by Jennifer E. Hayes, M.D.
I vividly remember my first Friday night as an anesthesiologist in private practice. I got sign-out from my partner and knew she was heading out for the night … and the closest help would be 30 minutes away. Gulp.
This is when you rely on your training, previous experience, and faith in yourself that your education and skills will lead you to “do the right thing.”
When you leave the cushions of an academic hospital — with mounds of support, other attendings, residents, and CRNAs who could assist in times of need — this is when you really learn what you know, and what you don’t know. The transition to private practice is also the time to build confidence in yourself. It is as if with each decision tree, you are standing in a courtroom defending your decision, or sitting in a hotel room answering your oral board questions. Why? How? Is there evidence to support that, Dr. Hayes? And now you can’t intubate and the patient’s oxygen saturation is 89 … 88 … 85… what next?
Occasionally I would imagine who I could call if I really couldn’t intubate and couldn’t ventilate. Could the ER doc help? Was there anyone besides me in this hospital who could get an airway? I would go through the “what next” in my head before inducing. Then there was the fear of performing a general anesthetic on someone who really needed a spinal if I couldn’t get it. The pressure was on and, once again, I needed to rely on my skills and sometimes figure out new tricks to best serve my patients.
During daylight hours, reliance on your seasoned elder partners is a key to success. You may think that you’re the hottest new thing on the anesthesia scene, but, remember, your elder partners have been doing this for far longer, probably in more diverse practice settings than you have. More than likely, their 20- to 30-plus years of clinical experience in the trenches can teach you a thing or two. A few more hints:
Know When to Say ‘No’
Remember to follow your gut. If something doesn’t feel right, talk it over with a senior partner, and don’t do things that you can’t justify ethically. Some of the best advice I received from a partner was, “You can always get a new job. You can’t get a new license.” In other words, don’t be pressured into something that you feel isn’t safe. If a surgeon in a free-standing office wants you to do a case in his office-based OR that hasn’t been used for years, and there is no dantrolene present, JUST SAY NO! Even if he tells you that the patient is “perfectly healthy” and there’s dantrolene across the street at the main hospital. Do you really think that when a patient is having an MH crisis there will be a free person to run across the street and grab dantrolene? Always stay within ASA guidelines. Have (non-expired) dantrolene and intralipid available, no matter what the cost, and check the expiration dates frequently. There’s no defense in a court of law for using expired drugs.
If It Sounds Too Good to Be True, It Probably Is
I once interviewed for a job in a desired West Coast location. Great town, incredible compensation package, but after only a half day in the OR there I felt like I needed a vacation. The stress between partners and between anesthesiologists and surgeons was so palpable that you
could cut the air with a knife. In fact, even during my brief interview speaking to different partners, I could easily tell that they didn’t even like each other. The bottom line was that it just didn’t feel right. Something was off. Trust your judgment and move on.
Know When You Need Backup
When an obese patient is sitting in pre-op waiting for his lap chole and you can hear his stridor before you walk into the room, perhaps you should call a senior partner before you induce. Especially if it’s Saturday and you’re completely alone. Of course, you try to protect your partners from coming in unnecessarily, but know the times when you really need someone there because proceeding alone could put patient safety in jeopardy.
Don’t Just Be a Warm Body
Offer something to your group. Don’t just show up, push the good stuff, slam your locker, and go home. Show your group that you have a valuable contribution to make — a new block, echo experience. If you can’t think of anything immediately, at least be cheerful, helpful, and a team player. No one wants to work with a whiner, especially someone who states how “state of the art” and “amazing” the technology was where you came from. Don’t complain. Instead, take the necessary steps to change things in a thoughtful manner. If you are continually frustrated that you are unable to change things after a reasonable period of time, then look for a new job, taking the above advice along with you!
Jennifer E. Hayes, M.D., is the director of orthopedic anesthesia at Albany Medical Center. She practiced in both private and academic settings in the Seattle area prior to moving to the East Coast.
Sphere is published four times per year by the New York State Society of Anesthesiologists, Inc.
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