In Reply To:
Where did I say that this communication is happening on the day of surgery? Nor did I say anywhere that I'm dictating what the anesthesiologist will do, or keeping him/her from doing his/her "job." The statement I'm taking issue with is your assertion that surgeons don't know/understand/care what anesthesiologists do.
And doing joint replacements on an ASA 5... There's a reason nobody would touch her. I'm guessing in the last 3 weeks of her life she wasn't doing much with the hand. Even in the absence of retrospect it would be a bad idea to proceed with that case. In fact, you could go so far as to say that doing joint replacements on a debilitated, non-ambulatory patient is downright unethical.
You know, it was a quality of life issue. No one knew how long this 30 or so yo women had to live. If you can't feed yourself because you can't hold a spoon, what kind of existence do you have? If you are otherwise capable of doing some things but your fingers don't work, isn't it reasonable to try to help make them work. You may not have made that decision, however her doctor did. It was my job to facilitate her decision, if I could, not to second guess her. And, it wasn't an issue of the doctor trying to make a buck. This was done by a Navy physician at the navy hospital. So, be as critical as you want to be. I was simply pointing out that anesthesiologist may have a different perspective as to what a "difficult" patient, from an anesthetic point of view, than you.
And, I would suggest that until you have all the facts that I would withhold any judgment regarding the ethics of the decision. Hope you don't get assigned to any of Obama's death panels. (just joking, there are no death panels folks)
Anyhow, my position remains unchanged. In my experience most physicians don't have a clue as to what anesthesiologists actually do. Keep the air going in and out, keep the blood going round and round, keep them quiet and keep them still, and keep them alive. That is all they really care about. They may give lip service to more "concern" but that is about it, lip service. They have so little knowledge in this area they can hardly contribute anything worthwhile if they were to make a suggestion to the anesthesiologist. There are exceptions, of course. But, they are rare.
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Frank,
An original Ironman and the Inventor of PowerCranks