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NURSE PRACTITIONERS In 2012, 18 states and the District of Columbia allowed nurse practitioners, who typically have masters degrees and more advanced training than registered nurses, to diagnose illnesses and treat patients, and to prescribe medications without a doctors involvement.
Substantial evidence shows that nurse practitioners are as capable of providing primary care as doctors and are generally more sensitive to what a patient wants and needs.
In a report in October 2010, the Institute of Medicine, a unit of the National Academy of Sciences, called for the removal of legal barriers that hinder nurse practitioners from providing medical care for which they have been trained. It also urged that more nurses be given higher levels of training, and that better data be collected on the number of nurse practitioners and other advance practice nurses in the country and the roles they are performing. Tens of thousands will probably be needed, if not more.
Mary Mundinger, dean emeritus of Columbia University School of Nursing, believes highly trained nurses are actually better at primary care than doctors are, and they have experience working in the community, in nursing homes, patients homes and schools, and are better at disease prevention and helping patients follow medical regimens.
RETAIL CLINICS Hundreds of clinics, mostly staffed by nurse practitioners, have been opened in drugstores and big retail stores around the country, putting basic care within easy reach of tens of millions of people. The CVS drugstore chain has opened 640 retail clinics, and Walgreens has more than 350. The clinics treat common conditions like ear infections, administer vaccines and perform simple laboratory tests.
A study by the RAND Corporation of CVS retail clinics in Minnesota found that in many cases they delivered better and much cheaper care than doctors offices, urgent care centers and emergency rooms.
Substantial evidence shows that nurse practitioners are as capable of providing primary care as doctors and are generally more sensitive to what a patient wants and needs.
In a report in October 2010, the Institute of Medicine, a unit of the National Academy of Sciences, called for the removal of legal barriers that hinder nurse practitioners from providing medical care for which they have been trained. It also urged that more nurses be given higher levels of training, and that better data be collected on the number of nurse practitioners and other advance practice nurses in the country and the roles they are performing. Tens of thousands will probably be needed, if not more.
Mary Mundinger, dean emeritus of Columbia University School of Nursing, believes highly trained nurses are actually better at primary care than doctors are, and they have experience working in the community, in nursing homes, patients homes and schools, and are better at disease prevention and helping patients follow medical regimens.
RETAIL CLINICS Hundreds of clinics, mostly staffed by nurse practitioners, have been opened in drugstores and big retail stores around the country, putting basic care within easy reach of tens of millions of people. The CVS drugstore chain has opened 640 retail clinics, and Walgreens has more than 350. The clinics treat common conditions like ear infections, administer vaccines and perform simple laboratory tests.
A study by the RAND Corporation of CVS retail clinics in Minnesota found that in many cases they delivered better and much cheaper care than doctors offices, urgent care centers and emergency rooms.
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Joe Goebbels used a similar idea that repeating a lie multiple times, people will actually believe some brain dead nurse can deliver better care than a physician. The people who have to cover cRNAs that I have met are so terrified of their incompetance causing a lawsuit. I am so thankful I just do my own cases.
Anyway, I had a patient last month who was so terrified of having a cRNA do her anesthesia. When I told her there is no cRNA to be found in my hospital, she became so thankful. I found out later she had two kid in medical school.
Anyway, I had a patient last month who was so terrified of having a cRNA do her anesthesia. When I told her there is no cRNA to be found in my hospital, she became so thankful. I found out later she had two kid in medical school.
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😱
This is a classic example of society thumbing its nose at perceived "authority."
On another note, glad to hear about the ruling in NJ.
D
deleted126335
For decades, NJ has been legislatively aone of the most pro-physician and anti CRNA states as far as state law goes. One possible reason: About 30 years ago, There was one of those perpetual scope of practice battles going on in the NJ state legislature. A plastic surgeon who did procedures in his office with a CRNA gave a rant in front of the legislature calling the measure "about protecting anesthiologist's income". Well as fate would have it shortly thereafter there was an anesthetic death in his office on a healthy young woman. The president of the NJ society of anesthesiologists personally made sure that this event was communicated to every measure of the legislature. Needless to say the measure passed and was built upon.
