Current Events > I've decided to specialize in anesthesiology, AMA

(+) Yeah! (+)

It was between that or emergency medicine for the longest time, but I think the night shifts would wear on me after a while. And I flirted with the idea of general surgery for a moment, but I don't think I could commit to that lifestyle.
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What are your thoughts on the opioid issue?
Why are so many people ODing?
Do you care that the public thinks your nurses/assistants can do the same job as an anesthesiologist?
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whitelytning posted...

What are your thoughts on the opioid issue?

The 90s saw a trend in treating pain like a "6th vital sign." It led to a higher prescription rate for opioids, because if you didn't, you were seen as an unempathetic doctor who didn't care about pain. Then it snowballed in the past 5-10 years because reimbursements have been tied to patient satisfaction scores (Press Ganey scores). The thing is, medicine isn't exactly customer service, and what the patient wants is not necessarily in their best interest/health. But, medicine's history is a bit touchy with respect to paternalism so here we are. Either refill that prescription for Oxy or get a shitty review and continue to make less and less or get reprimanded by administrators.

Though the new generation of doctors are already being taught about the dangers and it seems likely that they will be fairly conservative with prescribing opioids. Of course, this pendulum swing will affect the small subset of chronic pain patients who will suffer in the current climate. It's a hard balance to strike.

whitelytning posted...

Why are so many people ODing?

It's a good question. I think with how common opioids are, people underestimate how easily one can get addicted or go into mild withdrawals. Hell, I was surprised at how loose my wife's ortho would prescribe them post-op. Then once you're "cut off", I think some turn to the black market. And a lot of heroin these days is apparently being cut with fentanyl and the problem is that fentanyl is extremely potent. It's perfectly safe in the appropriate dose, but we're talking in the micrograms, and I don't expect a lot of drug dealers to be brushed up on their pharmacology.

whitelytning posted...

Do you care that the public thinks your nurses/assistants can do the same job as an anesthesiologist?

Not really. It's really a behind the scenes specialty and even a lot of other doctors don't really understand an anesthesiologist's scope. The internet has been crying of doom and gloom of the specialty, but it's been that way since the early 2000s, and it's still strong. There is definitely a place for CRNAs, but I do think their professional lobbying is a bit too heavy-handed, at the expense of patient safety. My grandmother died after a routine cholecystectomy because a CRNA failed to diagnose a tension pneumothorax. There is a lot I don't know yet as a lowly med student and I have much to learn, but even I could have made that diagnosis. Advanced nurse practitioners are very algorithmic in the way they practice medicine, but it's very apparent when things don't go according to plan or formula they don't really know what to do.

Besides that, there is a lot more an anesthesiologist does outside the OR including pain management and critical care ICU. I think a bigger problem is private anesthesia groups getting bought out by large corporate medical management companies, but that's for another discussion.
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Amazing, already putting CE to sleep.
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What does it entail?
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