Surgeon's CNN article about anesthesiologists

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I'm just an MS1, but my first thought is that there is a more obvious reason to choose 7:30 a.m.

You don't have to be NPO all day long.

That said, circadian rhythms were emphasized in my undergrad Neuroscience degree, so I can see the line of thinking there. Bu I have shadowed in the OR and the Anesthesiologists and CRNA's worked 12 hour shifts... which would put them getting off work at 6 pm. I certainly don't know how every operating room in the country works or how anesthesiologists set up their schedules everywhere, and I feel the author would have done well to recognize that fact as well.
 
The shift change is pretty accurate around 3pm in our academic hospital. Not everyone changes but residents/attending relieve each other unless they are on call/backup call etc. I would think this is the case with most academic institutions since we have to abide by ACGME duty hour rules. This does not in any way mean that pt's will have an increased complication rate though. Hand-offs are thorough. Anyone else care to chime in on how their institution works?
 
I hope that buffoon didn't get paid to write that... Seriously, what's the point?
 
lane said:
I hope that buffoon didn't get paid to write that... Seriously, what's the point?
Click to expand...

He is basically equating anesthesiologists with nurses and scrub techs that work 8 hours and leave. Whats the problem with that? Anyway it is a "duh" type of an article.

But my first job there were no hand offs allowed. If you started a case you HAD to finish it.
 
I like how he claims everyone is tired but forgets to emphasize the surgeon.
 
pgg said:
It's like "Deep Thoughts" with Jack Handy, minus the entertainment value.
Click to expand...

Haha, yeah - i miss phil hartman. anyway, lotta backlash in the comments section. i'm sure that guy was already the most popular surgeon where he works 🙄

Edit: just googled him. he's a plastics guy - explains a lot.
 
He's a poster here, but I can't remember his name. Couple featured articles he's done here -

http://studentdoctor.net/2011/11/20-questions-anthony-s-youn-md-facs/

http://studentdoctor.net/2012/05/how-to-survive-medical-school-without-becoming-a-patient/

I have no interest of going into gas, and I thought the article was pretty irresponsible. Painting a dramatic picture of regaining consciousness during surgery or in the ICU (ambiguous as to where)? Really? There are very possibly increased incidence of poor outcomes with shift changes (just another chance to make a mistake) and toward the end of shifts (fatigue), but I would think it is marginal.
 
Best comment below the article:

"queefexplosion • 2 hours ago −
because the doctors usually have a few drinks during they lunch break plus they are tired from banging all the nurses with big jugs."

Oh, I love the internets. Well, said mr. Queef Explosion, well said.
 
this does make me wonder if prolonged NPO status (i.e. NPO after midnight for a 3PM procedure versus NPO for an 8AM procedure) would affect PONV
 
He's so right. I'm sure the PGY-1 ENT resident on his required general surgery rotation is exactly who you want exchanging your seton in your anal fistula while the chief resident does the time out over the phone and the attending doesn't even know you're in the hospital. Oh yes, "your" surgeon will never leave you because they're unaware you're even there to begin with.
 
IveGotTwins said:
He's so right. I'm sure the PGY-1 ENT resident on his required general surgery rotation is exactly who you want exchanging your seton in your anal fistula while the chief resident does the time out over the phone and the attending doesn't even know you're in the hospital. Oh yes, "your" surgeon will never leave you because they're unaware you're even there to begin with.
Click to expand...

This, x100.
 
IveGotTwins said:
He's so right. I'm sure the PGY-1 ENT resident on his required general surgery rotation is exactly who you want exchanging your seton in your anal fistula while the chief resident does the time out over the phone and the attending doesn't even know you're in the hospital. Oh yes, "your" surgeon will never leave you because they're unaware you're even there to begin with.
Click to expand...
WholeLottaGame7 said:
This, x100.
Click to expand...
Is that really how they do things at your programs? We don't start a case without the attending in the room.
 
Every single day regardless of what surgical specialty. I'm not saying that staff are never there but it is not uncommon for lower level residents to do entire "easy/routine" cases with no one else scrubbed. A PGY4 has to be present for the timeout but doesn't have to do anything else.
 
We don't start any operation without the attending surgeon in the OR, except for a handful of specified cases that the fellows are approved to do themselves. Residents can close alone, though they're usually with a fellow. It's one of the benefits of a specialty hospital.
 
