What Do Anesthesiologists Really Do?

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Do you guys ever get pissed off when people in the general public do not really know what we do and our training to get to where we are?

Little do they know we can transition from being primary care to emergency room to critical care doctors in a blink of an eye.
What do you guys say to the misinformed that think all we did is push some medications into an IV and then wake someone back up?

 

[deleted171991]

Do you guys ever get pissed off when people in the general public do not really know what we do and our training to get to where we are?

Little do they know we can transition from being primary care to emergency room to critical care doctors in a blink of an eye.
What do you guys say to the misinformed that think all we did is push some medications into an IV and then wake someone back up?

If I feel disrespected, I tell them that I put them into a controlled coma, like in the intensive care unit. That gets their attention.

Why do I always say that intensivists are seen as doctors, but anesthesiologists just as techs, even by other doctors? Because anesthesiologists tend to behave like techs, not like highly-trained specialist physicians and consultants; one reaps what one sows.

 

[vector2]

Why do I always say that intensivists are seen as doctors, but anesthesiologists just as techs, even by other doctors?

We don't really help our cause that much when the standard canned answer for "why anesthesia?" is that we hate dealing with awake patients, hate medicine and medicine wards, hate rounding, hate (pre-op) clinic, hate writing notes, hate follow-up.......aka hate all the things that comes with being a doctor in the vast majority of other specialties.

 

[nimbus]

We don't really help our cause that much when the standard canned answer for "why anesthesia?" is that we hate dealing with awake patients, hate medicine and medicine wards, hate rounding, hate (pre-op) clinic, hate writing notes, hate follow-up.......aka hate all the things that comes with being a doctor in the vast majority of other specialties.

I’m at peace with that.

It helps that all my friends are from work and they understand exactly what I do. As for others, I just don’t care.

 

[GandalfTheWhite]

We don't really help our cause that much when the standard canned answer for "why anesthesia?" is that we hate dealing with awake patients, hate medicine and medicine wards, hate rounding, hate (pre-op) clinic, hate writing notes, hate follow-up.......aka hate all the things that comes with being a doctor in the vast majority of other specialties.

Aren't many of these things true though? I dont like wards, I hate rounding and clinic, I hate writing notes, but I love actually practicing hands-on medicine and doing procedures. I hate being stuck to an EMR and wasting time for billing purposes.

 

[MoMoGesiologist]

I say “yup” then go back to counting my monies

 

[deleted171991]

I’m at peace with that.

It helps that all my friends are from work and they understand exactly what I do. As for others, I just don’t care.

Dude, that's f-ed up. That's the problem with American capitalism right there: your work(place) becomes your life.

 

[deleted171991]

Aren't many of these things true though? I dont like wards, I hate rounding and clinic, I hate writing notes, but I love actually practicing hands-on medicine and doing procedures. I hate being stuck to an EMR and wasting time for billing purposes.

You think medicine people like writing notes? They like helping people (that's what rounds and clinic are for, not intellectual masturbation). The latter is only for satisfying academic egos.

 

[dannyboy1]

Do you guys ever get pissed off when people in the general public do not really know what we do and our training to get to where we are?

Little do they know we can transition from being primary care to emergency room to critical care doctors in a blink of an eye.
What do you guys say to the misinformed that think all we did is push some medications into an IV and then wake someone back up?

No. If you care about these things then anesthesia is not the right line of work for you. It’s for lazy @ss guys who just want to make $$ and not be bothered with the mundane aspects of patient care.

 

[Mman]

I watch the direct deposits roll in and sleep well at night.

 

[drmwvr]

Dude, that's f-ed up. That's the problem with American capitalism right there: your work(place) becomes your life.

Oh that's the problem? Shoot...should have checked with you first...we'll make a note for next time....

 

[nimbus]

You think medicine people like writing notes? They like helping people (that's what rounds and clinic are for, not intellectual masturbation). The latter is only for satisfying academic egos.

Do those 3-4 page cut n pasted notes rehashing everything every single day really help people?

 

[vector2]

Aren't many of these things true though? I dont like wards, I hate rounding and clinic, I hate writing notes, but I love actually practicing hands-on medicine and doing procedures. I hate being stuck to an EMR and wasting time for billing purposes.

It is true. I'm just explaining and reinforcing for others FFP's point about how many other specialties see us.

I’m at peace with that.

It helps that all my friends are from work and they understand exactly what I do. As for others, I just don’t care.

