As an anesthesiologist and perioperative medicine specialist, I utilize this strategy! I pretty much use this script when talking with my surgical colleagues about a patient who I have any concerns: "My concerns with this patient under going anesthesia are x, y, z. I feel going to surgery right now could cause a, b, c and I don’t feel these risks outweigh the benefits of this surgery. I ask that the patient have the following addressed before proceeding. If you [surgery] still want to proceed, please document the why you want to pursue emergent surgery and I would be happy to get this patient through surgery as safely as possible."
@@michaeldouglas8202 except when they don’t get it or don’t care. So, after many years, I have decided IDGAF about their feelings. I’m not here for that. 😏 It’s just way more work than it’s worth.
It is reality. NEVER allow the surgeon sway you from sound judgement. The patient's life depends on it. And there is nothing more disheartening than witnessing such cowardice from another anesthesiologist.
Did you guys notice the surgeon went through all the stages of grief? Denial, bargaining, anger, even a little sigh of depression and finally acceptance (paired with a fair amount of surgical narcissism 😂). Nice job, putting a little clinical psychology in this video, Doc Glauc! 👍
This explains why my surgeon told me to "Go home and eat bananas next week" before my scheduled procedure. It wasn't about me and my (slightly low) potassium. It was so he could avoid being told what to do by anesthesia. It all makes sense now.
Potassium citrate sprinkled in a sports drink would have been a lot easier. But if you don’t dose it right it could be dangerous. Helps get rid of PVC’s for me.
Story from My psych prof; during his residency he was called by a surgeon for a consult. The patient simply did not want to be operated on but the surgeon apparently could not fathom this and called for a psych consult which deemed the patient completely sane. The surgeon thought the patient was mentally ill for canceling 😂
We actually had a patient decline a foot amputation recently, and got psych in to assess her capacity. The outcome of declining the operation is continuing infections, she already had sepsis several times, and refusing the op will result in her dying much earlier. But psych said she has capacity, so.
I don’t know the details but there are definitely scenarios/surgeries where the act of not wanting the surgery is itself enough for a psych consult. I can’t name something specifically but it would be something like a minimally invasive and safe surgery to fix an extremely deadly problem
I loved how the surgeon said he'd just do the case quickly, as if he usually just takes his time and he can magically do the repair faster today! I've witnessed them say this
I’m an anesthesiology resident and this is too true 😅 I once had a surgeon throw a fit in pre-op because we canceled a non-urgent case after a patient went into V-Tach and almost coded… fun times!
1. Were they actually coding? If no, then what's the problem? 2. If they code - when you have ROSC, we roll. 3. Chest compression time will be recorded as an Anesthesia delay.
@@theworkinginvestor Yeah I don't think this is specific to any speciality but the thing that makes a competent doctor in my mind is knowing a lot of things they can't actually do. Like an orthopedic surgeon might never treat any sort of vascular disease but if they can't recognize thrombosis or manage blood thinners they will be failing their patients.
That last bit is actually serious by the way.. I believe it was an EMCrit podcast on the psychology of dealing with hard to work with people in medicine and one of the strategies is making them think that they’re in the driver seat of the decision
If you could change a particular part of you sentence to *hard-to-work-with people or *people who are hard to work with, it could make it easier to undestand what you meant ^.^
The problem with that of course is that you're supporting their negative behavior instead of challenging it. That's how a-holes usually stay a-holes... (In the case of the video being a psycho who would rather endanger someone's health than be mildly inconvenienced.)
@@notthere83 they've been like like their entire lives. There's nothing you can do to change them now, especially when they're in a position of power and wealth and you aren't their superior to keep them in check.
As I medical representative I always use this strategy. I deliver the info while making them think they already know that shit. Most of the doctors have no clue about details of drugs.
The first 10 years of my anesthesia career were just like this. The second 10 years the surgeon wanted an explanation and complied. My last 10 years I just told them the surgery was canceled and the surgeon already knew why and said he just wanted someone who agreed with him before telling the patient/family - so he could blame anesthesia..
