When a family doc plays as both a plastic surgeon and anesthesiologist. Wow.

[TheLoneWolf]

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[TheLoneWolf]

 

[The Duck Knows]

These judgements are far too lenient. At minimum they should never practice again. In my opinion blatantly ignoring the boards decision not to operate anymore should be treated as assault. You shouldn’t be able to lie to people, cut them open illegally, and put their lives in jeopardy without seeing prison time.

 

[Ashers]

This is absurd.

My massage therapist just had lipo done with sedation using pills in AZ. She was telling me about it before she had it done, and she survived it, but I warned her it wasn't safe. I assume her surgeon was a plastic surgeon, but I have no idea. She said her friend had it done at the same place the same way and did fine.

I did help convince a friend not to go to Florida for a "mommy makeover." She started looking into it more and talking to more people after I talked to her about the reputation of some places in Florida and canceled (eg. the ob who was doing anesthesia).

 

[IMGASMD]

WTF?!
Did two stints of what I presume as surgical prelim, then family med. Get to call her self as cosmetic surgeon.

 

[TheLoneWolf]

WTF?!
Did two stints of what I presume as surgical prelim, then family med. Get to call her self as cosmetic surgeon.

I would imagine the vendors that supplied her surgical equipment should have looked at her credentials.

We could all potentially place subclavian central lines. Doesn't mean I can buy a bunch of pacemakers and rent out office space and a fluoro machine and just place pacemakers all day on a whim.

 

[coffeebythelake]

WTF?!
Did two stints of what I presume as surgical prelim, then family med. Get to call her self as cosmetic surgeon.

Scary.

 

[Dr. Rude]

Scary.

WTF?!
Did two stints of what I presume as surgical prelim, then family med. Get to call her self as cosmetic surgeon.

Kin to a DNP calling themselves "Doctor".

 

[IMGASMD]

Kin to a DNP calling themselves "Doctor".

“I went to a course for X. Therefore now I can do it.”

 

[abolt18]

I would imagine the vendors that supplied her surgical equipment should have looked at her credentials.

We could all potentially place subclavian central lines. Doesn't mean I can buy a bunch of pacemakers and rent out office space and a fluoro machine and just place pacemakers all day on a whim.

Or could you?

 

[PikminOC]

I would imagine the vendors that supplied her surgical equipment should have looked at her credentials.

We could all potentially place subclavian central lines. Doesn't mean I can buy a bunch of pacemakers and rent out office space and a fluoro machine and just place pacemakers all day on a whim.

Vendors don't care. The doc has an md

 

[Dr. Rude]

Vendors don't care. The doc has an md

Should it be a vendor’s duty to vet the credentials and and actual training of a licensed physician?

 

[Dr. Rude]

“I went to a course for X. Therefore now I can do it.”

How do you expect 50+ yo anesthesiologists to get up to speed on USRA? Just sayin.

 

[Gern Blansten]

Practicing at the top of her license…

 

[IMGASMD]

How do you expect 50+ yo anesthesiologists to get up to speed on USRA? Just sayin.

I’d hope that 50 yo had done some other nerve blocks before, is improving on some skillsets that they already have.

I find it also very disturbing that some PMNR and anesthesia trained pain doctors are doing spine surgeries.

Following your logic, if a medical student went to a weekend course for X, should they do it? Can they do it with the device rep? It has to stop somewhere right?

 

[Maz777]

How do you expect 50+ yo anesthesiologists to get up to speed on USRA? Just sayin.

Doing a crappy ultrasound-guided block is a lot easier (and much less riskier) than doing a breast augmentation or abdominoplasty. I hope every 50+ year-old anesthesiologist has some degree of percutaneous ultrasound skills (and colleagues to run things by).

 

[Dr. Rude]

Doing a crappy ultrasound-guided block is a lot easier (and much less riskier) than doing a breast augmentation or abdominoplasty. I hope every 50+ year-old anesthesiologist has some degree of percutaneous ultrasound skills (and colleagues to run things by).

I agree. But one acquires these skills by doing things like going to weekend courses.

 

[Maz777]

I agree. But one acquires these skills by doing things like going to weekend courses.

