Why/what about you made you choose anesthesia?

[NOTJOHN]

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Why do people keep saying we are in a risky field? We deal with sick pts but people need to realize that the family of the 90 y/o train wreck cabg or ruptured AAA ain't gonna sue when $hit hits the fan Bc it's not unexpected.

DUDE, if ANYBODY.. ANYBODY dies in the operating room you have a great potential to hav e legal problems.

Certainly, as the above poster said, if anything untowards happens to a child. Kiss your career good bye. If you lose an airway, you will have major problems.. So when you say oh its ok for the train wreck to die. I say no its not ok. If it were ok, they would not be having surgery.

 

[ssmallz]

Another thing is the cumulative risk you amass throughout your career. If you are in a supervisory practice that is somewhat busy, let's say you'll be responsible for about 3,000 cases a year. Over a 10 year period, that's 30,000 patients and many, many potential complications. You can extrapolate out and see how your potential risk can increase exponetially.

How is that any different from a busy clinic doc who see 4 pts/hr 8hrs a day for 10 years? That's over 70k pts in a 10 year period.. Yes law suits are real, yes bad things can happen to our pt and surgery is dangerous, but more often then not the cases that cause most people stress aren't the ones you're gonna get sued for. I agree w/you consig that healthy 5 y/o for a hernia is much more scary to me than a 70 y/o midnight septic bowel disaster.

 

[ssmallz]

DUDE, if ANYBODY.. ANYBODY dies in the operating room you have a great potential to hav e legal problems. .

I'm sorry to say it but that's just not true. Most people who die in ORs are sick. They're sick before they see us and they're sick when they us. Most sick people and their families know the score, there's a significant non zero chance they may not make it or may end up in the ICU for a prolonged period of time. If they don't know the score, it's our job to educate them before taking them back. That 70 y/o septic pt w/ischemic bowel, the 65 y/o AMI for stat cabg, GSW to the chest, ruptured AAA, 95 y/o train wreck for new hip. These guys are high risk for medical badness but low risk for a law suit. Will they die? Some will no matter what. Will they sue? Maybe but unlikely and even if they do, they won't win a huge settlement. There's no "pain and suffering" c/b your anesthetic. There's no lost future income to compensate for b/c you used epi instead of dopamine. The bottom line is that you were dealt a $hit hand and did the best you could.

The real high risk cases from a legal perspective are the healthy ASA 1 and 2 pts, along w/OB and regional. The good news for us is that complications in this subgroup are rare and if they do happen aren't usually permanent or debilitating. If you take a look at our malpractice rates compared to those of other docs, we're toward the lower end, especially when compared to surgeons. These rates are figured out by smarter people than I am and take into account how often we are sued and how large the average awards are. So overall I think we need have a health respect for the pt and disease but we need to keep perspective on this and realize that just because bad things happen, doesn't mean we're gonna get sued

 

[Consigliere]

How is that any different from a busy clinic doc who see 4 pts/hr 8hrs a day for 10 years? That's over 70k pts in a 10 year period.. Yes law suits are real, yes bad things can happen to our pt and surgery is dangerous, but more often then not the cases that cause most people stress aren't the ones you're gonna get sued for. I agree w/you consig that healthy 5 y/o for a hernia is much more scary to me than a 70 y/o midnight septic bowel disaster.

It's different because said "busy clinic doc" is refilling HCTZ scripts and managing diabetes. A far cry from the life and death decisions and fast paced environment of the OR. Critical decisions MUST be made quickly or people get effed up. Not really analagous to the clinic doc deciding which ACE inhibitor his octogenarian patient will be put on.

 

[pgg]

It's different because said "busy clinic doc" is refilling HCTZ scripts and managing diabetes. A far cry from the life and death decisions and fast paced environment of the OR. Critical decisions MUST be made quickly or people get effed up. Not really analagous to the clinic doc deciding which ACE inhibitor his octogenarian patient will be put on.

That is all true.

But numbers don't lie, anesthesia is at worst middle-of-the-road in terms of likelihood of getting sued, and size of the payout:

 

[NOTJOHN]

I'm sorry to say it but that's just not true. Most people who die in ORs are sick. They're sick before they see us and they're sick when they us. Most sick people and their families know the score, there's a significant non zero chance they may not make it or may end up in the ICU for a prolonged period of time. If they don't know the score, it's our job to educate them before taking them back. That 70 y/o septic pt w/ischemic bowel, the 65 y/o AMI for stat cabg, GSW to the chest, ruptured AAA, 95 y/o train wreck for new hip. These guys are high risk for medical badness but low risk for a law suit. Will they die? Some will no matter what. Will they sue? Maybe but unlikely and even if they do, they won't win a huge settlement. There's no "pain and suffering" c/b your anesthetic. There's no lost future income to compensate for b/c you used epi instead of dopamine. The bottom line is that you were dealt a $hit hand and did the best you could.

The real high risk cases from a legal perspective are the healthy ASA 1 and 2 pts, along w/OB and regional. The good news for us is that complications in this subgroup are rare and if they do happen aren't usually permanent or debilitating. If you take a look at our malpractice rates compared to those of other docs, we're toward the lower end, especially when compared to surgeons. These rates are figured out by smarter people than I am and take into account how often we are sued and how large the average awards are. So overall I think we need have a health respect for the pt and disease but we need to keep perspective on this and realize that just because bad things happen, doesn't mean we're gonna get sued

While I agree the high stakes in this game are the healthy patients undergoign major surgery, dont write off the risks you take by anesthetizing sick people. There are ischemic bowels that I have saved because I knew something about resuscitation. . Yes they are sick, but that doesnt mean you can say, well they are sick thats why they died. I understand what you are saying but you are simplifying things. All patients that come to the OR are NOT supposed to die. If they were, why even bring them in. If someone dies in the OR a suit will be filed against you. And if you havent undergone Examination before trial, you havent lived yet. Everything you have done up until that moment will be questioned.

My first lawsuit was a triple A which ruptured in the ER. The surgeon brought the patient to the OR. He was Unstable as F. he arrested and expired on the table. .. 8 months later the family filed suit. Sued Me and the surgeon.

My second lawsuit was an obstetric case in which the baby did poorly. Family sued me and the obstetrician. We settled for a lot of money.

I dont care what the chart says. I know what im up against on a daily basis and what others are not up against.