My grandma had an abdominal aortic aneurysm that needed to be fixed so she had scheduled a surgery. The surgeon ended up spending hours in another surgery that was only supposed to take one or two so my gram said whelp I'll just have mine done tomorrow because it's 10 pm now and i dont want a tired doctor. The surgeon was begging her to do it now because he's had longer days and it's no big deal. This is exactly how I imagine it went on in his head 😂
billable hours my friend. billable hours. he doesn't do it? who's the next competent surgeon at this place who can do it? is the procedure hard? no? is it lucrative? well what the hell, why am i not raking in the fun coupons?
The way you cancel a case Anesthesia: knock knock Surgery: who's there? Anesthesia: interrupting anesthesiologist. Surgery: interrupting anesthesiol- Anesthesia: your surgery is cancelled.
Does Surgery's wife even answer the phone, or does she have an app that goes "uh-huh, I'll do that - you *would* know best" every time there's a pause?
@@barbarabreadman2373 sometimes it’s where people go to cheat on their spouses. It’s got almost everything. Nature, walks, lunch, friends, and surgery never comes home so this is where his wife goes.
I'm an "Ortho Bro" and just today had two arthroplasties cancel for blood pressure reasons. Went to this and brought it to Anesthesia.... we were all crying with laughter, crying! Good job as always!!!
My husband leads a surgical team. This is accurate. Key thing missing however is the vent call to another surgeon OR their spouse about how awful anesthesia can be. I’ve had to field that call a number of times.
Taking a surgery from a surgeon is like taking water from a fish. His will to live dwindles with each cancelation!! He doesn't wanna have to spend time with (*gasp*) his family ... the horror.
This is by far the most accurate video you've made yet. I have personally witnessed a conversation between a cardiac electrophysiologist (whose specialty is literally all about the ions in the heart doing their job) and our chief of anesthesia about canceling a case over low potassium. The EP went through a dramatic fit including telling the anesthesiologist they weren't a real doctor anyway and suggesting they give the patient a banana. The EP finally relented when we found an inpatient addon and let us admit the original patient overnight to do the next day.
Sure, have a banana! Now, with that full stomach, DEFINITELY cancel the case! Actually, I never cancel a case. I DEFER cases. If the surgeon or proceduralist (OMG, GI is THE WORST) is willing to wait 8h for proper NPO status, I'll be there. Yet they never wait, so THEY "cancel" the case. I defer the case until the pt is optimized. Use your words, colleagues. USE. YOUR. WORDS.
the fact that anesthesiologist is not a doctor is really true, no one knows them outside o.t , they r just puppets of surgeons , surgeon are real heroes
I was half expecting him to hand the surgeon a game of operation while he was in shock to help calm him down like a small child having a meltdown. Like, “Look at you and those perfect fine motor skills! You finished in only 5 minutes and there wasn’t a single buzz from Cavity Sam! I sure couldn’t get that Adam’s apple out without dropping it a few times, but you did it on your first try!”
I love to see how Surgery ride his roller coaster of emotions with such commitment. He goes through all emotions in 10 seconds and finishes the ride praising himself.😂😂😂😂😂😂
omg- As an O.R nurse- you nailed the surgeon's drama perfectly. Sometimes the charge nurse would have to deny the case- because anestheisia would want us to be their messenger- UGGGG
The week of my surgery, I absolutely forgot to show up to my pre-surgery consultation with my surgeon. Just straight up forgot (stress, pressure, lots of things to prepare). I already had gone in for anesthesia appt, and me and my surgeon had been planning this for months. I'd waited years for this, I'd been sacrificing everything to get this surgery (esp financially wise), I was all by myself, so I bawled my eyes out thinking I couldn't get it anymore. I mail him and he tells me to come in and we'll see. Day of surgery, I just check in, change clothes, get transferred to OR. I only talk to him to say good morning, any changes I've felt, until I get KOd by anesthesia and then wake up crying and drooling, surgery done. Glad surgeons love surgery more than anything.
