Why we do what we do

by
  • Hertzberg, Linda, MD, FASA
| Apr 30, 2012

On the days I get depressed or frustrated at work, I often think I should make a list to remind myself of why I am there and what the true value is of my labors. In moments of frustration, this list is not forefront in my mind nor at hand, so here I will present it in writing—for me and for you, to remind us of why we do what we do. As you are reading, mentally adding items of your own to this list, please share them in the comments section below.

The value of what we do as professionals, physicians and anesthesiologists can generally be divided into clinical and non-clinical pursuits. For today, I will tackle just the clinical arena, leaving the non-clinical list—certainly equally valuable, but even more difficult to define—for another day and an upcoming blog. On the clinical side, one would like to believe that “it’s all about the patient,” as a former ASA President would say. Unfortunately issues and situations may intervene that keep us or our surgical or nursing colleagues from remembering this. Distractions aside, this list will hopefully remind you of the fundamental value of being an anesthesiologist.

Patients need protection from surgeons. Most of our surgical colleagues are good physicians and technicians. However, sometimes they become so intent on just doing a case that it is difficult to focus the surgeon on the patient’s medical condition. Last week there was a patient in our practice who came for an elective procedure, who unexpectedly presented in atrial fibrillation with a heart rate of 170. Needless to say the procedure was deferred so the patient could receive treatment. However, the surgeon was grossly unhappy with the situation. Good patient care and advocacy requires that we not be distracted by the surgeon’s dissatisfaction with any given situation. We must be prepared to communicate and explain our concerns calmly and dispassionately to the surgeon and the patient.

Our colleagues need guidance to protect them from committing acts that can potentially cause patient harm. Gastroenterologists, cardiologists, pulmonologists and others who have privileges for moderate or deep sedation at the facilities where we practice need to be educated about good pre-sedation airway assessments so that they do not get themselves and their patients in trouble. I am personally aware of  situations in the cardiac cath lab and endoscopy suite, where, as a consequence of a failure to properly evaluate a patient’s airway or medical condition, the patient suffered harm. Most anesthesia departments shoulder the CMS mandated responsibility to provide a medical director of all anesthesia and sedation services at their hospitals. We must be proactive in protecting patients by setting patient care standards for sedation services in our hospitals and educating our colleagues in the implementation of these standards in their practices.

Our patients need protection from themselves. Many of us have changed our routine or practice to satisfy a patient’s demands. A simple example is the removal of dentures or partials in patients undergoing general anesthesia. I have seen dentures become dislodged into the gastrointestinal tract and a patient require an endoscopic procedures to retrieve the denture. Many patients are unhappy about removing their dentures, arguing “they don’t come out,” but most will come around if the reasons relating to safety are well communicated.

A more complex problem is patients with known, documented sleep apnea who have not had a proper workup, do not have a CPAP machine or who are non-compliant with treatment. Last week I admitted two morbidly obese patients for airway monitoring overnight. These individuals were originally scheduled for outpatient procedures and were concerned about the need to remain in the hospital overnight. Even with the best of preparation and explanation, patients will sometimes not feel satisfied with what needs to be done to provide proper care. We cannot allow patient dissatisfaction to deflect us from doing what is safest and in their best interests.

Our skills are important and in demand. Who is better prepared to manage diabetes, hypertension, morbid obesity, sleep apnea and difficulty airways in the OR than anesthesiologists? Most of my patients have some of these conditions and some have all of them simultaneously—and these are just the most common or likely chronic disease states. Just this week I anesthetized two patients with end stage COPD for outpatient procedures with low spinal anesthetics and minimal to no sedation. Both did well and went home the same day. We are challenged daily to medically manage very ill patients whom we have just encountered either on an outpatient basis or in the performance of complex inpatient anesthesia and surgery. In areas such as the central valley, where poverty, poor nutrition and lack of access to chronic care play a role in determining underlying disease states, these problems are exacerbated in the patients presenting for anesthesia and surgery. Patients need and deserve the type of care only medically trained physicians / anesthesiologists can deliver in these circumstances.

Our patients want open communication about options in anesthesia care and want to know that someone will be their advocate in the operating room. This last item is the synthesis of all the others. If we perform professionally on the first few items, then this last will follow, but only if we make an honest and open connection with patients without appearing rushed or distracted. Even a few minutes in the preoperative area listening to patients’ concerns and reassuring them that you will be there for them in the operating room is time well spent. The value of an interpersonal connection to a patient cannot be understated. Your patients will be better provided for, and you will go home at the end of the day feeling like you had a positive impact on someone who needed a caring physician.

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