TejasDoc

Then he posts his little anecdote about physician arroganceInteresting, because you see, I saw it as a general posting about the value of humility and indirectly, the danger of arrogance/complacency, coincidentally (or not) using a resident's thoughts to get the point across. I am willing to acknowledge that perhaps it was a pointed post aimed at gotosleepy, but I think that was done earlier in the thread. I feel the lesson to be gained by the excerpt is valuable, and even if one learns it well, is a lesson that bears repetition. According to Gaba, in his anesthesia crisis management text, and with notations made in many places to Reason, an author dealing with the psychology of human error, many human errors have as a spawning ground 'hazardous psychological' attitudes. If the attitude of , "oh brand new residents doing locums work, no big deal" is not at least a slightly hazardous attitude, then they don't exist. Interestingly enough, I have some friends whom I have met since coming to school, who are recent graduate anesthesiologists (both last year and fresh this June);these folks ( a varied bunch) have uniformly expressed the feeling that this very statement is rather cavalier. Are they aware of it (new grads doing locums) occurring? Yes. Do they think it is great? No. Brand new anesthesia providers doing any anesthesia does not qualify as "no big deal", and I pray I have a vigilant attitude the rest of my career. Arrogant doctors are not the only providers with the unfortunate chance to kill people. They are certainly not the only arrogant ones out there. It doesn't even take arrogance. No retraction. I enjoyed reading your post. I knew as soon as I wrote the "save your butt" thing, I shouldn't have. But I let it go. Oh well, ya make some mistakes and you move on. I apologize. But I think you recognized the point I was trying to make, even if I wasn't making it in the best possible manner. Compensation is a tricky thing, and I don't really know that much about how it's done. Anyway, gotta catch some sleep, and there's still one more post I need to make. TD

Hellllllo Nurse, I would hate to disappoint you, so here I am. I've been incredibly busy with my own training to get back here as often as I'd like. There are a lot of things in your message that I'd like to respond to. Here goes. Sorry that happened to you. I'm not really sure what you said or what you asked, but I can tell you I understand about being jumped on by the majority at a bulletin board. You just have to get up and post again another day. I'm embarassed to say that I imagine at many medical schools, there is not. Mine may have been the exception, because I did have a formal class about the training and education of nurses and different advanced practice nurses. But it was elective, it wasn't part of the required curriculum, and it was literally just ONE class, not a course, but a class. I've honestly not thought that much about it, and maybe I should, I've been a little obsessed with my own situation recently. I'm a new resident, you can imagine, it's somewhat overwhelming. I can tell you what I do, and I try to make a conscious effort of it. The nurses I work with are great. They're smart, qualified and they work really hard. I try really hard to be nice, to thank them every time I get a chance, and defer to their opinions when I know they know more than I do. Not a day has gone by since I started that I haven't learned something from a nurse I work with, and I make sure they know that. I try to make my relationship with them as pleasant as possible. If the nurses I work with aren't happy with their work environment, I didn't cause it. That's my contribution. I'm really sorry that you've been treated badly and called nasty things ... all I can do is try not to be that way myself. Ether, Hmmmmm, I don't know where you are, but I wish I had interviewed at a program that put residents at the front of the bus. Last I checked they just shortened my work week to 80 hours ... wow, what luxury. And now, I can only work 30 hours in a row. Yep, I'm pampered. Lucky for me I make less money as a resident than I did when I graduated from college. Maybe if you all run up to the front of the bus, we can tip the thing over and I can get a couple extra hours of sleep. TD

Oh come on deepz, you don't have to long for the past, you're plenty ignorant and full of yourself now ... I imagine it would make up for an entire life of humility. You're right Lalaith, I may have misread Deepz. This I will freely admit. But, in a previous post he wrote. Then he posts his little anecdote about physician arrogance, using the example from a junior resident. So sure, I'll buy that maybe he's talking about the impact of a few moments on a human life. It's a distinct possibility. I've read it again and I can see how it would be read that way.I just want you to acknowledge that maybe he was taking a jab at gotosleepy after calling him arrogant, and then presenting that little anecdote as a chance to show how arrogant doctors like gotosleepy can kill people. I just don't think inside the bitterness and anger is a nice guy trying to teach me something about humility. Though Deepz, and everyone else who read his post, I want you to think about something. If you believe Deepz' comment about being able to earn an entire year's salary in a few critical seconds in the OR ... and I myself actually believe that, then how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year? BTW, Lalaith, I think you called me obtuse, but did so in a really diplomatic manner, way to go. Welcome to the discussion. TD