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If you go back a few years ago maybe 5 or 6 years ago there was a death in the philadelphia area. A plastic surgeon was doing a liposuction on a 18 year old girl home from college. No anesthesiologist, girl perfectly healthy. After the procedure she was having trouble breathing, I think the CRNA poo pood it saying it was nothing and left the facility and i think she eventually arrested in the recovery room in the guys office. I wish I had the energy to look it up but there was NO anesthesiologist involved there.
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I used to enjoy reading the NYTimes until I went to medical school.
Their coverage of American healthcare topics make it seem like they get all their information from a 58yo Nurse Administrator with an axe to grind
Their coverage of American healthcare topics make it seem like they get all their information from a 58yo Nurse Administrator with an axe to grind
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The Pennsylvania Superior Court has upheld a $20 million award, including $15 million in punitive damages, given by a Philadelphia jury that found a plastic surgeon and a nurse anesthetist liable for an 18-year-old college student's death after an elective liposuction procedure.
In a non-precedential decision issued by a three-judge panel Friday, Judges Mary Jane Bowes and Susan Peikes Gantman and Senior Judge John T.J. Kelly Jr. ruled in favor of almost all of the plaintiffs' claims. Gantman concurred in the result only, according to the opinion in Fledderman v. Glunk.
Plaintiffs Daniel H. and Colleen M. Fledderman sued on behalf of their deceased daughter, Amy M. Fledderman, as well as on Colleen Fledderman's claim of negligent infliction of emotional distress.
After a five-week trial in 2008 before Philadelphia Common Pleas Judge Sheldon C. Jelin, the jury unanimously found plastic surgeon Dr. Richard P. Glunk, as well as Main Line Plastic Surgery & Laser Associates, 75 percent responsible for Amy Fledderman's death. The jury found nurse anesthetist Edward J. DeStefano Jr., as well as Ambulatory Anesthesia Associates Inc., 25 percent responsible.
Fledderman sought elective liposuction for her chin, abdomen and flanks May 23, 2001, the opinion said.
The jury awarded $15 million in punitive damages against Glunk, $2 million for Glunk negligently inflicting emotional distress on Colleen Fledderman, and $5,000 for Glunk's failure to obtain Amy Fledderman's informed consent, The Legal previously reported. The jury also awarded $3.5 million under the Survival Act and $20,000 under the Wrongful Death Act against both Glunk and DeStefano, The Legal previously reported.
During the liposuction on Amy Fledderman's neck, Glunk ruptured a blood vessel, the opinion said. Her oxygen saturation dropped, her blood circulation became unstable, her heart rate rose, and DeStefano testified that "Amy's neck suddenly bulged with blood, swelling to twice its normal size," the opinion said.
DeStefano made Glunk stop the liposuction, and DeStefano reversed the anesthesia, according to the opinion. But Amy Fledderman did not awaken, and Glunk refused to let her mother see her in the operating room and he refused to send Amy Fledderman to a hospital emergency room for close to three hours, the opinion said.
When an ambulance crew finally was called and arrived at Glunk's office, Amy Fledderman was in "critical condition" and in "severe respiratory distress," the opinion said.
Amy Fledderman was diagnosed with respiratory failure and with a fat embolism entering her bloodstream, the opinion said. Amy Fledderman died two days later after she was transferred from Montgomery Hospital to the Hospital of the University of Pennsylvania, The Legal previously reported.
"The evidence in this case, taken in the light most favorable to the Fleddermans as the verdict winner, illustrates an appreciation of the risks and a conscious disregard for those risks on the part of Dr. Glunk that would support a claim for punitive damages," the opinion said. "Dr. Glunk ignored both the warning signs of a medical emergency and a mother's desperate pleas for transfer to a hospital."
