Some people just won't leave it alone will they?

[meandragonbrett]

This was posted over at studentdoctor.net

Hi Everyone, I've been off the forums for awhile. Busy with internship.

I just wanted to post a couple of things I've noticed this year concerning the need for anesthesiologists. I just finished 3 months of Surgery (Transitional year) and got to know many of the community surgeons, intensivists, and anesthesiologists. After these 3 months, I feel more secure then ever about anesthesiology's future. For example:

1. Just about every surgeon I've met (especially the CT, Vascular, and Neurosurgeons) expressed a strong desire to have an anesthesiologist present for their cases. Most of them had been burned to many times by working with CRNA's. Frankly, they said their patients were for the most part too sick for anyone but another physician to be taking care of them in the OR.

2. The rapidly expanding field of TEE is dramatically changing CT and vascular surgery. This is not just for valve surgery, since many unexpected intraoperative occurences are being detected by TEE. Examples of these are rare things such as ventricular thrombus formation to common things like volume depletion. I don't know any CRNAs who are adept echocardiographers.

3. The true skills of the anethesiologist really show through in the emergent cases, which many people not in the field forget entirely. In my minimal 3 months of general surgery, we took some really sick people to the OR. I'm talking about people who are in DIC, renal failure, septic and hypovolemic shock, with heaps of necrotic bowel and just a day or two out from major anterior wall MI's. The funny thing is, until you actually get into the field (surgery or anesthesia), you don't really notice how often these presentations actually are. Not to mention those with the above problems, plus being 5'0", 250 lbs, and major pulmonary hypertension. The hospitals know this and that's why they want anesthesiologists available 24 hrs a day. The major medical center/trauma center here just made it mandatory that all anesthesiologists with attending priviledges take in house call on a scheduled basis, or lose their priviledges. They already had in house CRNAs.

Anyway, I could go on for awhile but I'll stop now. I guess the impression I've been getting during internship, is that the future of anesthesia is very bright, as long as you don't mind taking care of sick people and working hard.

Bye the way, internship is a blast so far.

[WntrMute2]

Originally posted by Tenesma

"they like to use TEE to add more to anes. bill"

gowkout... give me a break. Typically your posts are a lot better thought out than that... That kind of falls into the category of: "whatever MDAs do and CRNAs don't do must be because we want more money"

Gotta agree w/ Tenesman here. I don't believe we want to get into the position of just disagreeing with what MDs do. We exist as a partnership and if CRNAs want to learn to interpert TEEs they need to seek out the training not just slap down the practice. I happen to learn a lot about reading TEEs from a bunch of Docs that didn't exclude me in their teaching.

This battle should not extend into every area of practice. We don't want to sound like the guys on that student doc board now do we?

[Tenesma]

good luck MICU RN... anesthesia is a great and rewarding field...

[kmchugh]

Brett

You are right, there are some people who just won't leave it alone. But, if you look more closely, you'll find that most of the folks who won't leave it alone are med students and residents. And, in my practice, I have found that the residents who feel this way are usually in the minority.

I think most MDA's and surgeons are glad there are CRNA's around. In most cases, you will find that MDA's and CRNA's work very well, side by side, and both have the interests of the patient at the top of their lists. That's why I have such a problem with the arguments presented (on both sides) in this debate. They are about "territory" and "who can do what", rather than about what is demostratively best for patients.

The best you can do when confronted with this type of argument is present the facts, then leave it alone, knowing the majority of MDA's, surgeons, and CRNA's don't agree with the extremist point of view on either side of the argument.

Kevin McHugh

[kmchugh]

Tenesma

To answer your question, I have not heard of any special organizations that certifies just CRNA's to do TEE's. My understanding is that CRNA's are trained and certified in the same way physicians are. It seems here we are a bit behind the times, because I have only heard of one or two intraoperative TEE's being done, and have never seen one myself. I'd very much like to learn, though.

Kevin McHugh

[Tenesma]

i have to agree with Kevin... Most of the people I know who have issues with CRNAs are med students and beginning residents. They are still unsure of their own skills and feel threatened ... that is all. For a person in internship (like that person you quoted at the beginning) to think they know anything about anesthesia is beyond asinine. The more experienced residents and the attendings tend to have a less territorial attitude, mainly because they have become secure in their fund of knowledge and their orificenal of skills. This isn't a game about who is better, but rather what is more appropriate care for a patient - bottom line.

As far as you being behind the times (kevin), i disagree... it is just a matter of resources and level of sophistication/level of difficulty of the cases provided by the surgeons you are working with... The patients at my hospital are the ones that most surgeons would never operate on (which is cool, because we get to see crazy stuff, but not so cool, because it can be really back-breaking work sometimes) and therefore we tend to pull out more stuff to get the job done... I doubt our morbidity and mortality is anything to be proud of though :), nor am I 100% sure we are actually improving outcomes or really helping the patient... but that is a topic for an ethics forum...

anyway, i hope everybody has a great columbus day weekend (i live in an italian neighborhood - so i don't have much of a choice!)

tenesma