'Stalker' deepz? No not quite. But I have a keen sense of smell, and I'm able to follow the scent of BS from one website and to another. It's not rocket science. Hellllllo Nurse, I agree, there is a huge difference in the sub-standard nursing lounge and the opulent physicians lounge. I think it's awful that the nursing staff is given such a horrible facility. I just don't think it's the same as the civil rights movement and "drinking from a different water fountain", in the civil rights sense of it. The difference isn't obviously clear, and you may or may not agree with me, but here's what I think. In the civil rights sense of it, you were black, you were treated unfairly, and there was really no escaping it. You, if you don't like the nursing lounge, and feel SO strongly about it, can just quit. No oppression, no being forced into submission, nothing. Just quit ... find another job that treats nurses better. OR, and I can only imagine the **** storm I am opening up by even suggesting this, go to medical school, finish a residency, and then go ahead and enjoy the opulent physicians lounge. That option, while being a lot of work to enjoy a lounge, is also available to you. Blacks couldn't just quit being black, and they definitely couldn't just go to school and become white through education. So do I think the nurses lounge you describe is awful? Yes I do. Do I think the physicians should get a beautiful lounge the the nurses a hell hole? No, awful idea. I just don't think it's comparable to the civil rights movement. No, no way, no how. You're not an oppressed people, you described a crummy lounge, that's all. You can only imagine how I feel about the Nazi holocaust thing that Alan Smith mentioned. Soon I'm going to have to read a comparison of the treatment of CRNAs to the genocide of Native Americans. TD

Deepz, While I think that anecdote from the resident is educational in sheading light on the experience of training physicians, it does not really apply here. You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology. Sorry, the comparison is weak. TD

It's a ridiculous comparison, and if you would ever use such a comparison in a setting that wasn't anonymous like this message board, people would think you were ridiculous. It's ridiculous that you would defend it, though at 60, you'd know better than I the oppression that African Americans lived under in this country ... I don't think there's a hospital anywhere that makes CRNAs drink from a different water fountain. Though who knows what's going on in Durango ... Unfortunately, there's no way for me to filter out nonsense messages and comments. I read some interesting things from time to time on this board, if I have to read some garbage now and again, well, that's just the cross I have to bear. BTW, you're welcome to wear clean badges. TD

Yet another really offensive comparison of CRNA's to slaves by sleepy. You're on a role man. Nobody is oppressing you Sleeepy. Nobody lied to you about what being a CRNA would entail, and nobody twisted your arm not to become an anesthesiologist. You still have the opportunity. Don't make it seem as though you're under a blanket of oppression and simply cannot escape. Not only is the assertion ridiculous, it's just wrong, but also really ridiculous ... and did I mention wrong? In the very end, this is all academic. As I've been told many times, CRNA's are not restricted by law from practicing anywhere, yet in major metropolitan areas and medical centers throughout this country, CRNAs are not the sole providers of anesthesia care or pain management medicine. So Sleepy, while you may go to bed at night thinking that I'm having nightmares about CRNAs taking my job and livelihood, you're wrong. As far as money goes, tt's really a non-issue for me as I imagine it is for most anesthesiologists. Now that you know, you too can 'wake up!'. TD

Yet another really offensive comparison of CRNA's to slaves by sleepy. You're on a role man. Nobody is oppressing you Sleeepy. Nobody lied to you about what being a CRNA would entail, and nobody twisted your arm not to become an anesthesiologist. You still have the opportunity. Don't make it seem as though you're under a blanket of oppression and simply cannot escape. Not only is the assertion ridiculous, it's just wrong, but also really ridiculous ... and did I mention wrong? In the very end, this is all academic. As I've been told many times, CRNA's are not restricted by law from practicing anywhere, yet in major metropolitan areas and medical centers throughout this country, CRNAs are not the sole providers of anesthesia care or pain management medicine. So Sleepy, while you may go to bed at night thinking that I'm having nightmares about CRNAs taking my job and livelihood, you're wrong. As far as money goes, tt's really a non-issue for me as I imagine it is for most anesthesiologists. Now that you know, you too can 'wake up!'. TD

So yeah, that's pretty offensive, comparing the "plight" of nurse anesthetists making more than 100k a year PLUS overtime to the actual plight of a race of people who had to come out from under the foot of hundreds of years of slavery and legalized oppresion. Like I said before, the comparison is just offensive. And as I've been told numerous times, you by law can practice as an independent anesthesia provider, so what are you complaining about? I hear there are plenty of jobs just a few hours outside the major metropolitan areas in South Dakota and Montana just waitin' to be picked up by an eager CRNA like yourself. Not an anesthesiologist in sight, so have fun. TD