The opinion continued: "Despite respiratory distress, and the pleas of Mrs. Fledderman to transport her daughter to a hospital, Dr. Glunk maintained that hospitalization was unnecessary. Critical hours passed when Amy needed care only available at a hospital. Dr. Glunk failed to act. He did not have the protocols in place to swiftly arrange for emergency transport. Experts testified that the two-and-one-half hour delay in calling an ambulance increased the risk of Amy's death."
Glunk also wanted Amy Fledderman to be admitted on a non-emergency basis, he tried to get Colleen Fledderman to call their family doctor and have her daughter admitted under that physician's authority, and he requested no lights and sirens when an ambulance was finally summoned, the opinion said.
Finally, the opinion said it was appropriate to instruct the jury that they could make an adverse inference against both defendants from the fact that Glunk did not keep track of Amy Fledderman's vital signs in her medical chart and DeStefano had not printed off the data kept on an anesthesia monitoring machine before shutting off the machine.
The panel mainly ruled in favor of the Fleddermans' appeal of Jelin's ruling denying delay damages.
Plaintiffs' attorney of The Beasley Firm said that he would ask the Superior Court to publish the opinion, particularly because of the court's findings on the delay damages rule, Pennsylvania Rule of Civil Procedure 238.
The opinion said that Rule 238 has the goal of encouraging settlements and to compensate plaintiffs for the loss of the use of their money during the course of litigation.
Jelin ruled that the plaintiffs were not entitled to delay damages because the Fleddermans said they would not entertain settlements.
But the panel said that even when the plaintiffs are postured against settlement, defendants should make offers of all the assets available to them in order to avoid delay damages being levied against them.
The court remanded for the calculation of delay damages.
Under The Beasley Firm's calculations, the $20.5 million verdict could be molded to include $522,000 in delay damages, or a little more than $21 million, firm attorney Maxwell S. Kennerly said in an e-mail.
Among other arguments, the court also ruled against Glunk's argument that Colleen Fledderman's claim for negligent infliction of emotional stress required that she contemporaneously observed the allegedly negligent surgery.
The court also ruled against Glunk's argument that it should not have been admitted into evidence that his facility was not licensed as an ambulatory surgical facility.
DeStefano testified that he would not have provided anesthesia during Amy Fledderman's liposuction if he had known Glunk "had no written emergency plan, no agreement with an ambulance company, and no admitting privileges at the nearest hospital," the opinion said.
But DeStefano was liable for negligence under his "own professional standards," which required him "to ascertain whether the facility was licensed and accredited and had a written transfer and emergency services agreement in place before administering anesthesia in the facility," the opinion said.
The court also ruled against Glunk's claim that, because of the legal protection peer review provides, it should not have been admitted into evidence that his privilege to conduct liposuction on patients at Main Line Health Hospitals required a physician proctor be present.
DeStefano's counsel, Irving Steven "Steve" Levy, of White & Williams, said DeStefano is still deciding on whether to try to appeal.
Glunk's counsel, Dean F. Murtagh of German Gallagher & Murtagh, could not be reached for comment.
Glunk's primary insurance policy is through Clarendon National Insurance Co. and his secondary coverage is through state insurance provider MCARE, Kennerly wrote. DeStefano is insured by TIG Insurance, he wrote.
According to court papers, the Fleddermans argue Glunk's debt "was obtained by false pretenses, a false representation, or actual fraud, and so is non-dischargeable."
In a non-precedential decision issued by a three-judge panel Friday, Judges Mary Jane Bowes and Susan Peikes Gantman and Senior Judge John T.J. Kelly Jr. ruled in favor of almost all of the plaintiffs' claims. Gantman concurred in the result only, according to the opinion in Fledderman v. Glunk.
Plaintiffs Daniel H. and Colleen M. Fledderman sued on behalf of their deceased daughter, Amy M. Fledderman, as well as on Colleen Fledderman's claim of negligent infliction of emotional distress.