(They only want you to come in before surgery day so they can get paid for the consult. If they do it the day of the surgery it's included in the surgery fee.)
My dad (83 years old) broke his hand so we went to his surgeon for a consult. Of course, he suggested we get him in on Monday for the procedure…it was Friday. My father had a history of CHF and had been recently presenting w/ pursed lipped breathing and cyanotic lips with a SpO2 84%. I asked him if he thought it was a good idea to put under general anesthesia an octogenarian with clear respiratory symptoms and a history of chf without an anesthesia consult. He didn’t seem to see the problem….we didn’t opt for the surgery. His hand healed just fine in a soft cast a month later.
Having worked for a surgeon I have to say that the narcissism, self-entitlement, complete detachment from reality when it comes to just how bloated their income is compared to everyone else, and the absurdly dramatic nature of their behavior when they're contradicted about anything, especially something that they don't actually know anything about, is absolutely on point.
I will say I am thankful they can do it because every single time I have been in the OR cutting a live human freaks me out. I have dissected humans cadavers, stitched myself as a child so it’s not human viscera it’s the idea of cutting into a human and knowing the body will have to heal every unnatural incision /motion made inside and it will cause pain. That to me must have to create some dissonance or a person who lacks that sense of empathy. One or the other in order to perform the task. Just out of necessity because every time I would see it I would be overwhelmed by an urge to stop it or my entire thought process while fascinated by the repair itself was very focused on how our techniques affected the recovery process I had witnessed at the bedside/long term out patient Even as a nurse I am very aware of any painful stimuli I can give to a patient. Especially working in oncology they endure a lot. It has to be done but it’s something I’m hyper aware of. I can’t imagine that fixation as a surgeon.
As a retired pre op nurse , all I could do is shake my head and laugh. I saw this happen too many times, usually with an extremely elevated potassium. The goal was to get them on a cardiac monitor and transferred out before they coded on us 🤞🏼😱
I heard from a family lawyer that one of the most difficult to deal with people during divorces are surgeons. Like they will be horrible to deal with. The family lawyer even advised people to maybe not marry surgeons lmaooo
As nurses, our strategy is ALWAYS to make you, MD, believe that this great idea that just saved the patient's life was from you. This is the most important module we get to learn. ^^
Best part of this is that it's true for non-medical fields too! I had a boss that was a heavy micro-manager who wouldn't listen to the team's imput, so I'd just walk by him while casually mentioning Plan G. A week later he'd tell everyone he had a great idea called Plan G and we'd all start implementing it 😄
@@notmyname1883 that is very true. I was just sharing from my own experience, as I have not had a coworker that acts that way (or at least, not that I've put up with!) =)
Had my gallbladder removed 12 years ago. My physician was the physician's choice of physician to do the procedure. He had a gleam in his eye he told me I needed surgery. Literally said let's just rip that thing right out of you. He reminded me of John Lithgow and was so happy to arrange my surgery. He did a great job, but it was like offering opening a candyshop to a kid. I think surgeons are a unique breed. Thank God for them!!! But, I wouldn't want to be the resident raining on their parade.
😂MYDog!! Hahahaaaa!! As a former plastic surgery scheduling coordinator 😃 I was the one who had to tell the surgeon that surgery was canceled 😂😂😂😂 soooooo much fun 😅 Hahahaaaa!!! You nailed it Doc❣️❣️
The overreaction! The drama! The pinpoint accuracy! And only Anesthesia could have gotten by with standing right next to him. That's actually some respect right there. Because where I worked, the surgeon would sometimes do the Daffy Duck routine when the surgery scheduler broke the good news. No way she got that close - might accidentally have caught a flailing arm or hand. 🤣🤣🤣 Good show, Doc!