So yeah, that's pretty offensive, comparing the "plight" of nurse anesthetists making more than 100k a year PLUS overtime to the actual plight of a race of people who had to come out from under the foot of hundreds of years of slavery and legalized oppresion. Like I said before, the comparison is just offensive. And as I've been told numerous times, you by law can practice as an independent anesthesia provider, so what are you complaining about? I hear there are plenty of jobs just a few hours outside the major metropolitan areas in South Dakota and Montana just waitin' to be picked up by an eager CRNA like yourself. Not an anesthesiologist in sight, so have fun. TD

I am. TD

thanks, though i knew what you were getting at the first time, it was a rhetorical question. but that's my fault, i gave you an excuse for a diatribe, i can't really complain when you do. though maybe it'll make you feel better if you look at the situation you described in a different manner. just think of all the autonomy you get at night in those situations! wow, how exciting. see, the glass is half full, not half empty. it must be quite a sight at 3pm, all those mds leaving, wearing their flight suits with a donut in one hand and a driver in the other talking to their brokers on a cell phone and counting the money they make off your back breaking labor. td

Lemme guess Deepz, you turn into a pumpkin? TD

I'm sure you've heard the surgery saying ... "Sometimes in error ... never in doubt." I do my fair share of moaning and groaning about the attitude of surgeons, but I think it takes a certain healthy amount of bravado to think that you can affect healing by cutting into the human body. TD

Gaspassah, I haven't had a chance to say, but I REALLY appreciate the court cases you posted. I wish I could say that I've had time to look them up, I haven't. I've just been too busy with work stuff recently. I will take a look at some point, just don't know when yet. But thank you for posting those. Loisane ... you're right, this discussion has gotten pretty far away from the anesthesia care team topic that it started on. In the very end, I don't know what's going to happen with this model of care. If nothing else, I hope it ends up that CNRAs and anesthesiologists have an amicable relationship. From what I hear, in the private world, this is true. I think anesthesiology, from a physician point of view, is going to stress this perioperative role more and more. Right now, the ABA is considering tacking on more time in the ICU during an anesthesiologist's residency. Abroad, many anesthesiologists have to spend a year in ICU training as a part of their residency. A lot of physicians are changing their practices, cardiothoracic surgeons have to contend with interventional cardiologists, general surgeons with GI docs, neurosurgeons with interventional neuroradiologists ... everyone's practice will change eventually. I don't really know what's going to happen in our case. I disagree with Deepz, this is not an issue of economics. I don't imagine it is going to cost the health care consumer any less to get anesthesia from a CRNA than it would have from an anesthesiologist. As far as I know now, reimbursements are the same whether or not an anesthesiologist or a CRNA does the case, but in general, in the case of supervision or direction, the anesthesiologist takes half. So perhaps in that case, many of you are thinking that the reimbursement will simply drop to half, therefore the health care consumer is only paying half what they were before, to get anesthesia care (in this case, imagine there is no supervision, CRNAs are treated as exact equals to an anesthesiologist). So in this case, if an anesthesiologist does a case, he gets X amount, if a CRNA does a case, they get X amount. While I think this sounds like it would be agreeable to CRNAs, you know it would not be. Can you imagine the **** storm that the AANA would create if before, you got paid X to do an anesthetic, but now that nurses and physicians are equal in this matter, you got paid half of X? I just don't see that happening, so I don't think it's an issue of the economics of it all. You said you thought there might be cases when the expertise of an anesthesiologist would be needed, but not every case. But which cases? I imagine you wouldn't necessarily know, so that would mean that every hospital in America that performs surgeries should at least have a consultant anesthesiologist on staff, just in case one of those emergencies arises. But every hospital does not have an anesthesiologist, and they'll never get one if the anesthesiologist receives his/her only compensation from consultation. As for the leadership of the ASA. I don't really know. I know very little about the attitude of the leadership. From a financial point of view, I'll lead a very good life if supervision of CRNAs in an anesthesia care team stays the predominant model. And I know I'll lead a good life if anesthesiologists are the sole providers of anesthesia care in this country. But if CRNAs are doing all their own cases under a full scope of practice, well, how will this help me? You really just then become my direct competition for employment. The ASA is protecting the practice of anesthesiology for me ... so I wouldn't be reclaiming anesthesiology, I'd just be giving a bigger chunk to you if I tried to vote in a more pro-CRNA leadership. Why would I want to do that? Deepz, I'm not sure you've ever had anything positive or constructive to say in this discussion, if I'm mistaken, I'd hope someone would point it out to me. It's always something negative, it's always a jab at anesthesiologists, the ASA, or AAs, and rarely is it backed up by any kind of real facts or substantial proof. This last message is a great example, you could have made a simple comment about the anesthesia provider shortage and supervision not really being "proscriptive of any standard of care", but you ruined a perfectly reasonable argument with comments about CNBC, golf, and stock brokers. Again though, I'm going to agree with you, Loisane makes good posts, people could learn a lot from her approach, including me. TD