After a five-week trial in 2008 before Philadelphia Common Pleas Judge Sheldon C. Jelin, the jury unanimously found plastic surgeon Dr. Richard P. Glunk, as well as Main Line Plastic Surgery & Laser Associates, 75 percent responsible for Amy Fledderman's death. The jury found nurse anesthetist Edward J. DeStefano Jr., as well as Ambulatory Anesthesia Associates Inc., 25 percent responsible.
Fledderman sought elective liposuction for her chin, abdomen and flanks May 23, 2001, the opinion said.
The jury awarded $15 million in punitive damages against Glunk, $2 million for Glunk negligently inflicting emotional distress on Colleen Fledderman, and $5,000 for Glunk's failure to obtain Amy Fledderman's informed consent, The Legal previously reported. The jury also awarded $3.5 million under the Survival Act and $20,000 under the Wrongful Death Act against both Glunk and DeStefano, The Legal previously reported.
During the liposuction on Amy Fledderman's neck, Glunk ruptured a blood vessel, the opinion said. Her oxygen saturation dropped, her blood circulation became unstable, her heart rate rose, and DeStefano testified that "Amy's neck suddenly bulged with blood, swelling to twice its normal size," the opinion said.
DeStefano made Glunk stop the liposuction, and DeStefano reversed the anesthesia, according to the opinion. But Amy Fledderman did not awaken, and Glunk refused to let her mother see her in the operating room and he refused to send Amy Fledderman to a hospital emergency room for close to three hours, the opinion said.
When an ambulance crew finally was called and arrived at Glunk's office, Amy Fledderman was in "critical condition" and in "severe respiratory distress," the opinion said.
Amy Fledderman was diagnosed with respiratory failure and with a fat embolism entering her bloodstream, the opinion said. Amy Fledderman died two days later after she was transferred from Montgomery Hospital to the Hospital of the University of Pennsylvania, The Legal previously reported.
"The evidence in this case, taken in the light most favorable to the Fleddermans as the verdict winner, illustrates an appreciation of the risks and a conscious disregard for those risks on the part of Dr. Glunk that would support a claim for punitive damages," the opinion said. "Dr. Glunk ignored both the warning signs of a medical emergency and a mother's desperate pleas for transfer to a hospital."
The opinion continued: "Despite respiratory distress, and the pleas of Mrs. Fledderman to transport her daughter to a hospital, Dr. Glunk maintained that hospitalization was unnecessary. Critical hours passed when Amy needed care only available at a hospital. Dr. Glunk failed to act. He did not have the protocols in place to swiftly arrange for emergency transport. Experts testified that the two-and-one-half hour delay in calling an ambulance increased the risk of Amy's death."
Glunk also wanted Amy Fledderman to be admitted on a non-emergency basis, he tried to get Colleen Fledderman to call their family doctor and have her daughter admitted under that physician's authority, and he requested no lights and sirens when an ambulance was finally summoned, the opinion said.
Finally, the opinion said it was appropriate to instruct the jury that they could make an adverse inference against both defendants from the fact that Glunk did not keep track of Amy Fledderman's vital signs in her medical chart and DeStefano had not printed off the data kept on an anesthesia monitoring machine before shutting off the machine.
The panel mainly ruled in favor of the Fleddermans' appeal of Jelin's ruling denying delay damages.
Plaintiffs' attorney of The Beasley Firm said that he would ask the Superior Court to publish the opinion, particularly because of the court's findings on the delay damages rule, Pennsylvania Rule of Civil Procedure 238.
The opinion said that Rule 238 has the goal of encouraging settlements and to compensate plaintiffs for the loss of the use of their money during the course of litigation.
Jelin ruled that the plaintiffs were not entitled to delay damages because the Fleddermans said they would not entertain settlements.
But the panel said that even when the plaintiffs are postured against settlement, defendants should make offers of all the assets available to them in order to avoid delay damages being levied against them.
The court remanded for the calculation of delay damages.
Under The Beasley Firm's calculations, the $20.5 million verdict could be molded to include $522,000 in delay damages, or a little more than $21 million, firm attorney Maxwell S. Kennerly said in an e-mail.