The utility of those are very low. To be competent in ultrasound-guided regional, you have to do actual nerve blocks on patients. Scanning on models and poking cadavers or phantoms will only get you to a kindergarten level of procedural competency.

 

[Dr. Rude]

The utility of those are very low. To be competent in ultrasound-guided regional, you have to do actual nerve blocks on patients. Scanning on models and poking cadavers or phantoms will only get you to a kindergarten level of procedural competency.

I also have a degree from YouTube Univesrity.

 

[IMGASMD]

I also have a degree from YouTube Univesrity.

Is Dr. Google also your mentor?

 

[Maz777]

I also have a degree from YouTube Univesrity.

Excellent. I'd say there is more utility in that than a weekend of scanning live models.

 

[nimbus]

I also have a degree from YouTube Univesrity.

Same. We are fellow alums.

 

[nimbus]

The utility of those are very low. To be competent in ultrasound-guided regional, you have to do actual nerve blocks on patients. Scanning on models and poking cadavers or phantoms will only get you to a kindergarten level of procedural competency.

Gotta start somewhere. When I finished residency (1996), we didn’t use ultrasound for anything. So yeah I had to go to a few courses and practice by doing crappy blocks on actual patients until I got better. No different than surgeons learning to do robotic mitral repairs and prostates.

 

[pgg]

How do you expect 50+ yo anesthesiologists to get up to speed on USRA? Just sayin.

It's not the monkey skill of driving a needle that matters.

It's patient selection, assessment, risks and benefits, the ability to avoid complications, and the ability to diagnose and manage complications if they occur. You know - doctor stuff.

An anesthesiologist watching a YouTube video to learn or refine a technique within the usual scope of anesthesia practices is not the same as a nurse going to a weekend course to learn the mechanics of a procedure, much less whatever this crazy plastic not-a-surgeon quack did.

 

[Maz777]

Gotta start somewhere. When I finished residency (1996), we didn’t use ultrasound for anything. So yeah I had to go to a few courses and practice by doing crappy blocks on actual patients until I got better. No different than surgeons learning to do robotic mitral repairs and prostates.

I think it is different. Many ultrasound-guided blocks are generally not difficult to perform. I wouldn’t compare them to robotic valves. It should be in scope of every anesthesiologist that has basic needling skills. Some act like ultrasound-guided blocks are special and require a fellowship to perform, which is ludicrous. Don’t get me wrong, I’ve led a bunch of ultrasound workshops for Regional and POCUS, but honestly both are honed by doing on real patients many times and seeing the fruits of your labor. They aren’t technically challenging procedures.

 

[nimbus]

I think it is different. Many ultrasound-guided blocks are generally not difficult to perform. I wouldn’t compare them to robotic valves. It should be in scope of every anesthesiologist that has basic needling skills. Some act like ultrasound-guided blocks are special and require a fellowship to perform, which is ludicrous. Don’t get me wrong, I’ve led a bunch of ultrasound workshops for Regional and POCUS, but honestly both are honed by doing on real patients many times and seeing the fruits of your labor. They aren’t technically challenging procedures.

Yeah I wasn’t trying to imply that an ultrasound guided block is as challenging as a robotic mitral repair. What I am saying is that medicine progresses rapidly after we finish training and we need to keep up. 5 years from now there will be things that are not currently being taught in residency. This is true for most specialties. It’s what makes medicine engaging.

 

[Lee Ik-jun MD]

yes this is scary.. but still she has an MD and a residency after med school.
Here in California, there's a lot of med spa, beauty clinics etc run by RNs, NPs or PA's.
they're just paying an MD ( like a retainer ) to front the clinic but it's their actual business. We've seen a lot of Botched cases coming from these clinics

 

[Anesthesia_Guy]

Should it be a vendor’s duty to vet the credentials and and actual training of a licensed physician?

Why?! As long as the check clears you're golden.

 

[Gasworks]

This is absurd.

My massage therapist just had lipo done with sedation using pills in AZ. She was telling me about it before she had it done, and she survived it, but I warned her it wasn't safe. I assume her surgeon was a plastic surgeon, but I have no idea. She said her friend had it done at the same place the same way and did fine.

