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If you're speaking about the US, you are incorrect on the legality. A license is issued by a state to a physician, and carries no qualification of specialty. A

If you're speaking about the US, you are incorrect on the legality. A license is issued by a state to a physician, and carries no qualification of specialty. A licensed physician can do anything for which they have informed consent. A board certification is a piece of paper put out by an Academy or Society or College that says a physician has been trained in a particular specialty and passed their post-training exams. I am a board certified anesthesiologist. I also hold a license to practice medicine in the state where I live. I can do neurosurgery, if I can find a facility and a patient willing to let me (and although that sounds like a joke, how else would you describe placing an epidural for labor during childbirth but "minor neurosurgery"? Which is why a license to practice medicine is necessarily broad.). That doesn't mean anyone would insure me, or that any sane hospital would let me, but it would be legal.

spondylosaurus 3y ago
Ah, good terminology catch there—I did indeed mean "board certified" :) And re. epidurals, "minor neurosurgery" honestly sounds about right! Doesn't that thing literally go in your spinal cord? You can't mess around there unless you know what you're doing...
- devilbunny 3y ago
  Inside the spinal column (the bones), not into the cord itself but just outside a thin layer (the dura mater - Latin for "tough mother") around it (thus "epidural" - "outside the dura"). Labor epidurals (which are most epidurals) are placed in the lower lumbar region. The five lumbar vertebrae are creatively named L1 through L5; the spinal cord itself ends around L2, and below that level the spinal column just provides a space for the nerve roots to be protected. Whatever; the local anesthetic diffuses across it just fine. But yes, you do have to keep in mind things like timing of anticoagulant usage (it's bad if you have a bleeding spot that doesn't want to stop, but it's catastrophic if you have a bleeding spot inside a bony cavity that can't expand - you can easily have a big bleed whose pressure compresses and damages the spinal cord higher up).

spondylosaurus 3y ago

Ah, good terminology catch there—I did indeed mean "board certified" :) And re. epidurals, "minor neurosurgery" honestly sounds about right! Doesn't that thing literally go in your spinal cord? You can't mess around there unless you know what you're doing...

devilbunny 3y ago
Inside the spinal column (the bones), not into the cord itself but just outside a thin layer (the dura mater - Latin for "tough mother") around it (thus "epidural" - "outside the dura"). Labor epidurals (which are most epidurals) are placed in the lower lumbar region. The five lumbar vertebrae are creatively named L1 through L5; the spinal cord itself ends around L2, and below that level the spinal column just provides a space for the nerve roots to be protected. Whatever; the local anesthetic diffuses across it just fine. But yes, you do have to keep in mind things like timing of anticoagulant usage (it's bad if you have a bleeding spot that doesn't want to stop, but it's catastrophic if you have a bleeding spot inside a bony cavity that can't expand - you can easily have a big bleed whose pressure compresses and damages the spinal cord higher up).