Surgeon’s Experience is Part of Broader Problem

Stephanie Jo Dyer, MD

I am heartsick about the surgeon’s perioperative experience recounted in the summer 2004 issue of the APSF Newsletter. I take him at his word that he considers anesthesia a team member, a colleague, and that he did not receive a true consultant’s expertise.

Unfortunately, the vast majority of surgeons want what I call “Nike Anesthesia”—Just Do It. They don’t want to find out that the patient has trepidation and may be better off rescheduling for another day. Surgeons don’t want to find out the their patient is a previously undiagnosed hypertensive or diabetic. Many surgeons do not do even vital signs in their offices before scheduling surgeries. I recall 1 surgeon arguing with me about an undiagnosed hypertensive with a diastolic of 140, rechecked multiple times, who was coming in for a knee scope. Another incident involved a middle-aged woman coming for blepharoplasty, who was clearly having angina and a left strain pattern on the EKG. When I stated I would cancel the case, the nurse administrator asked why we couldn’t do the case under straight local. When the surgeon arrived, he thanked me and transferred the patient who underwent PTCA within hours. The administrator is always standing right behind the surgeon—more cases equal more billings. Meanwhile, anesthesia risk is increasing, production pressure is unbearable, and the system cannot continue this way.

We have only to look as far as Selye and the Yerkes-Dodson curve to know that we are on the path to destruction. The productivity levels business has enjoyed over the past 4 years are simply not sustainable. Now business is complaining about worker’s compensation claims. Business blames the doctors, the ambulatory surgery centers, and the implant manufacturers, but they do not take a look inward at the stresses the workers are under. ACCIDENTS ARE A STRESS-RELATED DISEASE. Whether those accidents are as (thankfully) mild as a lack of common courtesy and consultation in this case, or as egregious as delivering a fatal dose of the wrong drug—accidents kill and maim every day. What we pay for in controlling hours worked and and in more flexible scheduling, along with surgeons abandoning the “Captain of the Ship” mentality, we will more than pay for in lower unemployment and higher morale—leading to fewer sick days and fewer accidents.

Stephanie Jo Dyer, MD