Too true!! When I was observing non urgent colonoscopies (as a Med student), the last case of the day had a BP of 189/102!!! The anesthesiologist told the surgeon we need to reschedule and the fit he threw! 😂started telling her to just give some lasix and he would be “quick with it”😂, but anesthesia just walked out telling him he was free to do the anesthesia himself if he was adamant 😂😂
Surgeons are not good with internal medicine I mean one just said give NTG but man yes i can give NTG and the bp will fall but post op most cases the bp shoots up rapidly and lead to further complications I think it's because of such experiences that anesthesiologists don't risk otherwise we have over 10 ways we can reduce that bp but is it worth it 🤷♂️
Looks like all of the sessions with therapy have been paying off for surgery. We did this all the time with some of the more difficult interventional cardiologists and EP’s. The CRNA’s ended up leaving the breaking the bad news to us since we knew how to handle the….let’s say more complex personalities of some of our docs.
Totally understand and can relate. I've got one EP doc that would just chill out and say ok, whatever. Then there's the Drama King.... I think you know exactly what I'm talking about, LOL 🤣
My dad is an anesthesiologist, and from what I've heard the good ones reschedule immediately and the grumpy ones complain for a bit before they reschedule
Haha! So true! You should do one on how anesthesia is always getting blamed for delays. My favorite one blamed on me was a 2.5 hr delay. The delay code read "CRNA late to see patient." Do you know WHY I was late to see the next patient? Because my surgeon lost a needle inside a laparoscopic patient and spent 2.5 hours looking for it! 😂
@@Kevin-fj5oe you do realize the size of a standard metal detector, right? The laparoscopic incisions are usually an inch or so. Besides, it’s not like metal detectors are just laying around in the OR anyway.
@@alexfurman1486 That's what the "or something" was for. You don't need to be a jerk when answering what should be a common question to those who know nothing about medicine much less a laparoscopic surgery needle. For your information, there are metal detectors roughly the same size as a large pen. If they could make them sensitive enough, it could help in figuring out what side of the surgical area the needle is on.
@@Kevin-fj5oe maybe they could just have all the tools have strings attaching them to the table or something, that way if you drop something you can just follow the string, and you wouldn't be able to close someone up without noticing the string(s). But that would probably get in the of the actual surgery, introduce a new risk of infection, and possiblly cause a little rope burn on internal stuff.
I was in anesthesia residency for one year and I've never seen a video this true!! I laughed so hard! "Go home?! Where my FAMILY LIVES??" ahahaha you're a genius!
Thank you for showing me how much behind-the-scenes happens during surgery - my GYN told me I managed to be everyone's fav patient of the day. I don't remember most of the day, but I do remember being super excited when I was introduced to the anaesthesiologist and the surgery residents, and giving them info on me they probably already had. My sister said I was absurdly grateful post-op, except when my pain was uncontrolled (I broke an orthodontic bracket somehow while I was in that pain lol, I wasn't there much) My point is: thank you. I can be a better patient, because of you.
Anesthesia here. This is absolutely correct. Also, the resident handled the delivery really well. He'd get an ACGME "Excellent" evaluation for the module.
I was almost one of these. Nurse anesthetist spent 10 straight minutes cussing quietly to himself about my vitals before calling people over to decide if they could anesthetize someone who was already half way to dead.
"My kids will have to become influencers because of you. Take the controls off of TikTok, its their only chance now" is probably the funniest thing I've heard all day
Rather accurate, even if you tend to only see one or two of these aspects when canceling a case. The one you see nearly every time is getting the surgeon to agree the case cannot be done today, with how to fix the problem and reschedule it with the surgeons help. If the surgeon fights the necessity of the cancelation, get two other anesthesiologists to agree with your assessment. They rarely argue with the whole department...bad mouth it, yeah...but rarely argue.
Actually 1:13 There was an amputation which was done under a minute the doctor accidently cut the assistant's finger he died from infection, the patient died of blood loss and an observer died of shock. The only surgery in history with 300 percent mortality rate.