Among other arguments, the court also ruled against Glunk's argument that Colleen Fledderman's claim for negligent infliction of emotional stress required that she contemporaneously observed the allegedly negligent surgery.
The court also ruled against Glunk's argument that it should not have been admitted into evidence that his facility was not licensed as an ambulatory surgical facility.
DeStefano testified that he would not have provided anesthesia during Amy Fledderman's liposuction if he had known Glunk "had no written emergency plan, no agreement with an ambulance company, and no admitting privileges at the nearest hospital," the opinion said.
But DeStefano was liable for negligence under his "own professional standards," which required him "to ascertain whether the facility was licensed and accredited and had a written transfer and emergency services agreement in place before administering anesthesia in the facility," the opinion said.
The court also ruled against Glunk's claim that, because of the legal protection peer review provides, it should not have been admitted into evidence that his privilege to conduct liposuction on patients at Main Line Health Hospitals required a physician proctor be present.
DeStefano's counsel, Irving Steven "Steve" Levy, of White & Williams, said DeStefano is still deciding on whether to try to appeal.
Glunk's counsel, Dean F. Murtagh of German Gallagher & Murtagh, could not be reached for comment.
Glunk's primary insurance policy is through Clarendon National Insurance Co. and his secondary coverage is through state insurance provider MCARE, Kennerly wrote. DeStefano is insured by TIG Insurance, he wrote.
According to court papers, the Fleddermans argue Glunk's debt "was obtained by false pretenses, a false representation, or actual fraud, and so is non-dischargeable."
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WOW.. you are better than blade on the internet!!!
yes it is that one. I read about it prior to it going to trial. BUt it has to be that one. good job gas em.
I bet you that plastic surgeon is kicking himself for trying to save a few bucks LOL
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I am usually more worried when covering residents.
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Well, you shouldn't worry about this issue for much longer, because soon a CRNA will take your job! Why, you ask? Because CRNAs are better than anesthesiologists! After all, that's what the research shows (unequivocally of course) and according to you CRNAs are better than all residents. Following this line of reasoning, if they're better than residents, then an experienced CRNA must be better than an attending, right? Or am I to believe that magically, somehow the day that a resident graduates, the tables turn and suddenly anesthesiologists are better than CRNAs.
Yeah, that makes a lot of sense.
Oh wait, because you made this comment on a public forum, I presume you somehow bypassed residency. And that's why your job will be secure! You're not subject to this "CRNA is better than MD" phenomenon that, based on your comment, evidently starts in residency...
I hate attendings that favor CRNAs. You guys are the worst.
🙄
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That's a pretty intense response.
Some CRNAs are outstanding and supervising them is usually less stressful than supervising a junior resident who's just starting.
That said I interact with the residents much differently and teach them anesthesiology not just how to get through the case at hand. However the onus is also on the residents to bring something more to the table especially curiosity.
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Lots of misdirected anger there chief.
I don't read any of that from what precedex said. He said he's more worried when covering residents, not that he dislikes working with residents.
I'm much more worried about covering rooms with the new (to kids) CA2s (and some CA3s🙄) at the Children's Hospital. They can be unpredictable and lose situational awareness. It's a fact. The seasoned CRNAs that I've worked with for years are very predictable and are much less likely to lose situational awareness.
Having said that, I enjoy teaching the residents and fellows, that's why I took the job. You're there to learn. One thing has nothing to do with the other.
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I don't know I feel like the comment in this scenario does incite that reaction, maybe not as extreme but there is the undertone that a CRNA is better than a resident. But then the further expansion by Destriero hedges by comparing green (to peds or other new specific situations) residents to "seasoned" CRNAs. Now that obviously shows the caveat that in the end specific training/experience is what leads to you Attendings being able to feel comfortable...... Either way I dont think most residents like being compared to CRNAs, especially if that comparison is at best depicting equivalence, especially in this day and time, by the attendings that are currently those that we look up to......