I can easily make the argument that lipo under general is the completely absurd. Most of the nationwide “laser lipo” groups are doing thousands of procedures under po sedation and I have yet to see any evidence that you are any safer having it done with a tube in your trachea.

Without outing myself let’s say that I personally had “laser” lipo, which is basically just plain old lipo done with a single Xanax and a Percocet. Procedure lasted 30 minutes, I was able to assist with positioning myself and was out the door 15 minutes after the dressings went on. Was it fun? ABSLOUTELY NOT but there wass no way I was going to be under general for this.

 

[coffeebythelake]

I can easily make the argument that lipo under general is the completely absurd. Most of the nationwide “laser lipo” groups are doing thousands of procedures under po sedation and I have yet to see any evidence that you are any safer having it done with a tube in your trachea.

Without outing myself let’s say that I personally had “laser” lipo, which is basically just plain old lipo done with a single Xanax and a Percocet. Procedure lasted 30 minutes, I was able to assist with positioning myself and was out the door 15 minutes after the dressings went on. Was it fun? ABSLOUTELY NOT but there wass no way I was going to be under general for this.

You just admit that it might not be for everyone.

 

[IlDestriero]

You just admit that it might not be for everyone.

Exactly, people want sedation for an MRI, let alone what I’m sure was a pretty painful procedure.

 

[Gasworks]

Exactly, people want sedation for an MRI, let alone what I’m sure was a pretty painful procedure.

Want to be “knocked out” because the nurses and the radiologist/surgeon assured them it was perfectly safe is a solid 20% of the headaches I deal with in a daily basis. A vast majority of those are in the radiology suite.. surgeon decides patient is too sick for anesthesia so they send them to IR.. who in turn want general anesthesia for their percutaneous procedure. Nobody takes them time to properly educate patients and families on associated risks and grandma winds up in the icu for a week “anesthesia complication”.

My point is that the percentage of people who actually NEED anesthesia for things like MRI or cosmetic procedure is a tiny fraction of the people who just WANT to be knocked out. Just last week one of my colleagues did ga/ett for a PD cath removal on a septic patient with low EF because surgeon thought he might need to do a quick scope of the cath was stuck. Guess what the cath wasn’t stuck and the patient never recovered from induction. The patient, surgeon and the patients son were all demanding he be “knocked out” despite the risk and my unfortunate colleague did not have any fight in him and gave in to their demands. I can’t wait to sit at next months M&M and watch the same surgeon throw anesthesia under the bus.

 

[IMGASMD]

Want to be “knocked out” because the nurses and the radiologist/surgeon assured them it was perfectly safe is a solid 20% of the headaches I deal with in a daily basis. A vast majority of those are in the radiology suite.. surgeon decides patient is too sick for anesthesia so they send them to IR.. who in turn want general anesthesia for their percutaneous procedure. Nobody takes them time to properly educate patients and families on associated risks and grandma winds up in the icu for a week “anesthesia complication”.

My point is that the percentage of people who actually NEED anesthesia for things like MRI or cosmetic procedure is a tiny fraction of the people who just WANT to be knocked out. Just last week one of my colleagues did ga/ett for a PD cath removal on a septic patient with low EF because surgeon thought he might need to do a quick scope of the cath was stuck. Guess what the cath wasn’t stuck and the patient never recovered from induction. The patient, surgeon and the patients son were all demanding he be “knocked out” despite the risk and my unfortunate colleague did not have any fight in him and gave in to their demands. I can’t wait to sit at next months M&M and watch the same surgeon throw anesthesia under the bus.

Just like everything in medicine, the answer is “multifactorial”. We do plenty of colons that does not “need” general anesthesia. We don’t have the time, nor does surgeon have the time to educate/be educated.

How many patients comes in and demand to “be out” or “not know anything”. If I have the energy, I will give a quick reasonable response. It gets harder especially when the surgeons/proceduralist “promised” them something. I usually reserve my energy to fight for smoking cessation than educate them the difference between sedation/general anesthesia.

On top of that, at end of the day some of us need work for incomes. That’s the reality of the situation. Had a thought provoking conversation with one of my good friend in med school. Most of doctors make a living while patient is sick or in the need of us. If they don’t need us or not sick, we are actually pretty useless. But that’s certainly the cynical and realist part of me speaking….