What’s the most difficult aspect of OR practice

[TorMed]

I’ve heard repeatedly that “you can teach a monkey to intubate”. Besides difficult intubations , what is the most challenging aspect of anesthesiology practice in the OR?

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[teeva]

Biggest for me is taking (home) call and irregular sleep schedule. But at the same time, I’d never want to give up having post call weekdays off in addition to 3 weekends off a month.

Second is dealing with surgeon screw ups without cursing and storming out the room. It’s really irritating when a 30 min case becomes 2h because surgeon did something wrong.

Third is keeping dying pts alive or preventing them from dying, all the while looking cool and calm going about it.

 

[deleted126335]

local personal dynamics.

 

[Aether2000]

The sublime knowledge that for elective surgeries, we can never make patients any better- we can only make them worse.

 

[Mman]

juggling attempts to keep all parties happy with your performance that all have different things they want from you. Patients, surgeons, nurses, administrators, etc. While your ultimate responsibility is to the patient, if you pretend that none of the others matter you will suffer. That tends to create conflicts at times that require good people skills to navigate, especially when you are under duress.

 

[Ezekiel2517]

Not succumbing to the boredom.

 

[urge]

Spending a lot of hours on your feet running around. First one in, last one out.

But worse than that is knowing/dealing with a surgeon that scheduled a case way above his head.

 

[MoMoGesiologist]

Having to do a long case that is minimally stimulating surgically on a somewhat healthy person. Gets boring real fast and there's only so many emails you can catch up on. It becomes mental torture...

Work dynamics are also very difficult. Having to ask a CRNA to do something differently when they've been practicing a lot longer than you or giving feed back to a junior resident without crushing their spirit or having them resent you is really difficult. Some people do not do well with being told what they did wrong or what to improve upon. Or maybe I'm not saying it in a nice way...

 

[Noyac]

All good responses. But the one I see missing is the wealth of knowledge that it takes to be a “good” anesthesiologists and not just a glorified crna. I don’t mean anesthesia knowledge. I mean real medical knowledge about diseases and their processes. I mean deep in depth knowledge of anatomy, physiology, chemistry, and pharmacology. The kind of knowledge that lets you discuss a pt with a surgeon that is attempting to do something beyond his or her understanding and having that surgeon walk away thinking, wow that anesthesiologist just saved my ass. But it also takes a surgeon with a solid bank of knowledge to understand what happened. And once you have proven this to the general surgeon population you will find that the job becomes even easier as people are reluctant to go against your recommendations.

 

[deleted697535]

All good responses. But the one I see missing is the wealth of knowledge that it takes to be a “good” anesthesiologists and not just a glorified crna. I don’t mean anesthesia knowledge. I mean real medical knowledge about diseases and their processes. I mean deep in depth knowledge of anatomy, physiology, chemistry, and pharmacology. The kind of knowledge that lets you discuss a pt with a surgeon that is attempting to do something beyond his or her understanding and having that surgeon walk away thinking, wow that anesthesiologist just saved my ass. But it also takes a surgeon with a solid bank of knowledge to understand what happened. And once you have proven this to the general surgeon population you will find that the job becomes even easier as people are reluctant to go against your recommendations.

Just do ICU for a while and you get all that for free...
In fact just do ICU anyway then going back to the OR is just like having a break...

The only hard thing about all this is the fecking paperwork, and hoops to jump thru to get the job done and go home.

The constant evaluations, presentations, meetings that are not constructive, phone calls about nothing.
I love days when I'm just flat out so I can tell ppl piss off ive no time for bs... That's great. I just look after sick people and bureaucracy be damned....

 

[dhb]

Just do ICU for a while and you get all that for free...

Like when they give lasix to treat a low urine output in a hypovolemic patient?

 

[GA8314]

All good responses. But the one I see missing is the wealth of knowledge that it takes to be a “good” anesthesiologists and not just a glorified crna. I don’t mean anesthesia knowledge. I mean real medical knowledge about diseases and their processes. I mean deep in depth knowledge of anatomy, physiology, chemistry, and pharmacology. The kind of knowledge that lets you discuss a pt with a surgeon that is attempting to do something beyond his or her understanding and having that surgeon walk away thinking, wow that anesthesiologist just saved my ass. But it also takes a surgeon with a solid bank of knowledge to understand what happened. And once you have proven this to the general surgeon population you will find that the job becomes even easier as people are reluctant to go against your recommendations.

