table up...table down...

[phillyfornia]

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so i was speaking with a surgery acquaintence of mine at a different program and he was talking about how there was a certain anesthesiology resident that he didn't get along with. he was telling me how next time they work together he's going to "abuse" him. he said something along the lines of "i can't wait until the next time we work together, i'm gonna tell this guy 'table up...table down...trendelenberg...tilt left'--i'm gonna abuse this guy..." for a second, i thought that this guy was joking but i from the tone of his voice and the look on his face, he was dead serious.

i almost died laughing.

it reminded me of another guy a met during internship. he was a family medicine resident who had considered being an anesthesiologist but in the end decided he couldn't be a "surgeon's bitch". he said something along the lines of "i couldn't handle being told to 'move the table up....move the table down' for the rest of my life..."

personally, the table thing isn't really a big deal to me. i'm just pushing a button. it's hardly abuse. i can see how it could be a power thing but it's really not a problem for me.

however, i think that to a lot of people the "table issue" is huge. i would say that it might even be a dealbreaker to some med students considering anesthesia as a career. to some people, moving an OR table for a surgeon is degrading.

anyone else experience this?

 

[dfk]

the table thing is no big deal for me. WTF do i care if and how they want it? i begin to have issues when they (surgeons) want to attempt to dictate and tell me when i should be and how i should be doing my anesthetic. yea, i'll go ahead and push that stick of saline. there, belly loose enough now? good! table up. yessir!

 

[Bougie]

Really? I think of it as us having the control. I've told surgeons no numerous times in regards to bed positioning (i.e. steep reverse tburg in hemodynamically brittle patients). We have the bed controls so we can monitor patient tolerance to positioning...otherwise any idiot nurse or tech in the room could do it. Tell your colleagues that surgeons have been operating for hundreds of years without fancy bed controls.

 

[Planktonmd]

so i was speaking with a surgery acquaintence of mine at a different program and he was talking about how there was a certain anesthesiology resident that he didn't get along with. he was telling me how next time they work together he's going to "abuse" him. he said something along the lines of "i can't wait until the next time we work together, i'm gonna tell this guy 'table up...table down...trendelenberg...tilt left'--i'm gonna abuse this guy..." for a second, i thought that this guy was joking but i from the tone of his voice and the look on his face, he was dead serious.

i almost died laughing.

it reminded me of another guy a met during internship. he was a family medicine resident who had considered being an anesthesiologist but in the end decided he couldn't be a "surgeon's bitch". he said something along the lines of "i couldn't handle being told to 'move the table up....move the table down' for the rest of my life..."

personally, the table thing isn't really a big deal to me. i'm just pushing a button. it's hardly abuse. i can see how it could be a power thing but it's really not a problem for me.

however, i think that to a lot of people the "table issue" is huge. i would say that it might even be a dealbreaker to some med students considering anesthesia as a career. to some people, moving an OR table for a surgeon is degrading.

anyone else experience this?

In this business you move tables, you push stretchers and very frequently you help move patients.
On othe other hand there are many things you don't do:
You don't do rectal exams, you don't place Foley catheters, you don't stick you hands in abdomens full of pus or fecal material, you don't get called in the middle of the night because your patient is constipated, you don't have to stand on your feet hours surgerizing....
So, considering that I get paid more than many surgeons I am glad to push the button if they want me too.

 

[Bertelman]

Really? I think of it as us having the control. I've told surgeons no numerous times in regards to bed positioning (i.e. steep reverse tburg in hemodynamically brittle patients). We have the bed controls so we can monitor patient tolerance to positioning...otherwise any idiot nurse or tech in the room could do it. Tell your colleagues that surgeons have been operating for hundreds of years without fancy bed controls.

You're kidding youself. There's no glory or power in controlling the bed. Any idiot in the room can do it, it just happens to be our job because we're sitting on our asses. If there were any hint of power in controlling the bed, the surgeons would have commandeered the controls a long time ago, wrapping it in a sterile drape like the C-arm.

It doesn't bother me one bit to move the table, because as Plank suggested, later on in the case when the Code Brown is called, we just hang out at the top "securing the airway".

 

[deleted126335]

.

 

[militarymd]

The control has a LONG cord....hand it to the circulator.

 

[morpheus md]

so i was speaking with a surgery acquaintence of mine at a different program and he was talking about how there was a certain anesthesiology resident that he didn't get along with. he was telling me how next time they work together he's going to "abuse" him. he said something along the lines of "i can't wait until the next time we work together, i'm gonna tell this guy 'table up...table down...trendelenberg...tilt left'--i'm gonna abuse this guy..." for a second, i thought that this guy was joking but i from the tone of his voice and the look on his face, he was dead serious.

i almost died laughing.

it reminded me of another guy a met during internship. he was a family medicine resident who had considered being an anesthesiologist but in the end decided he couldn't be a "surgeon's bitch". he said something along the lines of "i couldn't handle being told to 'move the table up....move the table down' for the rest of my life..."

personally, the table thing isn't really a big deal to me. i'm just pushing a button. it's hardly abuse. i can see how it could be a power thing but it's really not a problem for me.

however, i think that to a lot of people the "table issue" is huge. i would say that it might even be a dealbreaker to some med students considering anesthesia as a career. to some people, moving an OR table for a surgeon is degrading.

anyone else experience this?

