With What Other Disciplines Should We Work?

Published on 27/02/2015 by admin

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Last modified 27/02/2015

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CHAPTER 6 With What Other Disciplines Should We Work?

“Why can’t we all just get along?”

Rodney King

Cooperation among specialties, especially between anesthesiology and surgery, is the stuff of legend. Of note, a legend is defined as “a story coming down from the past; one popularly regarded as historical although not verifiable.”

Try verifying this legend.

A 68-year-old man with benign prostatic hypertrophy was on the OR table, spinal anesthetic in place and functioning well. He was a calm man requiring little sedation, so he was quite awake and aware of his surroundings though, of course, unable to move his lower body with the spinal anesthetic on board. The drapes were up and the circulator was prepping the patient.

His urologic surgeon and his anesthesiologist were discussing the schedule in a manner most heated. Both doctors were standing to the left of the OR table, on the patient’s side of the drapes, so the patient, merely by turning his head to the left, could see them.

And, of course, he could hear them too.

“They was sayin’ somethin’ about some other guy, I guess it was someone gonna have the same thing as me, you know, the ream out job of the prostate,” the patient said. “And they’s gettin’ louder, you know, which first I think is kinda funny ’cause I thought doctors just talk that quiet kind of ‘I’m real smart and you’re not, so I’ll take this real slow’ kind of talk.

“But now they’s yellin’ and start to pushin’ and I’m thinkin’, ‘Hell’s bells who’s gonna do the ream job if one of em cold cocks the other one?’ and sure enough they start throwin’ punches. I’m not kiddin’.

“Well I had to laugh cause I thrown a few punches in my day and these docs here they look more like girls fightin’ and pretty soon it’s a huggy up and down to the ground they go and they’re rollin’ around. And now the one nurse comes around and spill some brown stuff out a little plastic dish and she’s yellin’ and people comin’ in hollerin’ and oh my God such a sight to see and here right in the hospital and me so numb and jes’ layin’ there with all my privacy danglin’ in the breeze for all the world to see.”

Suffice it to say, there is room in this world for more cooperation between the specialties. What better place to accomplish this than the simulator!

The simulator is just the place to mix and match the various medical elements, getting them to work together in a crisis, iron out who does what, and most importantly to start to talk to each other.

• Anesthesiology and Surgery—to foster better understanding in the OR, and possibly reduce the number of fist fights!

• Anesthesiology and Internal Medicine—we most often encounter each other in the supercharged atmosphere of a code. No time for much dialogue in a real code, but there sure is in a Simulator mock code.

FIGURE 6-1 Interdisciplinary interaction can get heated in the hospital.

• Anesthesiology and ICU nursing staff—another group of highly trained specialists we work with every day. Training together in the Simulator makes perfect sense, plus can help build esprit de corps among ICU teams.

• Medical students and nursing staff—as the twig bends, so grows the tree. At an early point in their training, future doctors can practice doctor–nurse interactions in a crisis.

• Anesthesiology and OR nursing staff—we work hand in glove with the OR nursing staff through all kinds of emergencies. Because we work together, we should practice together too.

• Anesthesiology and anesthesia techs—we need their help in a big way in the big cases, so practicing together in the Simulator with them makes sense too.

• Anesthesiology and Pharmacy/Information Technology/Billing—automatic pharmacy dispensing systems, automated billing and record keeping, all these elements are entering the ORs. And new systems have quirks, glitches, and potential disasters. Work them out in the harmless setting of the Simulator.

• ER docs and EMTs—hand-off of the critically ill patient has its own set of dangers. Do a few “critical handoffs” in the Simulator to make sure the transition from emergency response team to hospital team is seamless.

• Anesthesiology and OB—you want a critical situation where two specialties may be at odds, try the stat C-section. Every variant (lost airway, twins with the second one breech, shoulder dystocia that just won’t go) you can rehearse together in the Simulator.

• Anesthesiology and Pediatrics—neonatal resuscitation after a stat C-section? The Simulator’s the place to work it out.

• Intensivists (from any discipline) and nursing staff.

• Intensivists and nursing students.

• Office-based practitioners (plastic surgeons/oral surgeons) and their nursing staff.

• Military teams of doctors/nurses/technicians.

The list goes on. In the Simulator, any combination, any threesome of different specialties and training can work together. You can put together entire teams, for example look at all the people involved in a code.

ICU nurse—calls the code

Unit clerk—sends out the word, makes sure the code cart is stocked, ready to go, and refilled at the end of the code

Anesthesiologist

Surgeon (say it were a surgical intensive care unit)

Respiratory therapist

Pharm D (often in intensive care units these days)

Medical students

Nursing students

A whole army of people descends on a code, each with a certain role to play. And rather than working together the first time in a real code, it is better to practice together the first time in a mock code.

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