Every time Doc. Outta the ballpark! Every. Single. Time. 🤣 Your comedy is as reliable as Surgery being a pouting bully. P S. Had a rough week and really needed a laugh. Started a quiet Saturday breakfast and was hoping you would be on RU-vid. And there you were. Thanks. Great start to the weekend.
Spent my entire career in surgery as a CST this is a perfect enactment of what really happens! I've witnessed it many times in 20 years. Awesome LOL memories with gratitude for such competent anesthesia personnel.
That's why I always call them and go real fast like: "Your patients GFR is too low; holler when it's above 60" click. I throw the "holler" in there to distract and confuse just to avoid a quick reply before I can hang up on them; works wonders on busy days because good luck getting through to us again lmao! #EfficientCoordinatorWork
You make me laugh so much!! The influencers Kids!! Thats was hilarius!!! You make my day, thank you very much!! Big hugs and much love from Argentina 🥰🥰🥰🥰
I was waiting to go under the knife one time, and I heard screaming in the block. I got worried, and asked the nurse what happened. You guessed it, the case before mine got cancelled and the surgeon made a scene 😂
i work in pre-admissions and we don't want cancellations too, instead we call it postponed, cos pre-admissions tests can be valid for 3-4 weeks , and they dont have to re-do everything, so long as the actual surgery is carried out we can still e-file the expenses to the insurers. but cancellations means the patients pay for the PAT out of pocket as insurance wont cover those if there is no surgery
My team of doctors had a nearly impossible time finding a surgeon willing to perform a splenectomy once they did the anesthesiologist called in back up anesthesiologists. I was "circling the drain" and most surgeons said surgery would kill me and finally one said it may very well kill me but not doing surgery would definitely kill me. Anesthesia had extra eyes on becuse I was critical and unstable so they didn't want to be blamed if it went sideways. 2 and a half hours later my spleen was on the floor (pathology didn't expect it to be so heavy at almost 10lb not-cancerous) and I spent a few weeks on a ventilator (not fun! A machine forcibly breathing for you makes you very panicked when it isn't syncing with your body trying to breathe) but I'm here 10 years later.
1:50 i work in audio and we had one studio engineer that was a literal god and would run sessions from 7am to 3am every single day. A true artist, scientist, and crippling workaholic. There was one day where a client cancelled last minute and i said, "I'm sorry, but...you're gonna have to go home and spend time with your family." At the end of the day it was alright because he had a full studio at home so he could still work on back log mixes, but that was a close one.
I had to have an adrenal vein sampling done. The IR doctor bitch his kid wanted to be a) a RU-vidr or b) Instagram influencer. The kid was refusing to take calculus and biochemistry in high school. "Never going to med school, so why bother?" Dad was at stroke level rage 🤣
This makes it make way more sense why I got to still have my ACDF after insurance decided they knew better than my surgeon what I needed and denied the hardware he wanted to use THE AFTERNOON BEFORE SURGERY. The ruptured disc was removed, and I got demineralized doner bone as a spacer instead of a titanium collar. It was incredibly stressful, but it helped a lot of my myelopathy to resolve. Not sure if it would have a difference to use different hardware, as I ended up with only partial fusion, but at least I’m more functional than I was with my disc ruptured into my spinal cord.
I went through the Whipple Procedure 10 years ago for pancreatic cancer that had spread to the liver. Originally a liver resection was going to be done at the same time. Thankfully, I bled too much from the liver resection so the Whipple was done 8 weeks later. I was excited to be the first person to have both done at the same time in the U.S. But I’m thankful now it didn’t happen because the having the Whipple was hard enough on my body. You just don’t play around with someone’s life.
My first day training in the chemistry lab, I had a surgeon call about a low potassium and kept asking me “is there any way the machine had taken a wrong measure, surely a draw from an hour ago will could be back to safe levels right? Could hemolysis have caused an inaccurate read? Are you sure it was on the right patient?” Needless to say I have the conversation over to a senior tech to explain, and then after it had been explained that I hadn’t don anything wrong, I laughed for a solid 2 minutes