But that's just my 0.02, coming from a guy toiling away in medicine anxiously awaiting my chance to kick some anesthesia ass. 😀
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What I'm talking about has nothing to do with that and you know it. You know what situational awareness is. If you can't control your CRNAs grow a pair and rein them in. One of our CRNAs likes to extubate the kids without calling. Not my patients. One time, and it was fixed. No arguments, no BS, professional conversation, NEVER do it again to my patient, the end. I don't care what others tolerate. I tell the families that I'll be there, attest that I was there, and I will be, or stay asleep.
And for the record, I like to work with the residents and fellows because they are enthusiastic learners, the residents in particular. They may not have the best clinical judgement yet, but they are sponges, picking up clinical pearls left and right, engaged, etc. Most of the CRNAs don't want to learn anything. They're on the clock. I give pertinent articles to the residents and fellows all the time. 90% of the CRNAs would throw then in the burn box on the way out of the OR without a second glance and will roll their eyes when my plan differs from the routine "plan A".
They do it though.
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In case you really don't know. It's the sixth sense that keeps you out of trouble that you develop with experience.
Situational awareness is the perception of environmental elements with respect to time and/or space, the comprehension of their meaning, and the projection of their status after some variable has changed, such as time, or some other variable, such as a predetermined event. It is also a field of study concerned with perception of the environment critical to decision-makers in complex, dynamic areas from aviation, air traffic control, power plant operations, military command and control, and emergency services such as fire fighting and policing; to more ordinary but nevertheless complex tasks such as driving an automobile or bicycle.
Situational awareness (SA) involves being aware of what is happening in the vicinity, in order to understand how information, events, and one's own actions will impact goals and objectives, both immediately and in the near future. One with an adept sense of situational awareness generally has a high degree of knowledge with respect to inputs and outputs of a system, i.e. an innate "feel" for situations, people, and events that play out due to variables the subject can control. Lacking or inadequate situational awareness has been identified as one of the primary factors in accidents attributed to human error. [1] Thus, situational awareness is especially important in work domains where the information flow can be quite high and poor decisions may lead to serious consequences (e.g., piloting an airplane, functioning as a soldier, or treating critically ill or injured patients).
Having complete, accurate and up-to-the-minute SA is essential where technological and situational complexity on the human decision-maker are a concern. Situation awareness has been recognized as a critical, yet often elusive, foundation for successful decision-making across a broad range of complex and dynamic systems, including aviation and air traffic control, [2] emergency response and military command and control operations, [3] and offshore oil and nuclear power plant management. [4]
Situational awareness is often studied in the context of leadership and roles involving time-critical applications, however it is often referenced in other fields as well. For example, in the study of influence, situational awareness is found to be a critical component. This is further extended into the animal kingdom, where very often the alpha pair demonstrates superior situation awareness with respect to the well being of those within the animal pack.
Situational awareness is the perception of environmental elements with respect to time and/or space, the comprehension of their meaning, and the projection of their status after some variable has changed, such as time, or some other variable, such as a predetermined event. It is also a field of study concerned with perception of the environment critical to decision-makers in complex, dynamic areas from aviation, air traffic control, power plant operations, military command and control, and emergency services such as fire fighting and policing; to more ordinary but nevertheless complex tasks such as driving an automobile or bicycle.
Situational awareness (SA) involves being aware of what is happening in the vicinity, in order to understand how information, events, and one's own actions will impact goals and objectives, both immediately and in the near future. One with an adept sense of situational awareness generally has a high degree of knowledge with respect to inputs and outputs of a system, i.e. an innate "feel" for situations, people, and events that play out due to variables the subject can control. Lacking or inadequate situational awareness has been identified as one of the primary factors in accidents attributed to human error. [1] Thus, situational awareness is especially important in work domains where the information flow can be quite high and poor decisions may lead to serious consequences (e.g., piloting an airplane, functioning as a soldier, or treating critically ill or injured patients).
