It is a common happening and I guess is prevalent in all developing countries where mortality meets are very less. It is evident from the two following article too. https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14134 and http://www.joacc.com/article.asp?issn=2249-4472;year=2016;volume=6;issue=1;spage=38;epage=40;aulast=Ramos

But, we have to understand that anaesthesia related complications do happen; both immediate and long term. So, it is said that an death or adverse event within 24 – 48 hours of postoperative period should also be evaluated by anaesthesiologist for possible or ruling out anaesthesia related complication / death.



Ha Ha! Interesting observation. And is it true only for developing countries?perhaps not so much.

I agree with what Dr Karim says.

We also need to understand that it may be human nature- to pass on the buck where the other person may not be directly harmed ( or so it is perceived- many times the anesthetist is not in direct contact with the patient and his family- the 'dirty' job of breaking bad news falls on the surgeon and many times a junior one, at that- so they resort to the most comfortable option?)

all the time...the number of surgical outcomes blames on anaesthesia is amazing.....I say this a practicing anaesthetisit.....or should I say anaesthesiologist....just come to M&M’s......

Anecdotally and is common knowledge, surgeon find it extremely difficult to say both "no' to patient and accept a technically successful operation may have consequence. Some would agree current real-world decision making in surgery is a purely reductionist model.......those good surgeons understand the complexity...

Yes, that is absolutely truth. Anesthesiologists and anesthesiology approach are always the blame for the problems and/or complications. However, I learned one lesson long time ago, and it works! You can beat the surgeons and their vanity only with your knowledge and arguments about the problems with our together patients. Our (anesthesiology) knowledge is the strongest weapon in that war and, trusts me, working well!

Much happiness in further work!

Nikola

Dear Dr. Karim, Tripathy, Gillespie & Bradic;

I really appreciate and admire your valuable comments and observations. Suggestions are also quite useful. Thanks for sharing your feelings and outlooks.

Regards- Rabiul

On the other hand, surgeon's mistakes are obvious, even to non-surgical eyes, while anesthesiologists' mistakes are harder to detect, sometimes carefuly hidden.

We all had scenarios like:"What did you give him/her?" Usual answer is : "Nothing!", and empty syringes are just being dropped.

C'mon guys, I am sick of this surgeon/anesthesiologist war. There is only one quiestion (and task!): Be honest to yourself, and the patient in your hands.

currently doing PhD in surrogate decision making and violations in anaesthetic practice: differences between expert and non-experts. so anaesthetic have their own issues - let me know if you have any ideas!

Completely agree Igor....surprising how little there is out there especially honesty - gets tired up in all sorts metacogntion, complexity theory, psychological distance.

discussion in our little group the other day - third leading cause of death is maybe not medical error - perhaps it’s professional courtesy!

if you are interested in anaesthetic violations recommend Paul Griegs Go/No Go violations in anaesthesia (British Journal of Anaesthesia 2017)...slightly terrifying..we are about to repeat Australia wide though ANZCA...

Thanks Gillespie...

In our setups, I mean in developing countries... we have to compromise with lots of constraints which even affect the minimum standard of patients' safety. With lot lot many problems we sometimes become bound to proceed to innumerable difficult, unavoidable & lifesaving scenario... Violations, tensions, agony, responsibilities, blaming, accountability have become inescapably tolerable to us.

As it was said, knowledge and pure conscience are our ways. This can help in bad moments of our team work!

This conversation fits with a question I posted a couple of weeks ago: https://www.researchgate.net/post/Will_we_ever_acheive_truly_collabrative_healthcare_delivery_Absent_the_BLAME_game?_ec=topicPostOverviewAuthoredQuestions

Very interesting question and one with long-standing issues.

Whilst I have seen and indeed worked with surgeons who will look to involve as many people as possible(from all disciplines) in the fallout of an unwanted outcome,I would say that in my own experience,this number is falling,and in most cases is confined to those with a particular mindset,i.e.either unable to cope with poor or unexpected outcomes,or unable to shoulder the blame for those issues.

Audit,and regular multi-disciplinary M&M meetings go a long way towards mitigating these problems,and the point raised above about anaesthesiologists also having errors or complications falls under that as well.

Personally,I am very fortunate to work with surgeons who take great pride in their perioperative workup,and have never had any such problems with the "blame game" myself.

yes it is true. some surgeons dont liek to ask for anetshestits esp. private clinics to save time, money . he thought it is easy drug to use, maniulate for short procedures.

Thanks all.

God made anesthesiologists, so Surgeons can have heroes too...

yes- it may happen much as surgeon wants to reduce cost for private more financial benefit or sometimes if it is short case on sedation so surgeon thought no need for anessthetist.

it is bad wronmg habbit.

The surgeon's 'anything bad happened, stay calm and blame anaesthetist' attitude is commonly seen in our community (third world setting).Professional honesty is always expected from both parties though, we used to live (work) in a world where medical audit is ''what is that?''.Both surg and anaesthetist must not forget the basic ideas- Primum non nociere and every one may make mistake.

Everywhere....ubqitious...

No one is perfect in this world. We cannot change world but ourselves. Some surgeons think wastage of money but there are also surgeons who recognize the contributions made by anesthesiologists in the management of patients. Our deep knowledge and skill will always help in dealing with such scenario.

Dear Dr.Abiul,

In this day and age, perioperative care has become multidisciplinary, which involves multiple parties, providing both direct and indirect inputs. Surgeons and anaesthetists are major stakeholders thus shoulder a major portion of liability and responsibility in deciding the short and long term out comes. This being said, considering the increased tendency of medical negligence related litigations, the former party might resort to divert the cause effect to anaesthesia. I have witnessed my colleagues being put in such scenarios. The relationship and understanding between the two parties is hence a necessity and continued discussion and feedback during peri-operative care among all the stakeholders might avert such unfortunate incidents, which only leads to breach in trust between such parties.

I think the current post-COVID surgery risk is interesting case study. Current guideline about dealing elective surgery for 7 weeks post infection in Australia. Initially seen as obstructive & an 'anaesthetic risk' in terms of respiratory, despite trying to discuss. Surgeons trying circumvent guidelines. Once became apparent the risk was cardiovascular and relating to surgical insult...surgeons started to cancel especially when our Head of Surgery said they had to ensure consent as not an anaesthetic issue. They were more than happy to proceed whilst perceiving this as an 'anaesthetic issue'. I actually had a surgeon laugh because he could not comprehend that this might be a surgical issue.

I would say this is not uncommon but the trend is definitely decreasing with improvement in quality of healthcare, better protocols, implementation of healthy work environments, regular audits and root cause analysis of any events by the institute.

However, few practical points:

1. Preoperative - in high risk patients or high risk surgeries, inform and explain the patients and/or relatives about possible complications and document it. Incidence of pure anesthesia related complications (which is rare) and incidence of surgical complications (which is relatively more common) should be mentioned.

2. Intra-operative and postoperative - proper documentation of peri-operative management and detailed documentation of any untoward event should be done.

3. In case any untoward event happens, surgeon and anesthesiologist should be on the same page and jointly communicate the patient/relatives with adequate empathy. They should explain the reason behind the mishap and further prognosis based on the knowledge of available literature and the database from institute audit.

Remember, blame game is adopted mainly by an inefficient mediocre person.