So what, the surgery resident is going to abuse the gas man's thumb? Bring it on.....he can chart, read Miller, or surf the web with one hand and futz with the bed with the other while his passive aggressive surgical colleague gets his rocks off. The surgeon can't operate with the bed moving, so it is just delaying his day. HE is the one who is going to have to round on patients when the surgery is over, while the gas resident is burning rubber out of the parking lot.

 

[Consigliere]

So what, the surgery resident is going to abuse the gas man's thumb? Bring it on.....he can chart, read Miller, or surf the web with one hand and futz with the bed with the other while his passive aggressive surgical colleague gets his rocks off. The surgeon can't operate with the bed moving, so it is just delaying his day. HE is the one who is going to have to round on patients when the surgery is over, while the gas resident is burning rubber out of the parking lot.

Word

 

[periopdoc]

In this business you move tables, you push stretchers and very frequently you help move patients.
On othe other hand there are many things you don't do:
You don't do rectal exams, you don't place Foley catheters, you don't stick you hands in abdomens full of pus or fecal material, you don't get called in the middle of the night because your patient is constipated, you don't have to stand on your feet hours surgerizing....
So, considering that I get paid more than many surgeons I am glad to push the button if they want me too.

I place foley's.



If it gets me on to the next case 5 minutes faster.
-pod

 

[MTGas2B]

I've helped clean up the surprise code browns we find in the OR.

I've asked attending surgeons to place my a-line if we were in a hurry to get going and I had other things to do.

 

[Planktonmd]

I place foley's.



If it gets me on to the next case 5 minutes faster.
-pod

You will stop doing that eventually.

 

[pgg]

I place foley's.

If it gets me on to the next case 5 minutes faster.

Aw, man, you were on a tear of excellent and insightful posts until this.

It makes me a little sad inside to hear of an anesthesiologist touching a patient below the neck with anything other than a needle. 🙂

 

[deleted59964]

however, i think that to a lot of people the "table issue" is huge. i would say that it might even be a dealbreaker to some med students considering anesthesia as a career.

nah this is the exact reason I want to be an anesthesiologist.
chair - um i mean table goes up, table goes down, table goes up, table goes down.
mmmm dohnuts

 

[periopdoc]

You will stop doing that eventually.

Since I only do it for special occasions, you never know (the saving 5-minutes part is a little tongue in cheek)

It makes me a little sad inside to hear of an anesthesiologist touching a patient below the neck with anything other than a needle.

I knew I would get a little flack for this.

I don't really see it as below me, and it seems to me that doing little things like this actually improves my relationship with my surgeons who view me as a team player. It gives me more latitude to make "suggestions" later on in the case when it really matters.

It might make you feel a little less sad to hear

POD's rules for offering to place foley
#1) All of my work is done and charting is up to date
#2) Nurses have tried and failed - like PIV's it is a nursing skill after all
#3) Female patient - I interned in GYN and my surgical colleagues know it, if it is a male, get a urologist

Usually this happens on the 92-year-old with atrophic Va-jay-jay in whom you will never be able to see the urethral opening on since it has regressed into said Va-jay-jay. I just palpate the opening with two fingers then slide that Foley in like I am doing a digital intubation. Slick. Nurses = impressed. Surgeons = thankful they don't have to wait for a GYN to show up. Me, I just get to steal one of your cases at the end of the day since my scheduled cases will be finished early and you will still be waiting on the damn GYN to show up.



-pod

 

[Bertelman]

Usually this happens on the 92-year-old with atrophic Va-jay-jay in whom you will never be able to see the urethral opening on since it has regressed into said Va-jay-jay. I just palpate the opening with two fingers then slide that Foley in like I am doing a digital intubation. Slick. Nurses = impressed. Surgeons = thankful they don't have to wait for a GYN to show up. Me, I just get to steal one of your cases at the end of the day since my scheduled cases will be finished early and you will still be waiting on the damn GYN to show up.

Reminds me of a case I had a couple weeks ago...

Lady in for some gyn surg, med student attempting Foley insertion. Bertelman minding his own biz on the other side of the drape, when I hear the circulator say, "Ummmm, are you sure that's not the clitoris?"



It took all of me to refrain from a joke, but I may not have held my tongue if the med student had been a guy. Looking back, though, I would have expected a female to have known her own anatomy.

 

[pgg]

I knew I would get a little flack for this.

[...]

