Anesthesiologist vs CRNA?

Requesting an Anesthesiologist not a CRNA for my surgery?

• I'm hoping that someone in the anesthesia profession will give me some help in this matter; I am not trying to antagonize the CRNA profession in any way but I want to make sure that my anesthesia for an upcoming surgery is done by an Anesthesiologist not a CRNA. I believe that anesthesia is the practice of medicine not nursing and I think that I have a right to request an anesthesiologist not a nurse. I recently scheduled a colonoscopy (reluctantly) and received a letter informing me that the MAC would be done by an anesthesiologist. On the morning of the procedure I'm introduced to the CRNA who tells me that she's doing my case; I show her the letter and she says it's a typo and it should say "anesthetist" not "anesthesiologist"; she's working alone, no anesthesiologist available. I ask her if she's as equally qualified as an anesthesiologist and I'm surprized when she says that she is not; but for colonoscopy sedation she's qualified since I'm healthy etc. At least she was honest, but I declined to have a CRNA do my case and told the GI doc that I would skip the anesthesia and she reluctantly agreed after I reminded her that I did the prep for 2 days and was high-risk for colon cancer. The CRNA was apologetic even offering to "stand by" (no charge) with a "whiff of propofol" just in case things got too painful; I declined as politely as possible trying not to point out that I didn't want a CRNA doing my case. The drug-free colonoscopy was uncomfortable but complete; surprizingly the CRNA was right by my side the entire time offering propofol if I changed my mind and she kept apologizing for the mix up. This CRNA was honest and I'm glad that I didn't consent to her services. Months later I had to schedule ortho surgery and told the doc that I wanted an anesthesiologist not a CRNA; he said no problem. On the day of surgery I ask the anesthesiologist if he's personally doing my case, he says that my ortho doc spoke with him and that everything is fine, he's doing my case. I even relate the mixup that appened with the CRNA for my colonoscopy and he says not to worry, "please sign this consent". The sh*t hits the fan when I document on the consent that he has told me that he's personally performing my anesthesia not a CRNA. Suddeny he admits that he will be "managing" my case (and 3 others at the same time), but that a CRNA will actually be doing my case. This is an outright lie; the chatty CRNA and the anesthesiologist try to convince me that the CRNA/anesthesiologist "team" is just as safe as an anesthesiologist doing the case; but I ask several questions that refute this. 1. Do anesthesiologists ever have to "bail out" the CRNA during a case? answer-it happens every day but probably won't happen to you. 2. Since the anesthesiologist supervises 4 CRNA at once, what happens if 2 CRNA need "bailed out" at once? answer-that never happens (I guess one patient gets a nurse and one gets an anesthesiologist). After a long pointless discussion, I cancel the surgery and the reason is simple: I was lied to. The final insult came when the CRNA told me that the "anesthesia care team" was a safety record equal to and practices the same safety standards as the airline industry. I inform her, that unlike her "team", an airliner is flown by 2 fully qualified pilots and that the aircraft is never under the command of anyone else. Period. The anesthesia care "team" is nothing like that; for better or for worse the patient does NOT have a fully-qualified provider in command at all times; and I don't thing that 4 CRNA being supervised by 1 anesthesiolgist cuts it. I was getting a lot of arguments from the CRNA until someone mentioned that I was an airline pilot; so please don't compare the "anesthesia care team" model to my profession..it's a silly comparison. Am I being unreasonable requesting anesthesiologist-only care? and when this is what I'm promised (they admitted that) is it ethical to bait and switch the patient just before surgery? I was polite and professional in all of my interactions with these people; I was shocked at the subterfuge and deceit.. I'm hoping that an anesthesia professional will comment and possibly offer suggestions. My arm is killing me; the surgery is not a problem but the anestheisa is. Thanks.

• Answer:

  You totally understand the situation and I applaud you. We need more patients to look out for themselves. 1. Do anesthesiologists ever have to "bail out" the CRNA during a case? answer-it happens every day but probably won't happen to you. True - it happens all the time. Sometimes it's scary for the anesthesiologist. I choose not to supervise CRNAs anymore, because i don't like being responsible for what they might do or not do. There are a few - very few - I trust implicitly, and those are the ones that call me early and really keep me informed. There are too many "cowboys" that don't know what they don't know, and can get into real trouble. 2. Since the anesthesiologist supervises 4 CRNA at once, what happens if 2 CRNA need "bailed out" at once? answer-that never happens (I guess one patient gets a nurse and one gets an anesthesiologist). It does happen. In a large hospital, there is usually another doc that can be called. Or, the CRNA does his/her best until the doc is available. In the future, I would contact the ANESTHESIA department, not the surgeon, ahead of time. Continue to modify the consent forms. That will protect you. I've been in places where patients request doc only anesthesia, and that request is honored. Being lied to is not acceptable. Ever. I'd suggest a letter to the department chair and hospital CEO over that.