I am a doctor, but not like the kind on TV

I am a doctor, but not like the kind on TV     A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Hospital dramas are not very short on excitement, but for some reason, anesthesiologists never seem to get the glamour treatment. Maybe that’s because our job is so difficult to transition onto the silver screen. After all, it would be pretty boring to see only one person bridging communication gaps between physicians to provide comprehensive care, all while monitoring, advocating and caring for the patient.

We do not practice some ghoulish breed of medicine where we kill a patient, then bring them back to life, as some Hollywood storylines suggest, nor do we hang out around the procedure room without contributing to the actual procedure. It may be understandable that patients don’t necessarily comprehend all their anesthesiologist is responsible for and all that the specialty entails.  It’s to be expected— the patient is usually unconscious for the majority of the time they are around their anesthesiologist.  It might be easy to minimize what we do each and every surgery.

Anesthesiologists have a unique understanding of many medical specialties, making them a key component of a physician-led care team. We have led the way in perioperative testing and overall patient safety. We understand critical concepts of cardiology, surgery, internal medicine and many other specialties. With cross-specialty knowledge in addition to in-depth anesthesia training, we provide oversight and input as both a patient advocate and a component of a collaborative medical team.

Normally, entertainment also confines anesthesiologists to the operating room, but that couldn’t be any further from the truth. For instance, while my patient only sees me briefly before entering the operating room and maybe as he or she regains consciousness, my role in that patient’s care started well in advance of the procedure, lasted throughout its entire duration and also included planning for their care after the operating room.

I may call the other physicians the night before the surgery to receive a briefing on the specific case and ask any questions I have. I review the patient’s chart to verify test results and I will potentially order additional tests if I feel like there might be a gap in patient safety. In doing so, not only do I increase efficiency by preventing cancellations, but I also use my expertise to minimize the costs associated with unnecessary testing.

The morning of the surgery, I will assist with the patient’s preparations, including placing epidurals for post-operative pain relief and coordinating medications for optimal post-operative care and healing. Safety is my utmost priority, so I take part in key preventative checkpoints like reconfirming the correct surgery site, padding pressure points to avoid injury and conducting ongoing monitoring of the patient’s vital signs.

Throughout all this activity, I am working with each specialist present to help coordinate each discipline’s unique brand of care. My job doesn’t end there, but I think you understand my point. Anesthesiologists do not simply knock out the patient, then mill about the room. We’re there with you, working with you every step of the way.

Anesthesiologists have more than 10,000 hours of training and at least eight years of medical education. We’ve learned advanced technical skills like intubation and ultrasound interpretation, while also being fully prepared to participate in emergency situations and intensive care. We’re the first line of defense for patients, yet our job is misrepresented and misunderstood so frequently.

To learn more about anesthesiology and how patients can work together with their physician-led care team for the best surgical outcomes, visit Lifeline to Modern Medicine.

Paul H. Ting is a member of the American Society of Anesthesiologists. 

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  • FCinNH

    I have had two major neurological surgeries, done about 18 months apart. After the first surgery, the anesthesiologist came and saw me shortly after in the PACU, to check on me. I remember coming to in the PACU with the neurosurgeon there, and asking him why he had decided not to do the surgery because I felt exactly the same as I had when I went into the OR. He laughed and said that he HAD done the procedure (removal of a schwannoma at L1.) The tumor recurred so 18months later I had to have the rest excised again. I asked for the same anesthesiologist, but she was on another case. I figured it wouldn’t really make much difference in the end. When I awoke in the PACU after that procedure all I could say was “it hurts.” I felt like I had been run over by a truck. The only difference was who the anesthesiologist was. I learned then that who the anesthesiologist is makes a HUGE difference in how you recover. It took almost 48 hours to get the pain under control the second time, where I had virtually no pain the first time. It all had to do with what steps the anesthesiologist took at the end of the procedure in terms of drugs administered after the surgery was over. The second anesthesiologist never saw me post-surgically for even a second.
    I have now learned that I will be as at least as careful about who the anesthesiologist is as who the surgeon is. The difference between to two experiences was entirely the result of the difference in anesthesiologists. They are not all the same, and some do not exhibit the care that the author of this piece feels should be standard. The importance of the role of the anesthesiologist is severely underestimated.
    What I don’t know is how to distinguish the caring ones from the uncaring ones. I hope not to have to undergo any more major surgical events, but should I need to, I will need to figure that piece out.

  • EmilyAnon

    I had no idea that post op pain was governed by what the anesthesiologist does or doesn’t do. Can a patient choose their anesthesiologist as they do other providers? If you had a meeting before the operation, what questions should a patient ask?

    • FFP

      Unless the surgeon or the patient asks for a specific anesthesiologist, s/he is assigned to your case by the anesthesia floor runner, who is a senior anesthesiologist. 90+% of the time you will get an anesthesiologist who is competent at your type of procedure. But if you had a positive experience with a specific anesthesiologist in the past, adjust your surgery so that s/he is available. The same way you would not just simply accept your surgeon’s partner, you should not accept experimenting with another anesthesiologist. Different doctors may have the same knowledge/skills/education/academic position etc., but personality and work ethics usually differ significantly.
      People don’t realize that the anesthesiologist is many times the most important person in the operating room. Pain control, as described above, is downright minor to all the other possible complications of general anesthesia, which should be rather known as controlled coma. Lack of skill or inattention can lead to significant damage to important internal organs. Unfortunately, many times not even the surgeons realize the importance of having a skilled AND compassionate anesthesiologist.
      A good anesthesiologist will answer all your questions before you even ask them, when telling you what to expect about your surgery. S/he will not try to minimize the risk of possible complications just to soothe your anxiety. S/he will be friendly but professional, always putting your safety first, and comfort second, even at the risk of upsetting you or the surgeon. S/he will feel like your guardian angel, someone with your best interests at heart, someone you can trust 100% and who will do her best to deserve that trust.
      Most anesthesiologists don’t have the privilege of meeting their patients way before surgery, like most surgeons do. This means that both s/he and you will have very little time, often about 10 minutes, to develop a patient-doctor relationship. It also means that many times the surgeon is the main person to answer your questions about anesthesia, at the time you schedule your surgery. Unfortunately some surgeons have no real knowledge of simple basics of anesthesia, meaning they will have very unrealistic expectations about the possible outcomes.
      Be a smart patient and google your surgery and anesthesia before the day of your operation. This way, not only will you know what to expect, but you will be able to ask for methods of anesthesia or post-op pain control that might not be offered to you. Getting a more realistic image of what to expect, instead of the fairytale story of “going to sleep” and “waking up, like only a second had passed”, will also help you lower your expectations and set yourself up only for good surprises, instead of mostly bad ones. Anesthesia is a medical specialty; the human body is neither standardized or perfect, it’s not a machine, so complications can happen, completely out of the control of your doctors. What makes the difference between outcomes is pure luck and how good your doctors (including your anesthesiologist) are.