Saturday, February 19, 2005

Patient Management

Different groups of doctors manage patients in different fashions. The internal medicine doctors do it a certain way, surgeons another, and I have to say anesthesiologists another...Being an anesthesiologist in this setting is difficult. It's hard to please everyone. But you are put in the situation where you take a patient that you believe has not been managed optimally, you take them, fix them to the best of your knowledge, and then bring them back to the people you took them from and turn them over back to management you disagreed with in the first place. Also, you run into the problem where those other groups think you've mismanaged them in the interim.

I've seen situations where a patient has had surgery, received some fluid during the procedure, discharged home, and readmitted upto a week later, with a diagnosis of too much fluid during anesthesia when there are clearly other issues in play. A week later! I've seen surgeons blame anesthesia for kidney failure in a patient who had a liver transplant, when that is clearly a known complication during such an extensive operation. Seems to me that in particular surgeons are micro managers... at least in general... at least at the University level. I've had surgeons ask me to give blood products to patients at the same time not to raise the central venous pressure (which is a measure of volume status and raised directly by giving fluids or blood)

I'm not saying anesthesiologists are perfect. I'm saying that we've been to medical school too, and we've gone through specialized training. Give us a break.

1 comment:

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