“What’s this I hear?” said the CA-1 resident earlier this year as we were setting up for our first morning case. “You’re going to retire?” “Why yes,” I said. “That’s correct. In April.” He shook his head. “No,” he said firmly. “I know you have another two years in you.” That was very kind, and I appreciated it, as I did this text message from a senior resident: “If you try to leave before July, I’ll report you for resident abandonment.” It’s always better to leave while they still want you to stay, as opposed to lingering long past your sell-by date, right? Even two years earlier, if anyone ha ..read more

Author’s Note: This is the text of the Leffingwell Honorary Lecture delivered at the annual meeting of the California Society of Anesthesiologists on April 9, 2022. Slides are available on request. It is truly an honor to be here, and I want to thank Dr. Ronald Pearl and the California Society of Anesthesiologists for your kind invitation to speak.  I was quite surprised to receive it.  I’m neither a department chair nor an eminent researcher.  I find the concept of being a “thought leader” or an “influencer” frankly horrifying. Physicians aren’t sheep, and we don’t need to be l ..read more

Today’s noteworthy definitions, not new but often ignored: 1. Unintended consequences: The principle stating that an intervention in a complex system tends to create unanticipated and often undesirable outcomes. 2. Good intentions: The paving stones of the road to hell. In anesthesiology, these precepts should be kept firmly in mind in our attempts to improve “quality”. Anyone who speaks out against measures that are taken under the banner of improving “quality of care” or “patient safety” risks coming across as reckless, heartless, or both. Yet the pursuit of “quality” in healthcare has a tra ..read more

I found myself on the wrong side of the ether screen earlier this year, having surgery on my left hand to release Dupuytren’s contracture, a genetic gift from my father and (maybe) generations of our Viking forebears. Wondering how long it will take to heal – and when I’ll get some (any?) grip strength back in my hand – leads to reflection on the combination of brain and brawn necessary in the clinical practice of anesthesiology, something we don’t think much about when we’re young and fit. Obviously, our clinical work demands intelligence. But we should ask this question: does it need to be a ..read more

My patient and his wife didn’t understand that an anesthesiologist is a physician, despite his having been cared for by anesthesiologists during past procedures. They thought only CRNAs give anesthesia. What are we doing so wrong with our messaging, and how can we fix it? One recent afternoon in the GI endoscopy suite (not my favorite place to work, but that’s a topic for another day), I walked up to the bedside of my next patient and introduced myself as I always do. “Hi,” I said, holding up my name badge for the patient and his wife to see. “I’m Dr. Sibert.  I’m with the anesthesiology ..read more

Nurses argue that they can perform many hands-on tasks of anesthesia care just as well as we can. So why are we still doing those tasks? As we orient our brand-new, fresh-faced CA-1 residents to the operating room each year, I ask this question. Has anyone explained to them that much of what they’ll need to learn in the first couple of months is how to be a nurse? We watch them struggle to draw up propofol into a syringe without spraying white foam all over themselves. We emphasize the critical difference between a surgeon’s order of 5000 units of heparin to be given SQ or IV. We teach residen ..read more

Forget the pandemic, say hospital executives. What have you done for us lately? There was a time, at the peak of the pandemic, when many of us believed that anesthesiologists finally would get the public recognition and respect we’ve earned – at a painful price – for our front-line work in airway management and critical care. Some anesthesiologists like Ajit Rai, MD, a pain medicine specialist in Fresno, California, even boarded flights to New York last spring to help hospitals overrun with critically ill COVID patients. News reports nationwide celebrated these physicians as “healthcare heroes ..read more

If you think about scope-of-practice creep at all, you may think immediately of the advocacy efforts so many physicians have made to preserve physician-led care and discourage independent practice by nurse anesthetists or physician assistants. You may not have paid as much attention to the current momentum to grant independent practice to nurse practitioners, or NPs, nationwide. In addition to the District of Columbia, 28 states allow NPs full practice authority to treat and prescribe without formal oversight. Half of these states grant NPs full practice authority as soon as they gain their li ..read more

            How the ACGME and ABA are infantilizing resident training Not long ago, my patient in a complex thoracic case developed progressive bradycardia followed by a malignant-looking multifocal atrial arrhythmia that didn’t generate any blood pressure. “Get out some epinephrine!” I said to my resident, who was standing closer than I was to the drug cart. The resident quickly drew up a milligram of epi, but then paused. I could almost see the thought bubble overhead: “Should I print out a label? Put a tamper-proof cap on the syringe ..read more

Every death related to anesthesia is a tragedy; even more so when a minor procedure such as a colonoscopy leads to a completely unexpected death. Everyone knows that open heart surgery carries a mortality risk, but few of us walk into the hospital for a colonoscopy thinking that death is a plausible outcome. We know so few facts at this point about what happened on January 21 at Beaumont Royal Oak Hospital in Michigan. The patient who died, sources say, was a 51-year-old man who walked into the hospital for a routine colonoscopy. He was obese, with a BMI of 39, and suffered from obstructive sl ..read more