« bookofjoe's Favorite Thing: Greenberg's Smoked Turkey | Home | Sea Urchin Chair »

November 12, 2012

"Why do we always have to use the same technique?" — Sneak preview of just-completed chapter from my upcoming (2013) book "Think Like An Anesthesiologist"

6a00d8341c5dea53ef017d3d4608ff970c

One complaint I frequently heard from residents during my years as an anesthesia attending was that every general anesthetic employed fentanyl, midazolam, propofol, succinylcholine, nitrous oxide, vecuronium, neostigmine, and glycopyrrolate.

Same drugs, same sequence, every single case.

"Can't we try something else?"

"No."

"Why not?"

"Because you don't have a clue about giving anesthesia. So the best thing you can do to get better is to use the same drugs the same way in every single patient for a couple months."

"But that's boring."

"Boring? Yes, very boring. Good anesthesia is boring. Nothing happens out of the ordinary."

"But how will I learn how to use other drugs?"

"With all the other attendings who will be more than happy to humor your enterprising, inquisitive nature."

"You're no fun."

"I'm not paid to be fun. I'm paid to be safe. So are you."

••••••••••••••••••••••••••••

It seemed obvious to me then and it still does today — 11 years after I left academic anesthesia for private practice — that if you use the same drugs the same way thousands of times in that many different patients, over time a pattern of responses develops such that an unusual event instantly appears as if in lights, highlighted against a deep historical backdrop.

If the only variable is the patient, then the patient can tell you everything you need to know to fix something right after you recognize it as an anomaly.

Very sad to me was one resident who, finishing his third year in our program and slotted for a fantastically lucrative job upon completion of his residency, returned to the ready room after each day's cases remarking, "An amazing thing happened to me today."

If an amazing thing happened to him during his day's cases every single day after three years of training, he really didn't have a clue about giving anesthesia.

Because no competent resident has any business being amazed more than occasionally after three years of training and thousands of cases.

That amazement heralded an upcoming world of complications and misery for both the resident and his patients in the years to come.

Hey, don't get me wrong: He was a great guy and I liked him a lot — when he wasn't giving anesthesia in one of my rooms.

Some people just don't get it — and they never will.

November 12, 2012 at 07:01 PM | Permalink


TrackBack

TrackBack URL for this entry:
http://www.typepad.com/services/trackback/6a00d8341c5dea53ef017ee5079057970d

Listed below are links to weblogs that reference "Why do we always have to use the same technique?" — Sneak preview of just-completed chapter from my upcoming (2013) book "Think Like An Anesthesiologist":

Comments

Why?

Er, because it works?

Don't fix what isn't broken and don't gild the lilly.

Of course, Joe you inspire terror in lesser mortals. I know. I've seen you do it. Twice.

Posted by: 6.02*10^23 | Nov 13, 2012 4:04:57 PM

Hopefully I will not be thinking of that Dr. one day when I am being put under for surgery. Scary!

:)
mikky
www.todaloos.com

Posted by: mikky | Nov 13, 2012 12:41:20 PM

So looking forward to your book. This is going to be one good read!

Posted by: Kay | Nov 12, 2012 8:57:03 PM

"Some people just don't get it — and they never will.

...I'm not paid to be fun. I'm paid to be safe. So are you. ...Some people just don't get it — and they never will."

Wow! Please tell us that the clueless resident was either a product of today's public education system, or had at least one parent who was a government lawyer or a politician.

His medical attitude is cavalier at best, and unless he has a novel concept, seems absolutely irresponsible, in my humble opinion. I have been fully anesthetized just once --- over 50 years ago as a child with what was still called "ether".

Posted by: Juan Caruso | Nov 12, 2012 8:44:04 PM

The comments to this entry are closed.