I agree 100% that this "street cred" is very useful, and as you suggest, only comes from someone who knows their MEDICINE.

 

[Consigliere]

Dealing with the inane conversations in the OR. Absolute soul crusher.

 

[Man o War]

When supervising CRNAs- fixing or preventing them from doing stupid things without harming their overly fragile egos

Solo practice- most of my patients these days are really, really sick cardiac/pulm, so the mental gymnastics required to keep them alive and get through surgery unscathed can be mentally draining. I’m not that young anymore either so that may have something to do with it. Also, recovery from a rough call night takes longer these days.
From an admin standpoint, renegotiating contracts in the current landscape.
A surgeon with horrendous taste in music + a 12 hour case.

 

[amyl]

i would agree managing crnas is the toughest - because we are all to some degree control freaks and you have to give up some control. i have to trust that they will call me for stuff while running around trying to pre-op, give breaks, put out pacu fires, etc. its a hard line to walk with respecting them while also asserting yourself.... or correcting them tactfully when they are wrong. We also don't have the best support staff - we don't have enough or in some cases good enough techs and the quality of RNs is highly variable - by which i mean many of them are terrible. We have 22 ors and the board runner is overwhelmed often and sometimes not very communicative with anesthesia.

 

[deleted697127]

i would agree managing crnas is the toughest - because we are all to some degree control freaks and you have to give up some control. i have to trust that they will call me for stuff while running around trying to pre-op, give breaks, put out pacu fires, etc. its a hard line to walk with respecting them while also asserting yourself.... or correcting them tactfully when they are wrong. We also don't have the best support staff - we don't have enough or in some cases good enough techs and the quality of RNs is highly variable - by which i mean many of them are terrible. We have 22 ors and the board runner is overwhelmed often and sometimes not very communicative with anesthesia.

Your boardrunner isn’t an anesthesiologist?

 

[kidthor]

The sublime knowledge that for elective surgeries, we can never make patients any better- we can only make them worse.

I had this feeling on and off at times while I was a resident. An unhappy attending planted that seed in my mind. But now I see it differently. I still respect this frustration though.

Now I see what we do as sublimely magical at times. Aren't we making patients better by getting them safely and painlessly through surgery? For example - I find it amazing that I could get a kid through bilateral hip surgeries with huge blood loss... and then find him pain free, fully awake, and playing on his ipad the next day (with an epidural in place and with no need for opioids). And I find it rewarding when parents/patients report back on their happiness with the outcome of my efforts.

The "we can only make them worse" sentiment comes up when surgeons or patients don't respect our work. We make it look too easy and effortless to be appreciated by the haters... but haters gonna hate.

 

[Mman]

The "we can only make them worse" sentiment comes up when surgeons or patients don't respect our work. We make it look too easy and effortless to be appreciated by the haters... but haters gonna hate.

Fortunately our line of work has become exponentially safer over the years. So now the good happy outcome is the expectation because that is what happens 99.9% of the time. It's only the rare infrequent bad thing that happens that can provide the perspective needed.

It's kinda like flying on a commercial airline. At this point I expect to get from point A to point B as scheduled with a pleasant lounge to hang out in and wifi to use in flight if I so desire. I'll bitch and moan if the flight is delayed or cancelled or my bag gets lost or some A-hole is sitting next to me for hours. I kinda forget the small miracle that we actually get from here to there safely and quickly and don't crash and burn a fiery death.

 

[sigrhoillusion]

1. Managing CRNAs/residents. Giving them freedom, but also knowing who to watch. Not bickering over trivial things. As long as it's SAFE I'm OK with it. Some CRNAs complain of some attendings being overbearing and they "know when to call". Well know when to call, and then call a few minutes before that...

2. Shuffling feet... I'm pretty laid back, don't hate work, but at the same time I can enjoy work and talk with folks while also getting work done. When I'm at work, I want to work, get the jobs done and then go home to hang out with my family, eat, get personal stuff done and relax. Can't stand people shuffling their feet and not getting stuff done. Especially if they are the ones who complain about getting out at a certain time. I jut feel like if EVERYONE just worked a little harder to get things done, then we could get cases done in a timely manner and we could all go home and be happy. Instead you have all these little avoidable delays that add up to hours to the day and you end up running tons of room later than you should and have trouble getting people out on time. (this definitely is my #1)

3. Also HATE home call. Work at a big academic institute and much prefer in-house call. I hate having that thought of being called in at any time. Makes me feel like a prisoner. Rather just be in house, work all-night and then get off the next day.

 

[Noyac]

Just do ICU for a while and you get all that for free...
In fact just do ICU anyway then going back to the OR is just like having a break...

The only hard thing about all this is the fecking paperwork, and hoops to jump thru to get the job done and go home.

The constant evaluations, presentations, meetings that are not constructive, phone calls about nothing.
I love days when I'm just flat out so I can tell ppl piss off ive no time for bs... That's great. I just look after sick people and bureaucracy be damned....

I disagree to a degree. For example, we hired a CC fellowship person. That person is no different than any other general anesthesiologist in regards to the points we are discussing here. And that is not a knock against this person at all. They are doing very well. But the things I mentioned take time and experience to master, IMO.

 

[GA8314]

1. Managing CRNAs/residents. Giving them freedom, but also knowing who to watch. Not bickering over trivial things. As long as it's SAFE I'm OK with it. Some CRNAs complain of some attendings being overbearing and they "know when to call". Well know when to call, and then call a few minutes before that...

2. Shuffling feet... I'm pretty laid back, don't hate work, but at the same time I can enjoy work and talk with folks while also getting work done. When I'm at work, I want to work, get the jobs done and then go home to hang out with my family, eat, get personal stuff done and relax. Can't stand people shuffling their feet and not getting stuff done. Especially if they are the ones who complain about getting out at a certain time. I jut feel like if EVERYONE just worked a little harder to get things done, then we could get cases done in a timely manner and we could all go home and be happy. Instead you have all these little avoidable delays that add up to hours to the day and you end up running tons of room later than you should and have trouble getting people out on time. (this definitely is my #1)

3. Also HATE home call. Work at a big academic institute and much prefer in-house call. I hate having that thought of being called in at any time. Makes me feel like a prisoner. Rather just be in house, work all-night and then get off the next day.

Home call can indeed make you feel that way. But, I'd rather sleep in my own bed (which it frequently allows) than a hospital call room bed. We are rarely up all night.

 

[Hoya11]

I’ve heard repeatedly that “you can teach a monkey to intubate”. Besides difficult intubations , what is the most challenging aspect of anesthesiology practice in the OR?

Dealing with unreasonable partners who complain about being soo overworked despite a 500k salary and 9 weeks vacation plus lots of other perks working about 50 hrs per week. Sometimes you just cant reason with people and make them realize they have a good thing (they have lost sight of this over their career) Anyone else have any experience in dealing with this? I dont want to be a jerk to these guys, but come on and buck up, if you want to retire, retire.. dont wander around complaining its ridiculous

 

[Hoya11]

Dealing with unreasonable partners who complain about being soo overworked despite a 500k salary and 9 weeks vacation plus lots of other perks working about 50 hrs per week. Sometimes you just cant reason with people and make them realize they have a good thing (they have lost sight of this over their career) Anyone else have any experience in dealing with this? I dont want to be a jerk to these guys, but come on and buck up, if you want to retire, retire.. dont wander around complaining its ridiculous

I would even broaden my statement to: Trying to make necessary changes in a group run by only a few and set in its ways...

 

[Man o War]

Dealing with unreasonable partners who complain about being soo overworked despite a 500k salary and 9 weeks vacation plus lots of other perks working about 50 hrs per week. Sometimes you just cant reason with people and make them realize they have a good thing (they have lost sight of this over their career) Anyone else have any experience in dealing with this? I dont want to be a jerk to these guys, but come on and buck up, if you want to retire, retire.. dont wander around complaining its ridiculous

This x1000.
And CRNA whiners who get a 200k package to work 40 hours a week.
Complainers in general while at work are very annoying.

 

[dhb]

Complainers gonna complain