It might make you feel a little less sad to hear

POD's rules for offering to place foley
#1) All of my work is done and charting is up to date
#2) Nurses have tried and failed - like PIV's it is a nursing skill after all
#3) Female patient - I interned in GYN and my surgical colleagues know it, if it is a male, get a urologist

OK, I was interpreting your original post as leaping on the Foley-grenade to spare the nurse and speed things along by 5 minutes, which would be just appallingly shameful. 🙂 But having specialized physician skills and experience to offer up AFTER the nurse has failed and to avoid waiting around for the urogyn consult redeems this kind of non-needle patient contact. So yes, it does make me less sad.

I'm an enthusiastic highly motivated cheerful team player, but I touched my last Foley as an MS3. Even if the nurse is trying to put it in backwards through an ostomy, I'm not helping.

 

[DET0897]

so i was speaking with a surgery acquaintence of mine at a different program and he was talking about how there was a certain anesthesiology resident that he didn't get along with. he was telling me how next time they work together he's going to "abuse" him. he said something along the lines of "i can't wait until the next time we work together, i'm gonna tell this guy 'table up...table down...trendelenberg...tilt left'--i'm gonna abuse this guy..." for a second, i thought that this guy was joking but i from the tone of his voice and the look on his face, he was dead serious.

?

I always just tell the surgeon that medicare only pays for 3 table movements, they get the idea.

 

[deleted50478]

This table up down table down stuff was happening to me today, sort. Lots of moving the table, not to be rude but for improved surgical positioning, and with an ancient, crank table even. Pain in the butt, but no big deal either. At one point, I even returned a page for the surgeon which I normally never do, but I had sent the circulator out and he was scrubbed in, so I thought 'what the heck'. Anyway, to a casual observer I would seem like the surgeon's bitch.

There is a grander way of looking at things though. I prefer to think that he is taking calls all night, dealing with the kids worried parents, rounding, clinic visit etc. all to provide me with patients to give anesthesia. I know he isn't thinking about providing me patients, but from my point of view that's exactly what he does. I wouldn't go so far as to say the surgeons are really our bitches, but they do way more for us than we do for them. If anesthesiologists were really surgery's bitches, they'd have us presenting to them on rounds and writing clinic notes for them. No thanks. You go do that stuff... bitch.

just kidding. Sort of...

 

[numbmd]

There's two sides to this issue.

One is being part of a team. I look at the field to see what is going on, and I do it frequently. If I feel that the surgeon would operate better if the table was in a different position, I move it. If the light sucks, I change it. Usually I say, "I just saw you operating bent over" or "in the dark." Usually, they are happy and thank me. I am just trying to get the case done. In fact, I think it is better for the patient if the surgeon has good operating conditions.

But then we have this ass on staff. Gyn who asks for literally over 20 table manipulations for a LAPAROSCOPY. When I first worked with him I thought, "WTF? He's got to be f-ing with me. He is asking for another 2 degrees of trend!" The bowels ain't moving with another degree of trend. And as I watch, he's doing the same sh-t to the nurses. As I got a little more seniority I gave it back a little to him. He'd ask for a change, I'd do nothing, make him repeat it. Second request, I'd say, "Sure." Then do nothing. Third request for another 2 degrees of trend, "Absolutely, just give me a minute." Fourth request, "I'm sorry, I'm just drawing up some muscle relaxant." (let him know I may be doing something a little important) Or another tactic, is to say "Sure, let me just go get a bag of LR from the warmer first." Even if you just spiked a bag 20 seconds ago.

And usually the requests die down or stop altogether.

Last resort: "Do you want me to get you another attending to help? You appear to be struggling and these little table changes don't seem to be doing any good. I think there's somebody here in the OR who can help. In fact I just saw Dr. Keiser (good guy, a month out of his residency) maybe he can help."

 

[ESU_MD]

From a surgeons perspective I always wondered about table positioning. In general surgery I hated working with surgeons who constantly felt the need to adjust the table.

I personally try to limit table changing'. mostly because it is inefficient and makes it look like you cant operate.

Now that I'm in CV surg, I request very few table changes
-table up and away for LIMA takedown
then its back to baseline

 

[leaverus]

One is being part of a team. I look at the field to see what is going on, and I do it frequently. If I feel that the surgeon would operate better if the table was in a different position, I move it. If the light sucks, I change it. Usually I say, "I just saw you operating bent over" or "in the dark." Usually, they are happy and thank me. I am just trying to get the case done. In fact, I think it is better for the patient if the surgeon has good operating conditions.

That's how i've always seen it. You do what you can to help the PATIENT out. If it's not in the best interest of the patient, don't do it.

 

[Tenesma]

when i was doing anesthesia ... i would raise the table once or twice... when they (surgeons) started getting annoying w/ table up/down requests i'd just hand the controller to the OR RN and explain to them i have more important things to do...

AND IF the surgeon was trying to be a ****head about it, i'd just ask very nicely: "how come all the other surgeons in your department can operate with minimal table adjustments...? are you having difficulty with your case, should we call in another surgeon to give you a hand?"