Working with Surgeons I

One of my readers, Pat, asks, "Do you ever find it difficult to work with surgeons?"

This is a great question and a tricky one to answer. There are so many levels of complexity. The surgeon and the anesthesiologist have a codependent relationship; without a surgeon, an anesthesiologist has no work and without an anesthesiologist, a surgeon cannot operate. Our ultimate goal is the safe care of a patient, but often our motivations, priorities, thoughts, actions, and personalities conflict because the safe care of a patient is not always straightforward.

Surgeons and anesthesiologists differ quite a bit in our approach to the patient. Anesthesiologists are risk-averse; we are conservative, prepare for the worst-possible scenario, and consider ourselves protectors or guardians of the patient. This is reinforced not only by culture and training, but also by the fact that anesthesia is not therapeutic. Putting someone to sleep doesn't cure them of anything. The best we can do is to wake someone up exactly the way they were when they went to sleep; we can't make them any better. Anesthesia is simply a means to an end - the surgery.

And that's why the surgeon is usually more risk-taking than the anesthesiologist. You have to be, to take a scalpel and cut into someone with the confidence that you will make them better. The surgeon is the one in the spotlight, the star of the show.

So the two can get into conflicts when the anesthesiologist thinks a surgery is too risky and a surgeon wants to take the risk. The ideal way to approach this situation is to discuss the risks and benefits of proceeding or not and determining what the patient wants. But such ideal situations do not play out each time. I'll write more about working with surgeons tomorrow.