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Clinical Case For Discussion: A member of your anesthesia group is elected to the hospital Medical Board. The Board meets the first Wednesday morning of every month at 7:30 a.m., the same time that anesthesiologists begin their work in the operating rooms. What do you do?
Discussion: How about this reply? “This group is about giving propofol, not about going to meetings. The patients pay us for giving anesthetics, and no one pays us to go to meetings. At 7:30 a.m., we have 18 anesthesiologists, and 18 O.R. blocks to cover. If you are not available to give anesthesia care, then one set of surgeons, a nurse, a tech and a patient are going to have to wait. And that costs money, too. See if they can change the Board meeting to 5 p.m., when you are done and available.”
During the first year of my anesthesia residency at Stanford, a senior faculty member gave me this advice: “Find something to do that is outside the operating room. Most anesthesiologists are content to slip in the locker room wearing casual clothes or shorts, change into scrubs, and spend their whole professional life without interacting with the rest of the medical community.” He went on to describe opportunities such as the pain clinic and the ICU. I would expand that list to include medical staff meetings, hanging out in the cafeteria or doctor’s lounge, medical leadership roles within the hospital, or volunteer work. Most political and committee meetings are either the first thing in the morning or at noon. Both of these times are inconvenient for operating room anesthesiologists.
Consider the alternative: imagine a hospital run entirely by administrators, nurse executives, and physicians of other specialties. What do you think will happen to the agendas and desires of anesthesiologists? In academic medicine, faculty have full or partial days devoted to research, writing, lecturing, or going to meetings. On these days, no one expects them to give anesthetics, and it is possible to go to important meetings such as the Medical Board. Bryan Bohman, M.D., a member of my private anesthesia group, the Associated Anesthesiologists Medical Group of Palo Alto, California, was elected Chief of Staff of Stanford Hospital from 2008 -1011. Dr. Bohman is an example of an anesthesiologist who is extremely active outside of the operating room – well known and respected enough to win election by a vote of all specialties. Bryan has had multiple meetings to attend over his term of office. Because Bryan works in private practice, he has the difficulties discussed in the first paragraph. Because our group values representation in hospital politics, we consistently made Bryan’s schedule fit his political responsibilities. Options to make your colleague available for hospital politics and meetings include: 1) Schedule the individual in the shortest day, so that they can attend meetings at noon or later in the day; 2) Schedule one operating room to start late, or start with a local case, if meetings begin at 7:30 a.m.; or 3) Give the individual the whole day off and hire a freelancer to start the O.R. at 7:30 a.m. This last option will result in a lost day’s wages for the elected anesthesiologist in a fee-for-service practice. This raises an additional question: In private practice, does administrating and going to meetings have any financial value to the group? As discussed above, I believe there is clear value to being represented within the hospital and within the medical community. There is financial incentive to do an extra anesthetic. But there is no incentive to go to meetings, especially if the meeting keeps you from doing an anesthetic during that same time slot. Every private group will handle these issues in their own way. My recommendation, one way or another, is to give members the opportunity and incentive to get involved outside the operating room.
Published in September 2017: The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
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