Every few months, I attend the regional California Society of Anesthesiologists meeting. We usually go to a nice restaurant, listen to a lecture, and discuss updates in the political scene at a state and national level. These meetings remind me several things. Because community anesthesiologists attend, they often give perspectives on practice outside the academic setting. When we had a talk on difficult airway devices and techniques, I was surprised to find that I was more comfortable with the newer approaches than many non-academic anesthesiologists. Being at Stanford affords me the opportunity to use technological advancements that smaller hospitals and surgery centers have yet to adopt. It reminds me that when I finish residency, I have to prioritize active and continual learning so as not to lag behind the latest ideas.
The second part of the meeting reminds me of the importance of advocacy. I've realized more and more that we have to support our profession. There are a lot of competing interests, especially ones to control cost of care, and not all of these are the best for our patients. We still advocate a physician anesthesiologist in charge of all anesthesia care including pain procedures (rather than independent mid-level practitioners). We still fight cuts to reimbursement that may discourage physicians from caring for the Medicare population. We still seek to educate and inform the public about what we do as anesthesiologists, and hopefully this blog plays a small role in making that happen.
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In ancient Greece, the asclepion was a healing temple dedicated to Asclepius, the God of Medicine. Asclepius learned the art of surgery from the centaur Chiron and had the ability to raise the dead. The Rod of Asclepius is a roughhewn branch entwined with a single serpent.
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Hi! I am Craig Chen, a third year resident physician in anesthesiology at Stanford Hospitals and Clinics. I went to medical school at the University of California, San Francisco. Prior to medical school, I studied philosophy and biology at Stanford University, along with a minor in creative writing.
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2 comments:
Hi, I'm a medicine intern who came across your blog from a friend and UCSF classmate of yours. I really appreciate your taking the time to record, observe, think. I agree with the need to continually advocate in the midst of learning/practicing. I was wondering what you thought of the benefit for patient care is with preventing mid-levels from doing procedures. I imagine and have seen from experience in other areas that mid-levels can perform just as well as physicians, and that some of the advocacy on the part of patients stem in part from physician bias. Not to say that this is everything, but I think it's often overlooked; I've been guilty of the same myself (especially going into primary care, where it can be strongly argued that mid-levels provide equal, if not better, care).
Hi Kim! Thanks for the comment. You bring up an interesting point. I've had a lot of the same thoughts as well. Physician bias does play a big role in this even though it shouldn't. One argument that comes up is that mid-level practitioners doing procedures are great when everything goes well. In fact, they are more likely to follow checklists, protocol, etc. than physicians (for example, if you watch a PICC nurse place a line, they're fabulously on top of all the central line precautions, moreso than any physician I've seen).
But when procedures go wrong, they may not have the right training, background, or knowledge to be independent. As a resident, when I do procedures, my attendings will challenge me on what I might expect if things go wrong - if someone gets bradycardic and asystole with a spinal (described in young patients) or has a venous air embolism in a central line, etc. I'm trained to recognize, diagnose, and treat these sorts of things. I can't tell you how mid-levels are trained, but there are some who argue that they would not handle adverse consequences as well as a physician would.
For example, a couple months ago, there was a widespread epidemic of fungal meningitis resulting from contaminated dexamethasone ampules (http://www.cdc.gov/hai/outbreaks/meningitis.html) used for epidural injections. Well-trained mid-levels can certainly do the epidural injections, but what if a patient calls with the symptoms of fever, nuchal rigidity, and headache? A physician may be expected (medically & legally) to recognize symptoms of meningitis, but a mid-level who only does pain procedures may not.
In any case, these are just some ideas and opinions, and I'm not convinced there's a right answer. Thanks again for the comment and good luck with internship!
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