Having complete, accurate and up-to-the-minute SA is essential where technological and situational complexity on the human decision-maker are a concern. Situation awareness has been recognized as a critical, yet often elusive, foundation for successful decision-making across a broad range of complex and dynamic systems, including aviation and air traffic control, [2] emergency response and military command and control operations, [3] and offshore oil and nuclear power plant management. [4]
Situational awareness is often studied in the context of leadership and roles involving time-critical applications, however it is often referenced in other fields as well. For example, in the study of influence, situational awareness is found to be a critical component. This is further extended into the animal kingdom, where very often the alpha pair demonstrates superior situation awareness with respect to the well being of those within the animal pack.
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I agree with you when you want to be present for extubation. if the crna does not call you, what would you do?
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What do you mean? Tell them to call you every time. Period. If I can't be there I'll tell them to call whoever is covering for me. If they don't come, that's on them. (though they normally do come for extubations) Our CRNAs like their jobs too much to blatantly disregard a crystal clear order. It's not a request. They have a good thing going and they know it. If they didn't comply, I'd have a frank conversation with them about what my expectations are going forward. After that, if it was still a problem, I'd take it up with the Chief CRNA and the Division Chief. Our leadership is weak about some things, but patient safety isn't one of them. Quite the opposite actually. Not being called for extubation IS a patient safety concern. No question about that. Keep in mind that my patient population is sick kids, not a lot of teenage ASA1 and 2s around.
One of our CRNAs had some issues a few years ago, they were on probation for 3 months. No more problems.
They know we receive CRNA CVs all the time. It's a seller's market. Comply with expectations or move along.
D
deleted126335
Power over the CRNAs (disciplining, probation, ability to terminate) is not something that anesthesiologists have in all departments (except maybe the chief). Some markets are not seller's markets. I won't even go into the issue of CRNAs that are members of unions.
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thanks for the clarifications. Where I have worked you get into it too many times (whether you are right...which you are allthe time.. or wrong... you will be sent packing by the invertebrate chief or anesthesia... If you speak to a crna sternly as to why s/he did not call you for extubation and s/he complains about you being so dictatorial etc etc etc you are going to be in the chiefs office explaining yourself. And if you are explaining yourself too many times to the chief .. he is gonna find someone else and you will find yourself looking for another job regardless of how good you are or how many fellowships you have. I know its not right but it's reality. I just wanted to know how you handled it..
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what did you expect? your initial statement was inflammatory, and you'd have to be pretty dense not to realize that.
"I am usually more worried when covering residents."
so what you were saying is that all crnas are more capable than all residents?
or all crnas are more capable than only junior residents?
or only seasoned crnas are more capable than junior residents?
or only seasoned crnas are more capable than all residents?
if you're going to be deliberately vague then you're going to get the kind of response you got, especially on this forum. and i have to agree with etherbunny, whether it's true or not it's probably best to keep such thoughts to yourself - all it will do is provide more fodder for this ongoing mess.
i remember when i was midway through CA-3 year, doing a second heart month at an away hospital. The first day i walked into the heart room in the middle of a case and introduced myself to the attending; he in turn introduced me to their anesthesia tech, saying "this is such-and-such, our tech. he knows way more about hearts than you do." the tech got a really smug look on his face. i thought what a douchebag of an attending. i wouldn't have disagreed that the tech knew more, but i thought it was completely inappropriate to publicly disparage a senior resident and future colleague in that way.
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I have not dealt with invertebrate anesthesia chiefs but rather unfortunately I think that what you are saying about the anesthetists is true. The militant scum will ignore whatever you say (even if you are incredibly pleasant about things - ie please call me for the pediatric ENT emergence since the anesthetists don't know stage II of emergence versus a hole in the wall).
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Some people think they look better by putting other people down. They are wrong. When dealing with CRNAs or Residents or even Attendings choose your words wisely.
I had the exact same situation. Their coverage of healthcare topics is pathetically simplified. Reading the "well-blog" pieces makes you want to scream.
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Ok, option 3.
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D
deleted126335
If they can.
When you have power over them...they show respect for your directives even if they don't feel it.
Been in both situations. The militant CRNAs generally (not always) leave strong doc controlled groups. They prefer groups where the docs are weak.