IveGotTwins said:
Every single day regardless of what surgical specialty. I'm not saying that staff are never there but it is not uncommon for lower level residents to do entire "easy/routine" cases with no one else scrubbed. A PGY4 has to be present for the timeout but doesn't have to do anything else.
Click to expand...
But the attending doesn't even know the patient is in the hospital?
 
On the whole I would say that the majority of cases are done with staff in the room at the appropriate (critical) portions, but sometimes they show up and just sign the chart and the resident has done the case after a PGY4 or 5 has done the timeout, and occasionally they show up and appear to not know anything about the patient (name, procedure, etc.), and a few times they never show up at all. They've come from day surgery, the floor and the ER. I've seen it with wound vacs, hardware removal, large "complicated" lacerations, abscesses, amputation revisions and the occasional cystoscopy.

Since we are supposed to have our staff in the room for extubation (which I've assumed is standard for most anesthesiology programs) I was kind of surprised when they would always look at me weird and complain when I wasn't just extubating alone. But then I witnessed a case without an attending present.
 
urge said:
I like how he claims everyone is tired but forgets to emphasize the surgeon.
Click to expand...

That's because Dr. Youn is a master of self-promotion.

Frankly, my response was, "WTF does he know about shift changes? He is a plastic surgeon specializing in aesthetics and probably does all of his cases in a day surgery center where the staff stays until he finishes." His affiliation with Beaumont/being on academic faculty is relatively new.

Like TheProwler, I'm somewhat surprised to still hear that residents are doing cases without attendings scrubbed/in the room. I saw the autonomy change (for less independence by residents) during training and had assumed it was becoming standard for hospitals to not allow such autonomy by residents. By the end of my training, only Ortho and ENT had senior residents doing cases with the attending in another room - not suprising given the amount of money Ortho brings into the hospitals. I see that in PP as well: the only surgeons given 2 rooms are the Orthopods. 😡
 
I'm not defending this guy, but it DOES get a little ridiculous when between 3 and 4 p.m. it's not uncommon for 2-3 attendings to come in and sign the anesthesia record.

Our guys have a tiered system for getting out. Often, the early guy whom you've been working with all day signs out to one of the later guys. The problem is when THAT guy signs out to another guy, and sometimes THAT guy signs out to yet another. It begins to look like a bit of a circus act.
 
gasattack3 said:
I'm not defending this guy, but it DOES get a little ridiculous when between 3 and 4 p.m. it's not uncommon for 2-3 attendings to come in and sign the anesthesia record.

Our guys have a tiered system for getting out. Often, the early guy whom you've been working with all day signs out to one of the later guys. The problem is when THAT guy signs out to another guy, and sometimes THAT guy signs out to yet another. It begins to look like a bit of a circus act.
Click to expand...

you're right. to an extent we invite criticism of our field. i understand everybody wants to go home but sometimes it definitely gets ridiculous. i'll usually volunteer to finish my case when relief comes in because it's MY patient and i'm a DOCTOR. i'm not saying everybody should be doing that, but i hafta wonder what the surgeon's thinking when he's been grueling away on a tough case for a few hours and here i am going home cuz "my time's up"
 
gasattack3 said:
I'm not defending this guy, but it DOES get a little ridiculous when between 3 and 4 p.m. it's not uncommon for 2-3 attendings to come in and sign the anesthesia record.

Our guys have a tiered system for getting out. Often, the early guy whom you've been working with all day signs out to one of the later guys. The problem is when THAT guy signs out to another guy, and sometimes THAT guy signs out to yet another. It begins to look like a bit of a circus act.
Click to expand...

If that's happening like that it's because the call people are not relieving people properly. If you have a case that's going to go into the night it should be taken over by the first or second call faculty to minimize the risk of unnecessary hand offs. Musical attendings should be the exception and not the norm.
 
You must log in or register to reply here.

Similar threads

A
Megabill implications for anesthesiologists
3 4 5 6 7
Replies
317
Views
21K
pgg
pgg
Melo00
D.O Anesthesiologists
Replies
13
Views
2K
NicholasPavona
N
P
Minneapolis VA Bylaws Change to Remove Anesthesiologists
2
Replies
75
Views
8K
aneftp
A
spongebobdoc
Florida Society of Anesthesiologists meeting as a medical student
Replies
3
Views
918
anesthesiadoc
A
S
NYTimes article about OB anesthesiologist errors
2
Replies
55
Views
6K
anbuitachi
A
Top