Trust

Now that I'm more often than before taking the role of an attending anesthesiologist I've decided it's not about your skills, but more about your trust in others. First of all, for those who aren't familiar with the structure of how academic anesthesia works (most private practices I guess also) -- there is an attending anesthesiologist. He/she is "in charge" if the anesthetic. Usually she/he makes the plan and is there for the "critical" potions of the case. In academic anesthesia, usually there is also a resident involved. This is someone who is a licensed doctor, in the midst of her/his training to be a specialist, in this case anesthesia. That person is present for the entire case, and follows the plan of anesthesia set out by the attending. In private practice most places, and some academic centers too, there are also nurse anesthetists. They are nurses that go to special school to perform anesthesia also, usually under the supervision of an attending anesthesiologist. They would perform the same function as a resident -- being present for the entire case and performing the primary anesthetic. (For the rest of this, when I say "resident" I mean "resident or nurse anesthetist") The attending is usually responsible for one to four cases in total depending on the time of day and what type of cases are being performed. Now here are where trust issues come in to play. If the attending was present for the whole case, he/she could perform all the necessary functions and deal with any crises that arise without problem (most of time) because of their previous training. When you are supervising fours rooms, unfortunately you can't be four places at once so you rely on the residents to call you when there are problems. Most of the time, patients receive excellent care from residents -- sometimes even better than if the attending was performing the anesthesia him/herself. Occasionally because of the level of training there is a lapse in judgement, or a delay in calling for help. This is where you can get into trouble. If the resident doesn't call you... and there is a problem still... you are still responsible for the outcome. I trust most of the residents I work with, and I want to give them some space to learn and make their own decisions, but it's hard when i'm responsible for everything they do. So you need to trust their judgement and hope they have a low threshold for notifying you of a problem. I find myself walking from room to room checking things out from the doorway, even though I know everything should be fine. I'm told this nervousness gets better with time. I'm not sure I want it to. A healthy dose of doubt...