using SDN mobile app

 

[Wolverines83]

some OR questions/randomness..

As a resident, what is the best way to introduce yourself to OR staff? i.e. techs, scrubs, circulators. As Dr so and so? or as first name? To attendings and residents obviously as first name: By your first name, because first names are cooler. Lol; whatever everyone else does; this doesn't matter.

Or best, after introducing yourself, everyone decides to address you as what you are giving the patient "Anesthesia!": They don't understand what you do; this will become the basis of most of your "interactions" with surgeons.

Is there a way you guys respond or don't when addressed as Anesthesia? I've been tempted to just ignore them and their request or reply back "Yes (Circulator/Scrub Tech/Surgery/surgeon)" but I feel like that would cause hostility, not that I should care since they obviously don't about us. Hey I'm Bob, the anesthesia resident, what's up? Every time they address you as anesthesia repeat that. You can make it more polite if you want like "oh I know it's hard to keep track of all of us behind these masks, I'm Bob, the anesthesia resident. Its hard enough to ask them for help (few instances where they start draping right over my head and trying to push me out of the way while I'm placing the A-line or getting extra PIV's for bigger cases: That's bull****. Look them straight in the eye and tell them to stop. Use your big boy/girl voice but don't yell. Safe patient is more important than their feelings. I just held up a surgery yesterday because we lost IV access as a result of what the surgery team did during a flip. Oh well, told you not to just yank the patient without asking me... or start huffing and puffing if we take a bit longer because of a difficult start, but all the hours slotted for the surgery ignores our part Look them right in the eye, use your big boy/girl voice to explain why it took longer (difficult airway because they booked a 5' 4", 450 pound cysto with a jabba the hutt neck....) and don't apologize (unless you truly screwed up, then apologize because that's what big boys/girls do). Sometimes for the laparoscopic surgeries they decide to overinflate the belly and I'm fighting high peak pressures and I request them to turn down the insufflation if possible and either no response, or they say yes and the OR nurse doesn't do it, or when I do it, they run over and turn it back up and say how dare anesthesia. Again, safe patient is more important than their feelings. If they ask the nurse to turn it down and they don't, then you ask the nurse directly, using their name. "Bob, can you please turn down the pressure?" Just say you're concerned for x, y, z. If they ignore you, speak up and use their name to talk to them directly, in a big boy/girl voice. If the patient is being endangered it's not really a request at that point. It's "Hey Dr. Surgeon (attending) or Bob (resident) we need to desufflate while we get this blood pressure under control." Be ready with an explanation of what you've tried so far (and, in fairness, make sure you've exhausted your options) but if you truly need that desufflation, you need it.

Even intraop if pt bucks/moves sometimes, OH GOD PT IS WAKING UP. or I DEMAND ZERO TWITCHES, 1 IS TOO MUCH! I've had ortho PA's complain that the pt was moving (aka the toes starting to wiggle) when they were wrapping the leg with ace bandage at the end of TKA when the pt's spinal was starting to wear down . My eyes able to look at the back of my skull hearing that statement hahaha. Just say "yeah he's starting to wake up, surgery's over." I have an attending who said "Yes, the surgery has come to an end and so has the anesthesia. Wrap quickly!"

Sorry to sound like I'm lecturing you but seriously, just communicate directly (not hostily...is that a word? hostily? I'm post call) with them. In the end, it's your responsibility to ensure your patient is safe. If you don't speak with at least a smidge of confidence, they'll steamroll you. This is true in any job, any peer group, any social gathering on earth.

Oh and yes, I've used the "hand wave" over the sevo or the drape rustle to pretend I'm injecting "more anesthesia" when they think the pt's moving (uh, you're electrocuting the muscle with your bovie...) It's shockingly effective. Placebo effect is real.

 

[kidthor]

I had this issue earlier on in training (people throwing the drapes over me, not helping with things, etc), but as I became a senior resident it seemed to be less of a problem. It's even less of an issue now that I'm a fellow - part of that might be that I'm in pediatric anesthesia, where there is more of a focus on doing the best possible work for the patient. Part of it too is that I work more frequently with the same people and we all know each other.

So I'd say it'll get better once people know who you are. Also if it's clear that you know what you're doing and are efficient, people will respect you. If things need to be done, just tell people nicely to do them - e.g. just tell the nurse to put the armboards up and the monitors on (if they aren't doing so already). Tell the surgeons to help move the patient over to the stretcher. Do it all in a charming, non-douchey way.

While there are a select few who are just pieces of $h1t, I think most people in direct clinical settings really do want to do the right thing. Just make sure they're on the same page with you.

 

[powermd]

I remember my precious ego feeling bruised back in residency whenever I'd hear "anesthesia!".

I'd respond in different ways, sometimes passive aggressive, sometimes outright confrontational.

In retrospect, I would have responded differently if I could talk to that young hot head now.

I'd remind him that the best way to earn respect is to be respectful and courteous. That's not the same as being a doormat.

Use your first name with OR staff and they will find you more approachable.

OR staff are not used to being treated like they matter, so you will make fast friends with a little effort.

Write down the names of everyone in the room for every case, and make an effort to use each person's name at least once.

The staff will slowly start to show you respect in word and deed.

 

[abolt18]

The other day a nurse asked "anesthesia" to do something. The perfusionist immediately countered her with "anesthesia is the service they provide, but they all have real names up there" then she apologized and he continued to explain to her how it wasn't appropriate to refer to us as anesthesia. He was very tactful but stern. I was pretty amazed.

 

[sigrhoillusion]

I prefer to be called by my first name. I've actually failed to respond to people on many occasions when they refer to me as Dr. _____ cause it doesn't really register. But if they refer to me just by my last name it usually registers.

 

[bashwell]

I prefer to be called by my first name. I've actually failed to respond to people on many occasions when they refer to me as Dr. _____ cause it doesn't really register. But if they refer to me just by my last name it usually registers.

Here's a typical conversation I used to have in Australia in my early days:

Me: "Hi Dr Jonathan Mackenzie, just wanted to introduce myself, I'm bashwell, your medical student...."

Dr Jonathan Mackenzie (turning to another person): "Oi, Mel, who the f*** is 'Dr Jonathan Mackenzie'?!" (now turning back to me, with a wry smile) "Maaate, f***sakes, just call me Jono!" 🙂

 

[sigrhoillusion]

I'm a newbie, and I look it especially when I shave. I swear some of my pediatric patients look older than me...

 

[pgg]

The other day a nurse asked "anesthesia" to do something. The perfusionist immediately countered her with "anesthesia is the service they provide, but they all have real names up there" then she apologized and he continued to explain to her how it wasn't appropriate to refer to us as anesthesia. He was very tactful but stern. I was pretty amazed.

You should've said "Thanks, perfusion!"

Or not. 🙂

 

[sigrhoillusion]

You should have told her you were busy doing your crossword, but if she had any idea what a 4-letter word for "An ignorant nurse" that begins with C and ends with T she might be helpful...

 

[Pharmado]

I've always just taken it in stride when someone refers to me as "anesthesia." I figure that when I take the time to learn all of the nurses, scrub techs, surgeons and surgery residents names then perhaps I can expect them to all know my name. At a large institution, especially a large teaching institution, there is so much flux in terms of staffing that it is very difficult to learn everyone's name. I don't think anyone is trying to be rude by referring to us by our job. Plus it is a job that I am particularly proud to have earned the right to do.

 

[Man o War]

The other day a nurse asked "anesthesia" to do something. The perfusionist immediately countered her with "anesthesia is the service they provide, but they all have real names up there" then she apologized and he continued to explain to her how it wasn't appropriate to refer to us as anesthesia. He was very tactful but stern. I was pretty amazed.

Of all the "groups" of folks I interact with on a daily basis perfusionists are by far my favorite.

 

[sigrhoillusion]

Of all the "groups" of folks I interact with on a daily basis perfusionists are by far my favorite.

I think it's because they get to share in the joy of seeing the craziness that is cardiothoracic surgeons.

 

[Wiscoblue]

My hospital has recently outsourced perfusion services to Specialty Care. The pump boys are very pushy. They work at different hospitals where there are crnas in the heart room and then sometimes when they get scheduled to work at our hospital they irritate the crap out of me, asking questions like 'is that the real pressure'? And that too during an off pump CABG. I had to tell him to sit by his pump and mind his business. I ain't 'anesthesia' I'm Doctor Wiscoblue to you!