I really don't care what the general public thinks either. I do care though that the CMOs, administrators and politicians who ultimately decide how much I make also seem to hold an only slightly-better-than-laymen understanding of anesthesia.

 

[deleted171991]

Do those 3-4 page cut n pasted notes rehashing everything every single day really help people?

Those are the bad notes written for billing purposes only.

The good notes are basically medical letters to the other doctors, and can show the depth and breadth of one's thinking. Meaning that, as an anesthesiologist, nobody sees the quality of your thinking, just the end-product, which may be the same as the CRNA's.

As an internist, even if one f-s up, the thought process is there for everybody to see. One looks like a doctor to the other doctors, not just a procedure monkey.

Just my 2 cents.

 

[deleted171991]

I really don't care what the general public thinks either. I do care though that the CMOs, administrators and politicians who ultimately decide how much I make also seem to hold an only slightly-better-than-laymen understanding of anesthesia.

Bingo! When I am paid well, I too couldn't care less about what the patient thinks. I just "console" myself with my salary.

The less one makes the more one cares about being thought about as a doctor. That may explain how the previous generations have dug us such a deep grave.

 

[kidthor]

Do you guys ever get pissed off when people in the general public do not really know what we do and our training to get to where we are?

Little do they know we can transition from being primary care to emergency room to critical care doctors in a blink of an eye.
What do you guys say to the misinformed that think all we did is push some medications into an IV and then wake someone back up?

I don't mind that the general public doesn't understand what we do. They don't understand what really anyone in medicine does. Do they know the workings of pathology, interventional radiology, PM&R, or rad onc? Do they have any idea what a rheumatologist is, even if referred to one? Do they know the difference between colorectal surgery or GI? "Twilight" (whatever that is) vs TIVA-GA?

Probably not. Sure we have a marketing problem, but it's not unique. In visiting a patient pre-op they'll say "my doctor said..." and that "doctor" is an FNP or PA somewhere... The general public doesn't really know fully what an auto mechanic or plumber does either, to be fair. I don't blame them. And I respect every iteration of doctor - and tradesman for that matter.

It pisses me off when another doctor tells me what to do in the setting of not knowing what I do. Luckily that's rare - but it happens. BTW I'd never tell another doctor what to do, I'd only ask for their opinion, thought-process, or approach. When's the last time you told a surgeon to use a Stryker Fixios screw or a robot vs lap approach? Ok when's the last time they told you to use an LMA or that you didn't need an A-Line or that you should use epi not norepi? Yeah - that'll piss me off.

Our anesthesiologist overlords at the ASA don't help much - this is a great bother. Their cutting edge PR innovations include super special gold star names like "perioperative surgical home" (??!!) and "physician anesthesiologist" (to open the door for nurse anesthesiologist? to add more letters and words to combat those who add more letters and words!?). Do the surgeons call themselves surgeons or are they now super special gold star actual non-midlevel doctorate surgical specialists? Stupid ASA PR.

Odd that it's better basically everywhere else in the world. No doctor in Europe (or Japan, or NZ, or Canada, etc) would dare tell an anesthesiologist what to do. So why here?

In sum I'm not bothered by what the public thinks - it's not a really problem and it's not unique to us. I'm sometimes bothered when other peer doctors misunderstand us and then lurch outside of their sandboxes. And I'm really bothered when the ASA pours gas onto their PR dumpster fire.

 

[D P356]

When's the last time you told a surgeon to use a Stryker Fixios screw or a robot vs lap approach? Ok when's the last time they told you to use an LMA or that you didn't need an A-Line or that you should use epi not norepi? Yeah - that'll piss me off.

When obnoxiously asked by a surgeon why he was getting an a-line, a guy in my residency class would respond, “because I saw you were operating.”

 

[chocomorsel]

When obnoxiously asked by a surgeon why he was getting an a-line, a guy in my residency class would respond, “because I saw you were operating.”

That would have led to “unprofessionalism” and some red mark on your record and probably remediation in my residency. The overloads did not tolerate that from us.

 

[Robotic Wis-Hipple]

If I feel disrespected, I tell them that I put them into a controlled coma, like in the intensive care unit. That gets their attention.

Why do I always say that intensivists are seen as doctors, but anesthesiologists just as techs, even by other doctors? Because anesthesiologists tend to behave like techs, not like highly-trained specialist physicians and consultants; one reaps what one sows.

Ha! I’ve always found it interesting how the ICU sedation is a “medically induced coma” on TV/the News but general anesthesia is called “sleep” and a MAC/TIVA which is often deeper than ICU sedations is called “twilight”.

It comes down to us having minutes to meet, greet, consent, and calm our patients before going back to the OR on one of the most stressful days of their lives, the goal is anxiolysis not fear/respect. Most of us are self-deprecating and trained to downplay most things as well (at least outwardly) while we plan multiple contingencies for the potential disaster.

 

[Lidolover]

Anesthesiology is wonderful. I hate it though when it comes to transportation. Not sure why we have accepted this role among others? Anesthesiologists in the past must have had very low self-esteem.................

 

[Mman]

Anesthesiology is wonderful. I hate it though when it comes to transportation. Not sure why we have accepted this role among others? Anesthesiologists in the past must have had very low self-esteem.................

that is a location specific issue and not a specialty wide issue. I have seen plenty of locations where the circulator rolls the patient to the OR.

 

[Zekchar]

That would have led to “unprofessionalism” and some red mark on your record and probably remediation in my residency. The overloads did not tolerate that from us.

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

 

[chocomorsel]

that is a location specific issue and not a specialty wide issue. I have seen plenty of locations where the circulator rolls the patient to the OR.

And after? Out of the OR?

 

[vector2]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

You lost me after the adjust the monitor and raise the bed part.

 

[jw3600]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

Pretty good advice outside of being an anesthesiologist or even a doctor.

Edit: one exception may be the “mommy” aspect of the PD. I have noticed and felt other residents agree. You might get more **** from your own leadership as they don’t want to have to even be bothered with an issue pertaining to you. Basically you doing anything perceived as “wrong” only matters if they have to hear about it.

 

[chocomorsel]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

Yes sure. Except like you said, it should go both ways. Surgeons were allowed to treat us like **** but we weren’t allowed to stand up to them.
So to me, that makes no sense. I saw surgeons tell off the PD who just grumbled under her breath that she’s a doctor too.
She was a total POS.

 

[kidthor]

Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

I object.

 

[VA Hopeful Dr]

If I feel disrespected, I tell them that I put them into a controlled coma, like in the intensive care unit. That gets their attention.

Why do I always say that intensivists are seen as doctors, but anesthesiologists just as techs, even by other doctors? Because anesthesiologists tend to behave like techs, not like highly-trained specialist physicians and consultants; one reaps what one sows.

Speaking as one of those other doctors, I think a large part of it is that so few of us really know what all goes into what you do on a daily basis.

As an FP, I'm expected to know a little about every field of medicine but if not for SDN I wouldn't know **** about anesthesiology other than "uses drugs to make people go to sleep for surgery". Heck, at least a quarter of the meds y'all talk about here I had never even heard of during med school/residency.

My only experience with your specialty was during med school/residency surgery rotations and the MD/CRNA at the head of the table was mostly just sitting there charting vitals and occasionally pushing syringes into IVs. I obviously didn't see the planning that goes into making sure things run that smoothly, the intubations/lines that happen before the surgeons even come into the OR, or waking up the patient smoothly after the cutting was over.

Well that and OB epidurals, but we weren't encouraged to be in the room for that so it was "we walk out when the anesthesiologist gets there, when they walk out we go back in to a patient who isn't in pain anymore". A nice skill to have, but again we didn't see either the details of the procedure or the thinking behind it.

 

[kidthor]

Yes sure. Except like you said, it should go both ways. Surgeons were allowed to treat us like **** but we weren’t allowed to stand up to them.
So to me, that makes no sense. I saw surgeons tell off the PD who just grumbled under her breath that she’s a doctor too.
She was a total POS.

I agree - this is all fine and great as long as it goes both ways.

Where I was a resident the surgeons were nasty to the servile anesthesiologists and deferential to the the alphas (that includes alpha females). We were servile-heavy. And the surgeons and periop staff were quick to throw the anesthesia residents under the buss, only to have a couple residents fired per year. Meanwhile the surgeons were engaged in all kinds of scandals with no repercussions (sexual harassment, industry bribes, assault, etc).

Being weak sets a bad example.

There’s a big difference between being professional and being servile. Don’t accept any nonsense but be affable and professional about it.

 

[Mman]

And after? Out of the OR?

no, recently extubated patients need someone qualified to provide anesthesia watching them immediately after extubation

 

[chocomorsel]

no, recently extubated patients need someone qualified to provide anesthesia watching them immediately after extubation

No crap. But do we need to be pushing the beds? Or stretchers? I have worked in places where the nurses and techs pushed the beds for me and I just walked alongside and bagged the patient to the ICU. That was nice.

 

[Mman]

No crap. But do we need to be pushing the beds? Or stretchers? I have worked in places where the nurses and techs pushed the beds for me and I just walked alongside and bagged the patient to the ICU. That was nice.

 

[kidthor]

No crap. But do we need to be pushing the beds? Or stretchers? I have worked in places where the nurses and techs pushed the beds for me and I just walked alongside and bagged the patient to the ICU. That was nice.

Hence you were able to focus on keeping the critically ill intubated patient in a chemically induced coma alive during transport, rather than pushing the bed. Seems appropriate!

 

[deleted171991]

I agree - this is all fine and great as long as it goes my ways.

Where I was a resident the surgeons were nasty to the servile anesthesiologists and deferential to the the alphas (that includes alpha females). We were servile-heavy. And the surgeons and periop staff were quick to throw the anesthesia residents under the buss, only to have a couple residents fired per year. Meanwhile the surgeons were engaged in all kinds of scandals with no repercussions (sexual harassment, industry bribes, assault, etc).

Being weak sets a bad example.

There’s a big difference between being professional and servile. Don’t accept any nonsense but be affable and professional about it.

Better be feared than liked.

There are studies that show that rude surgeons get much better service. Hence so few surgeons are nice in the OR.

My rule is tit for tat. I start by being nice, but I stop if it's not reciprocated. There is a difference between nice and servile.

 

[Zekchar]

Yes sure. Except like you said, it should go both ways. Surgeons were allowed to treat us like **** but we weren’t allowed to stand up to them.
So to me, that makes no sense. I saw surgeons tell off the PD who just grumbled under her breath that she’s a doctor too.
She was a total POS.

I agree that respect should go both ways. I think it does to a large degree. The more big city and large academic you go the less that nonsense flied.

This may be my age (early career academic) showing through but times are changing. In the past surgeons were kings/queens. Misogyny, racist jokes, sexually inappropriate comments, battery (throwing instruments, kicking walls), verbal and emotional abuse, and all other kinds of bull**** was tolerated for profit's sake. That is changing and changing rapidly. Hostile environment, sexual harassment, and patient safety lawsuits are rendering this kind of behavior a relic of a not-so-great past. If it's one thing that suits understand, it's money. The loss of funds from a discontinued residency program, a sexual harassment lawsuit, anger management courses, professional remediation, and the downward pressure on salaries makes these surgeons no longer loathed, but now unemployed. The clinical production profit is simply not worth the headache, unless you are truly the elite of the elite. No matter how good you think your local surgeon is, they're overall statistically average and therefore not worth the trouble.

Know when to fight your battles and remember that you are far more replaceable than the surgeon. That doesn't mean allow yourself to be disrespected or disparaged, but not everything is worth the expected conflict.

 

[chocomorsel]

I agree that respect should go both ways. I think it does to a large degree. The more big city and large academic you go the less that nonsense flied.

This may be my age (early career academic) showing through but times are changing. In the past surgeons were kings/queens. Misogyny, racist jokes, sexually inappropriate comments, battery (throwing instruments, kicking walls), verbal and emotional abuse, and all other kinds of bull**** was tolerated for profit's sake. That is changing and changing rapidly. Hostile environment, sexual harassment, and patient safety lawsuits are rendering this kind of behavior a relic of a not-so-great past. If it's one thing that suits understand, it's money. The loss of funds from a discontinued residency program, a sexual harassment lawsuit, anger management courses, professional remediation, and the downward pressure on salaries makes these surgeons no longer loathed, but now unemployed. The clinical production profit is simply not worth the headache, unless you are truly the elite of the elite. No matter how good you think your local surgeon is, they're overall statistically average and therefore not worth the trouble.

Know when to fight your battles and remember that you are far more replaceable than the surgeon. That doesn't mean allow yourself to be disrespected or disparaged, but not everything is worth the expected conflict.

I am in private practice now. I don’t allow myself to be disrespected anymore. Them days are gone.
I have seen rude surgeons in academics and private. They can be crazy misogynists in both worlds.

 

[ProRealDoc]

Do you guys ever get pissed off when people in the general public do not really know what we do and our training to get to where we are?

Little do they know we can transition from being primary care to emergency room to critical care doctors in a blink of an eye.
What do you guys say to the misinformed that think all we did is push some medications into an IV and then wake someone back up?

 

[Robotic Wis-Hipple]

Speaking as one of those other doctors, I think a large part of it is that so few of us really know what all goes into what you do on a daily basis.

As an FP, I'm expected to know a little about every field of medicine but if not for SDN I wouldn't know **** about anesthesiology other than "uses drugs to make people go to sleep for surgery". Heck, at least a quarter of the meds y'all talk about here I had never even heard of during med school/residency.

My only experience with your specialty was during med school/residency surgery rotations and the MD/CRNA at the head of the table was mostly just sitting there charting vitals and occasionally pushing syringes into IVs. I obviously didn't see the planning that goes into making sure things run that smoothly, the intubations/lines that happen before the surgeons even come into the OR, or waking up the patient smoothly after the cutting was over.

Well that and OB epidurals, but we weren't encouraged to be in the room for that so it was "we walk out when the anesthesiologist gets there, when they walk out we go back in to a patient who isn't in pain anymore". A nice skill to have, but again we didn't see either the details of the procedure or the thinking behind it.

Even in Med schools that do have a defined rotation for anesthesia, it’s typically 2 weeks imbedded in the surgery one and the Med students treat it like a vacation while we just take them from IV start to intubation showing them the “cool procedures” and not actually teaching them any of the medicine/art/planning to what we do. It’s also impossible to do in 2 weeks.

But it’s silly the avg surgeon has no exposure in their formative years. It’s why every anesthesiologist rolls their eyes when a surgeon says “the patient’s waking up, or light” when they move a bit.

 

[Consigliere]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

Huh. Sounds like you're a real bitch.

 

[kidthor]

Even in Med schools that do have a defined rotation for anesthesia, it’s typically 2 weeks imbedded in the surgery one and the Med students treat it like a vacation while we just take them from IV start to intubation showing them the “cool procedures” and not actually teaching them any of the medicine/art/planning to what we do. It’s also impossible to do in 2 weeks.

In med school the surgery clerkship director removed the option for a 2 week anesthesiology rotation, stating it "diluted the surgery experience".

 

[Gas you down]

Stand up for yourself.
Save/invest because F U $ is the best kind

 

[GandalfTheWhite]

You think medicine people like writing notes? They like helping people (that's what rounds and clinic are for, not intellectual masturbation). The latter is only for satisfying academic egos.

Yes, Yes I do. The younger attendings do write concise notes, but then there are the attendings who have discovered Dragon and write essays pontificating themselves to climax. All the Copy/Paste bloat is absolute garbage. They know it, but continue to do it.

Those are the bad notes written for billing purposes only.

The good notes are basically medical letters to the other doctors, and can show the depth and breadth of one's thinking. Meaning that, as an anesthesiologist, nobody sees the quality of your thinking, just the end-product, which may be the same as the CRNA's.

As an internist, even if one f-s up, the thought process is there for everybody to see. One looks like a doctor to the other doctors, not just a procedure monkey.

Just my 2 cents.

If someone needs to know your thought process, they can ask you, you can write it in the intra-op comments or post-op eval.

When obnoxiously asked by a surgeon why he was getting an a-line, a guy in my residency class would respond, “because I saw you were operating.”

I'm going to definitely use this (once I have a job secured of course haha).

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

I'm sorry, I cant just ignore this, but this right here is bitch behavior. YOURE a DOCTOR. Not a nurse. You're answering their private calls? Is there a class in medical school where they taught you to be a secretary? Theres a big difference between being professional/courteous and a sycophant, I pray that others do not follow this example and fall into the latter camp. This sort of passive docile behavior is precisely why other physicians and staff treat our specialty as lesser than theirs.

 

[Lidolover]

... and now you understand how my plan to make surgical teams equally responsible for patients’ transportation gets ruined every time... because some super nice anesthesia colleagues offer generously their help the wrong moment

 

[Angus Avagadro]

If you act like a consultant, you will be treated like one. Diplomacy is the key. I define diplomacy as allowing the other person to have my way. You never say no. You say "Yes...but". You need to explain WHY you want or dont want to do something collegially and factually. The OR is such a small environment, if you tell.someone to F-off, fine. But tomorrow, there they are again. Now what? Surgeons and OR staff might not like your answer, but they will respect it, which is the best you can hope for.

 

[Planktonmd]

Ha! I’ve always found it interesting how the ICU sedation is a “medically induced coma” on TV/the News but general anesthesia is called “sleep” and a MAC/TIVA which is often deeper than ICU sedations is called “twilight”.

This is called marketing.
Think about about it: if you tell your average patient I am going to put you in a "medically induced coma" to perform this hernia repair, how many of them would actually agree to have surgery?

 

[Southpaw]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

I don't disagree in total with your comments, and it appears a lot of other people here like them as you've gotten a lot of comment 'likes'. Its impossible to ignore however that many of your actions, in my opinion, cross the line and no one in ANY OTHER SPECIALTY would or should do that sort of nonsense for the sake of 'getting respect' or 'getting along'. Especially if your goal, as you say in the post, is to get understanding and help when a patient concern arises or to simply get along with your colleagues. How must it feel for all of your colleagues who don't buy every breakfast, lunch, and dinner for nurses or surgeons when they take over your rooms?

Anesthesiology is a service specialty and your post absolutely proves it, like nail in the coffin, proves it. No one in any other specialty would pull any of that nonsense, and almost with 100% assurance when you leave they'll praise you for a day then totally forget about you.

It's great to be nice, pleasant, and get along. But we are caring for patients. And getting them through their surgery is our goal. If you have concerns or need help from a nurse, then a listening ear and helping hands should be found immediately, and it shouldn't have anything to do with all the crap you typed up there.

 

[cockblockandrun]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

You leave the head of the bed to push saline into foleys? I have NEVER heard of any anesthesiologist doing this. Would I assist if the circulator needed a hand? Sure.

I hope you are not adjusting the anesthesia monitors for the surgeon because thats quite bizarre.

You answer private phone calls for someone else? I don't remember "being a secretary" as part of my residency curriculum. You know what- I don't even pick up the OR phone when it rings unless someone asks me to. And even then I'll give them a look. Why? Because when you allow others to step all over you, you are going to be crapped on.

I am not saying be a jerk or arrogant to the surgeons, nurses or anyone in the staff. But they need to have respect to and one should not come across as a pushover.

"Speak softy and carry a big stick"!!!!

 

[cockblockandrun]

I can't say I fully disagree with your overlords. They may be trying to save you from legit consequences to boorish behavior than gets punished once you are an attending and don't have ACGME or a program director (mommy) covering your a$$. There may be some casual banter amongst colleagues, but obnoxious statements or snide remarks by either side should be frowned upon and discouraged. In anesthesia you are never the all-star, but rather the clutch supporting player. I've accepted this and the sooner others do, the easier and less complicated their careers will be.

During residency I was eager to take easy offence and use my tongue to prove myself in the eyes of anyone who doubted me. Now as an attending, I go out of my way to be nice to and befriend the surgeons. I adjust the monitors and raise the beds to an appropriate height for them. I help the circulator nurses tuck in extremities and push 10cc of saline when they insert foleys. I'll help answer their private phone calls when they are scrubbed and get the patient's nasal cannula out of the pyxis myself when the circulating nurse is stressed about getting new sutures for the surgeon. I tie the back of scrub tech gowns and get extra resources for them when noone else is available. I buy dinner on call days and bring bagels and snacks on weekend shifts.

Why do I do this? Because the once in a blue moon when I voice a concern that really will affect patient care the surgeons nod and defer to my judgement. They say hi to me in the morning and are happy when I am working with them or are grateful when I take over for some of my partners who are less than pleasant and are contentious with the surgeons. Likewise, when the time comes and I legit need something STAT, the nurses run to my aid with reckless abandon. This ends up benefiting me, the surgeon, the nurses, and most importantly, my patients. It also makes my day that much more pleasant and enjoyable.

I would urge any resident reading this to heed this advice. It's much more conducive to a healthy and long career than the alternative hot-shot, no-fear, know-it-all, big-d!ick, arrogant anesthesiologist superstar role.

Do you polish your CRNA's shoes and get them lunch from the cafeteria from your own funds?

 

[abolt18]

I'm all for being nice, learning names, please and thank you. It makes the work environment pleasant. I will gladly tie up the scrub's gown if the circulator is busy. But it pretty-much stops there.

 

[Robotic Wis-Hipple]

This is called marketing.
Think about about it: if you tell your average patient I am going to put you in a "medically induced coma" to perform this hernia repair, how many of them would actually agree to have surgery?

100% agree, “medically induced coma” and here, sign this consent in the 5-10min I’ve known the patient isn’t really compatible.

But because of this marketing as you call it, everyone from patients to nurses to surgeons think it must be super simple. It’s the price we pay for being such good marketers.