Wednesday, October 17, 2012

The Distracted Anaesthesiologist

The program director of our residency program who isn't given to long emails copied all the Site Chiefs on this long edict to the residents.  My comments are in normal text.

To all residents:

I have received numerous complaints from surgeons over the past year about anesthesia residents reading in the OR.  Typically these complaints come after a surgeon has had difficulty attracting a resident’s attention during the case, however, some have also noticed the increased use of iPads and iPhones during cases.  Please remember that the department and program policies are that residents should focus 100% on the patient and procedure.  Obviously if the staff is also in the OR and has requested that the resident read something that is different.  However, when your staff is absent you need to focus 100% on the patient and case! 

You may ask what about the staff?  There are many examples in the city of anesthesiologists doing things such as talking on the phone, wandering outside the OR, reading, working on their computers, reading the newspaper etc.    Three points here.  (1) You are not a staff who has spent years honing the ability to multitask and can respond to the surgeon’s requests even if concentrating on other things this related to the 10000 thing (2) All research done in multitasking demonstrates decreased effectiveness on all tasks.  Sure total productivity increases, but your ability to focus on the patient is decreased.  (3) Numerous adverse events have occurred in this city when the anesthesiologist was tied up away from the anesthesia work area.  Some of these have resulted in patients with permanent brain injury and/or death.  The CMPA considers it indefensible when the anesthesiologist is away from his/her work area. I can’t imagine how the hospital lawyers [who don’t work for you, ask me if you want to know more].   Lawsuits as a resident are bad.  Jail time is worse and can result in inability to obtain full licensure (yes, I have a case report of an anesthesiologist going to jail for being on the phone – 1995, Appeal File 6579, appealing ruling on file number QBCNJ148/93 J.C. Regina )

Note, I am not aware of any such incidents in our city.  The case where the anaesthesiologist went to jail involved him leaving the room to make a phone call, something that is a little worse (or just as bad depending on your outlook) than talking on the phone, texting or reading while in the room.)  Our PD doesn't define the work area.  Is the entire room the work area or is it just the triangle defined by the OR table, the machine and anaesthetic cart.

So, no matter what you see others do, no reading of any kind, even medical literature when you are looking after a patient on your own.  No iPad use, no texting or personal phone calls.  Place your cell phone on vibrate if you receive personal texts, emails or phone calls during the day and if there is an immediate personal concern ask for your staff to return.  You may answer your pager by cell phone if you in the anesthesia work area.   Please ask the nurse to answer your page.  If they give you sour looks just tell that that you have to focus on the patient and procedure.  As always, if you have issues with nursing or other ancillary staff, please inform me or the site chief of the hospital you are at.

Any questions?  I am happy to discuss this further.

Now obviously our program director must have gotten a real blast from some surgeons.  In my experience the only things surgeons really expect from anaesthesiologists or even have an interest in what we do are;
  1. Get the patient asleep and awake as soon a possible.
  2. Adjust the table and the lights.
  3. Select music that they like at a volume that they like.
  4. Know their place.
  5. Realize that everything bad that happens to the patient is their fault.
I suspect most of the surgeon's angst is related to 1 and 2.  Anaesthesia residents are, as somebody else observed, expected to be able to work as fast and competently as a consultant within the first month of their residency as opposed to surgery residents who have five years (and the first two plus years of their consultant career) to get up to speed.  Unfortunately  they can't complain (actually they can and do)  about the extra 5 minutes the anaesthesia resident took putting in the art line when it takes their residents 20 minutes to close a 6 inch incision; ergo everything that went wrong today is because the resident was texting.   

Staff anaesthesiologists on the other hand at some point in their careers, not sure just when, develop an ability to  read, work on their lap-tops, book vacations,  and do complex negotiations over the phone while still monitoring their patients.  The fact is, there are a lot of things that are part of our job that distract us from vigilance.  These include charting, taking phone calls from recovery or the ward, getting ready for the next case, adjusting the table and the lights and teaching students.  Sometimes surgeons like to engage us in their conversation.  I've never heard a surgeon complain, "he laughed at my jokes."  When we are staring at the ceiling or out the window  because we are so bored, we probably aren't as vigilant.

We didn't have laptops, I phones or texting when I was a resident.  I did read a lot in the OR during long cases.  I usually carried at least one textbook, as well as journals, and some photocopied articles which I read during cases.  One day the staffman was reading Umberto Eco's "The Name of the Rose".  He went out for a break, telling me as he left,  "this is a really good book, you should read it.".  Which I did starting with the book he left in the room and I later bought it and read the whole book and my life is more richer for discovering Umberto Eco, than anything I learned during that craniotomy.  And I don't think the patient or the surgeon suffered.

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