The Impossible Situation

One of the common problems on the anesthesia oral boards is the "impossible" situation. A patient's medical problems, surgical needs, and anesthetic risks all create conflicting priorities such that no course of action is without significant risk. Whatever you decide - cancel a case, proceed with a general anesthetic, try a spinal, optimize medical therapy - will ultimately end in some complication. It is a game of weighing risks and benefits and trying to choose the lesser evil. Examiners use these questions to get an appreciation of whether the examinee can reason through difficult situations, appropriately articulate the risks and benefits with each decision, and commit to a choice and handle its complications. These are some of the more stressful situations that come up in oral boards; hopefully I'll be ready for them. I'm going to take this week off blogging to prepare.