5 ms·

> this is a completely reasonable response. People have lives outside of work. For someone in IT, perhaps, but the professional expectations in medicine are st

> this is a completely reasonable response. People have lives outside of work. For someone in IT, perhaps, but the professional expectations in medicine are starkly different (although they are admittedly growing more lax, to the chagrin of the old guard). In this particular case, the geriatric meningioma patient had already been cancelled on once, rescheduled with the promise of being the first procedure of the day, and then delayed to the end of the day because she tested positive for MRSA and they needed to do a decon of the OR after her procedure. You would seem to find it reasonable to reschedule her yet again, but neurosurgeons don't have much room in their schedules to play scheduling games with, and in general, patients aren't undergoing elective brain surgery for the fun of it: they need it now. Perhaps the IT analogy is that neurosurgery is largely a hard real-time system: you must execute within a given time window or you fail.

joshAg 11y ago
Sounds like they need another anesthesiologist or they should have bumped someone else to start the meningioma procedure earlier in the day.
gpvos 11y ago
Well, in that case the hospital should pay for extra childcare that evening (including possibly relocating the child to another child care location, which is no fun for the child either), and give them extra time off to have time together with their child at another time. Times have changed, people often live alone with their children (or their partner may be working), and you just don't leave a child alone.
- stuaxo 11y ago
  That makes sense, afaict the cuts to NHS seem to adversely affect things like this.
viraptor 11y ago
> You would seem to find it reasonable to reschedule her yet again No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem. This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand. What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no. As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution)
- refurb 11y ago
  It sounds like this woman's surgery was delayed due to unforeseen circumstances.
- doktrin 11y ago
  > BTW, anyone shouting at anyone else is not even close to a solution It may not be a solution you approve of, but I've witnessed plenty of cases where managers have effectively bullied their subordinates into doing work they otherwise wouldn't want to do.
  - viraptor 11y ago
    Depends what you want to call a solution. Sure, if a manager bullies me into something I'll either do it or not. But I'm definitely raising this with his manager and/or looking for another position at that point. I'd call it a bad workaround for a current problem, not a solution.
    - doktrin 11y ago
      Whether or not something would work for you is not the sole measure of a solution.
  - ryanmarsh 11y ago
    In matters of life and death a little bit of yelling can go a long way.
    - doktrin 11y ago
      Truth. When the stakes are that high, at least some tolerance of discomfort is necessary.
- OopsCriticality 11y ago
  > No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem. The problem in this case was that the meningioma's MRSA positive culture results (from the first, cancelled procedure day) came back on the day of the rescheduled procedure, and that necessitated a schedule rearrangement (placing the meningioma at the end of the day) that the substitute anesthesiologist objected to. The author points out the absurdity of the situation re the MRSA culture when, if they had performed the procedure on the day originally planned, they would not have the culture results and so would not have done a post-op decontamination, but the rescheduling had forced the additional step. I think one does the best they can to budget for unexpected problems as had happened in this case, but in an overworked system, that cushion is among the first things to go. > This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand. Ideally, yes, one catches complications before they are a problem. Experience suggests complications still occur, and the only solution is to "be like water" and adapt. > What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no. Not for a physician. It is understandable for a physician to be ticked off, it's understandable for a physician to call in a favor and find someone to cover for them, but it is not understandable for them to say "no". The substitute anesthesiologist not only said no, but was apathetic to finding someone to cover for her. To that, I respond as I did before, the expectation from what I term the old guard of medicine is that your duty is to attend to your patients. Younger physicians, such as the anesthesiologist in question, would seem to share your perspectives on work scheduling, and the old guard say that the result is decreased quality of care. > As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution) That's a lot of handwaving. Keep in mind that in medicine, you can only kick the can down the road for so long, and that in this case, the patient's family had rattled legal sabers over the first cancellation. I suspect the possibility space is not as large as you think.
cdcarter 11y ago
So, the neurosurgeon should be allowed to throw a fit at an anesthesiologist for the hospital's fuck-up(s)? There may be a problem with the system here, but the solution isn't forcing people to work past their shift without notice.

joshAg 11y ago

Sounds like they need another anesthesiologist or they should have bumped someone else to start the meningioma procedure earlier in the day.

gpvos 11y ago

Well, in that case the hospital should pay for extra childcare that evening (including possibly relocating the child to another child care location, which is no fun for the child either), and give them extra time off to have time together with their child at another time. Times have changed, people often live alone with their children (or their partner may be working), and you just don't leave a child alone.

stuaxo 11y ago
That makes sense, afaict the cuts to NHS seem to adversely affect things like this.

viraptor 11y ago

> You would seem to find it reasonable to reschedule her yet again No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem. This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand. What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no. As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution)

refurb 11y ago
It sounds like this woman's surgery was delayed due to unforeseen circumstances.
doktrin 11y ago
> BTW, anyone shouting at anyone else is not even close to a solution It may not be a solution you approve of, but I've witnessed plenty of cases where managers have effectively bullied their subordinates into doing work they otherwise wouldn't want to do.
- viraptor 11y ago
  Depends what you want to call a solution. Sure, if a manager bullies me into something I'll either do it or not. But I'm definitely raising this with his manager and/or looking for another position at that point. I'd call it a bad workaround for a current problem, not a solution.
  - doktrin 11y ago
    Whether or not something would work for you is not the sole measure of a solution.
- ryanmarsh 11y ago
  In matters of life and death a little bit of yelling can go a long way.
  - doktrin 11y ago
    Truth. When the stakes are that high, at least some tolerance of discomfort is necessary.
OopsCriticality 11y ago
> No, I find it unreasonable that not everyone knew the schedule beforehand, or that someone who knew about it didn't raise it as a problem. The problem in this case was that the meningioma's MRSA positive culture results (from the first, cancelled procedure day) came back on the day of the rescheduled procedure, and that necessitated a schedule rearrangement (placing the meningioma at the end of the day) that the substitute anesthesiologist objected to. The author points out the absurdity of the situation re the MRSA culture when, if they had performed the procedure on the day originally planned, they would not have the culture results and so would not have done a post-op decontamination, but the rescheduling had forced the additional step. I think one does the best they can to budget for unexpected problems as had happened in this case, but in an overworked system, that cushion is among the first things to go. > This should never happen right before the operation. At that point it's too late and it's on everyone to deal with the situation at hand. Ideally, yes, one catches complications before they are a problem. Experience suggests complications still occur, and the only solution is to "be like water" and adapt. > What I'm pointing out that if the plan was a surprise then it's completely understandable that someone says no. Not for a physician. It is understandable for a physician to be ticked off, it's understandable for a physician to call in a favor and find someone to cover for them, but it is not understandable for them to say "no". The substitute anesthesiologist not only said no, but was apathetic to finding someone to cover for her. To that, I respond as I did before, the expectation from what I term the old guard of medicine is that your duty is to attend to your patients. Younger physicians, such as the anesthesiologist in question, would seem to share your perspectives on work scheduling, and the old guard say that the result is decreased quality of care. > As for solutions, it depends on a hospital, location, patient's state, available team, etc. Lots of possibilities. (BTW, anyone shouting at anyone else is not even close to a solution) That's a lot of handwaving. Keep in mind that in medicine, you can only kick the can down the road for so long, and that in this case, the patient's family had rattled legal sabers over the first cancellation. I suspect the possibility space is not as large as you think.

cdcarter 11y ago

So, the neurosurgeon should be allowed to throw a fit at an anesthesiologist for the hospital's fuck-up(s)? There may be a problem with the system here, but the solution isn't forcing people to work past their shift without notice.