> 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.
Irrelevant, the nature of your reason to refuse to work outside of scheduled hours is between you and your conscience. Be it a child, a dog, opera tickets, or Friday Night Magic - the rules have to be the same. Being a parent doesn't absolve you of responsibilities to patients nor does not being a parent increase your obligations to work additional hours.
Her disinterest in finding someone to cover is disappointing in a healthcare professional - but otherwise "I can't stay late tonight" is fine unless contractually you are on call.
> "I can't stay late tonight" is fine unless contractually you are on call.
This is potentially a reasonable point. If the surgeon can't make a compelling case to the on-call anesthetist that the case needs to be done, then the anesthetist present has a reasonable argument. That said, I've found that day shift staff may well stay late to handle a case they had already prepped for if that would prevent an up-prepped on-call from having to come in an hour later.
Bluntly, I don't care what they do so long as they do their job, and frankly, their personal lives are none of my business; they're a highly-educated mature adult capable of figuring it out just like their peers in the profession are somehow able to do. Some do a childcare service, some have nannies or babysitters, some have a stay-at-home partner… Surgeries run long all the time due to unforeseen complications, and I find it difficult to believe that this anesthesiologist didn't have a backup plan for those occasions. They may not have wanted to use it, and that is what I object to.
One of my parents is a physician and I didn't get to see them much when I was growing up (or even now); I intimately understand the point of view of those advocating for greater work-life balance in medicine. What I find lacking in the push for greater work-life balance is an acknowledgment that quality of care may be changing for the worse as a result.
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.