You choose the car you drive, the apartment you rent, the smart phone in your pocket, and the flavor of ice cream among 31 flavors at Baskin-Robbins. Most of you choose your family physician, your dermatologist, and your surgeon. But can you choose your anesthesia provider?
To answer the question, let’s look at how anesthesia providers are assigned for each day of surgery.
Who makes the decision as to which anesthesia provider is assigned to your case? The anesthesia service at every hospital or healthcare system will have a scheduler. This scheduler is an individual (usually an anesthesiologist) who surveys the list of the surgical cases one day ahead of time. There will be multiple operating rooms and multiple cases in each operating room. Each operating room is usually scheduled for six to ten hours of surgical cases. The workload could vary from one ten-hour case to eight shorter cases. The total number of operating rooms will vary from hospital to hospital. Typically each room is specialty-specific, that is, all the cases in each room are the same type of surgery. The scheduler will an assign appropriate anesthesia provider to each room, depending on the skills of the anesthesia provider and the type of surgery in that room.
There are multiple surgical specialties and multiple types of anesthetics. An important priority is to schedule an anesthesia provider who is skilled and comfortable with the type of surgery scheduled. An open-heart surgery will require a cardiac anesthesiologist. A neonate (newborn) will require a pediatric anesthesiologist. Most surgeries, e.g., orthopedic, gynecologic, plastic surgery, ear-nose-and-throat, abdominal, urologic, obstetric, and pediatric cases over age one, are bread-and-butter anesthetics that can be handled by any well-trained provider.
Each day certain anesthesiologists are “on-call.” When an anesthesiologist is on-call, he or she is the person called for emergency add-on surgeries that day and night. The on-call anesthesiologist is expected to work the longest day of cases, and the scheduler will usually assign that M.D. to an operating room with a long list of cases. If you have emergency surgery at 2 a.m., you will likely be cared for by the on-call anesthesiologist. A busy anesthesia service may have a first-call, a second-call, and a third-call anesthesiologist, a rank order that defines which anesthesia provider will do emergency cases if two or three come in simultaneously. A busy anesthesia service will have on-call physicians in multiple specialties, i.e., there will be separate on-call anesthesiologists for cardiac cases, trauma cases, transplant cases, and obstetric cases.
Different hospitals have different models of anesthesia services. In parts of the United States, especially the Midwest, the South, and the Southeast, the anesthesia care team is a common model. An anesthesia care team consists of both certified registered nurse anesthetists (CRNA’s) and M.D. anesthesiologists. For complex cases such as cardiac cases or brain surgeries, an M.D. anesthesiologist may be assigned as the solitary anesthesia provider. For simple cases such as knee arthroscopies or breast biopsies, the primary anesthesia provider in each operating room will be a CRNA, with one M.D. anesthesiologist serving as the back-up consultant for up to four rooms managed by CRNA’s.
In certain states, the state governor has opted out of the requirement that an M.D. anesthesiologist must supervise all CRNA-provided anesthesia care. In these states, a CRNA may legally provide anesthesia care without a physician supervising them. Currently, the seventeen states that have opted out of physician supervision of CRNA’s include Alaska, California, Colorado, Iowa, Idaho, Kansas, Kentucky, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Washington, and Wisconsin. In some hospitals in these states, your anesthesia provider may be an unsupervised nurse anesthetist, not a doctor at all.
Some hospitals have only M.D. anesthesiologists who personally do all the cases.
Academic hospitals, or university hospitals, have residents-in-training who administer most of the anesthetic care. In academic hospitals, faculty members supervise anesthesia residents in a ratio of one faculty to one resident or one faculty to two residents.
Can a surgeon request a specific anesthesia provider? Yes. At times, a surgeon may have certain anesthesia providers that he or she requests and uses on a regular basis. It’s far easier for a surgeon to request a specific anesthesia provider than it is for you to do so.
The assignment of your anesthesia provider is usually made by the scheduler on the afternoon prior to surgery, and you the patient will have little or no say in the matter. If you are like most patients, you have no idea who is an excellent anesthesia provider and who is less skilled. You won’t find much written about anesthesiologists on Yelp, Healthgrades, or other consumer social-media websites. Most patients don’t even remember the name of their anesthesia provider unless something went drastically wrong. Such is the nature of our specialty. Your anesthesia provider will spend a mere ten minutes with you while you’re awake, and during those ten minutes your mind will be reeling with worries about surgical outcomes and risks of anesthesia. The anesthesia provider’s name is not a high priority. After the surgery is over, anesthesiologists are a distant memory.
What if your next-door neighbor is an anesthesiologist whom you respect? What if you are scheduled for surgery at his hospital or surgery center, and you want him to take care of you? Can this be arranged? Most likely, it can. The best plan for requesting a specific anesthesiologist is to have the anesthesiologist work the system from the inside, several days prior to your surgery date. He will talk to the scheduler and make sure that he is assigned into the operating room list that includes your surgery. You’ll be happy and reassured to see him on the day of surgery, and he’ll likely be happy to take care of you. Anesthesiologists love to be requested by patients. It makes us feel special. Doctors aspire to be outstanding clinicians, and a request from a specific patient validates that we are unique.
As you can see, the decision of who is assigned to be the anesthesia provider for your surgery is a multifaceted process. Your best strategy for requesting a specific anesthesiologist is to (1) contact the anesthesiologist yourself and ask that he or she contact anesthesia scheduling and make sure that he or she is scheduled to do your case, or (2) contact your surgeon and ask your surgeon if they can arrange to have the specific anesthesia provider that you request.
Introducing …, THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a legal mystery. Publication date September 9, 2014 by Pegasus Books.
The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book image below:
Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.
Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.
Bang-Up Debut Novel, November 16, 2014
By Norm Goldman “Publisher & Editor of Bookpleasures”
This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.
This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.
TwinCities.com PIONEER PRESS Entertainment
by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press firstname.lastname@example.org, January 4, 2015
“The Doctor & Mr. Dylan” by Rick Novak (Pegasus Books, $17.50)
Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.
Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.
Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.
The Physician’s Late-Night Reading List
Two Pritzker alums pen captivating tales
By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine
For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.
Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan (Pegasus Books, 2014), transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.
Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”
One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.
The Doctor and Mr. Dylan (Pegasus Books, 2014) by Rick Novak, MD’80
“I thought it was a novel way of killing someone,” said Rick Novak, deputy chief of anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.
From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”
After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.
“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”
Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:
BOOK REVIEW “THE DOCTOR AND MR. DYLAN”
This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.
Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.
Rick, I can’t wait for your next book. Bravo!
Hibbingite writes twisted medical tale
HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.
Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.
“The dialogue is sometimes funny, and there are lots of plot twists,” he said.
Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.
“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”
Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.
This review is from: The Doctor and Mr. Dylan (Kindle Edition)
Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.
Learn more about Rick Novak’s fiction writing at rick novak.com by clicking on the picture below: