Being An Anesthesiologist At A Chronic Pain Management Clinic
By Rudy Garza, M.D., Anesthesiologist
As an anesthesiologist, I am not just an expensive bartender serving up margaritas or special cocktails. Being an anesthesiologist is a little more complex than the common stereotype. As an anesthesiologist, my job starts way before the surgery and extends past the time you leave the recovery room. Throughout the evolution of the specialty, an anesthesiologist has transformed themselves into perioperative medicine physicians. This means that I am there before, during, and after surgery, getting to know a patient and caring for them throughout the process.
Coordination of post-operative care begins with a good preoperative evaluation.
Before surgery, I take a look at a patient’s medical history, perform an examination, and create risk stratifications that aid in medical decision-making. Based on this stratification, I can predict certain outcomes and create an anesthetic plan that mitigates potential complications.
During the surgery, my job is to keep the patient alive! I administer medications that provide anesthesia and analgesia. I watch your heart, beat after beat. I drive your physiology to make sure the brain and other vital organs receive enough oxygen and blood supply. And at the end, I reverse everything we just did to make sure you wake up with minimal discomfort following corrective surgery.
Finally, for the post-operative phase, anesthesia focuses on maintaining the patient’s baseline hemodynamics, controlling patients’ postoperative pain, and ensuring any issues or complications have been addressed prior to discharge. Part of the job is to ensure the patient is discharged to an appropriate location i.e. home or admitted for a continuation of care.
At APC, our primary focus is the treatment of pain. As anesthesiologists, we have a strong background in performing pain procedures and knowledge in pharmacology and pain medications. As a consultant, I make sure to keep up with current literature around pain management and continue my education to aid in the treatment of my patients.
As an anesthesiologist, I serve to protect both parties, the surgeon and the patient. In other words, I’m the “middle man”. The safety of a patient is my number one priority. I review the patient’s medical history and ensure they are optimized for the appropriate surgery. I relay any concerns I have to the surgeon and together we create a plan that is in the best interest of the patient.
Anesthesia Is Getting More Complex
As baby boomers are starting to get older and as technology is continually advancing, we’re starting to see patients that are older and have more comorbidities, meaning their medical history is more complex and the risk of adverse events increases. What we are starting to learn is that pain is part of the aging process. Because APC focuses on the treatment of pain, the age of our patients is much older. As patients begin to age, their bones begin to deteriorate, their spine becomes more arthritic, and their muscles begin to atrophy. All of this causes pain. Hence at APC, we treat a lot of patients that are above 60 years of age. In fact, it’s not uncommon for us to see patients that are over 90!
A large part of my job is to make sure that patients are optimized prior to receiving anesthesia. The term “optimized” meaning the patient has a good functional status where their heart and lungs can handle the stress of surgery and anesthesia, and that they have appropriate care/resources upon discharge that will aid in recovery. Anesthesia is extremely safe when all is known about a patient and unsafe in the hands of the unknown. Hence, at APC, we have hired a team of very talented nurses to help the Anesthesia Team. Our PAT Team (Pre- Anesthesia, and Testing) obtain as much information on every single patient weeks in advance prior to any procedure so that if more information is required from a patient about their medical history, we have enough time to obtain tests or records from their primary/subspecialist physician. This concept is unique for a privately owned surgery center.
The way I operate as an anesthesiologist has had to change over time. I wish it was as simple as pushing a little propofol. “Pushing a little propofol for some may be okay and detrimental to others. My patients are complex and often take a handful of pills a day attempting to correct a bad heart or weak lungs. Polypharmacy is a big deal hence, keeping up with current literature and emerging drugs is extremely important. I am continually adapting and evolving to provide safe anesthesia.
Trust Is A Tricky Thing
For most people, the idea of undergoing surgery is daunting and anxiety-inducing. A lot of that emotional burden falls to the anesthesiologist. After all, we’re the last person the patient sees before they are sedated. We have a huge role to play in making a patient comfortable and easing their worries.
However, it’s tricky! Most care providers spend a lot more time with patients when they’re conscious. They may even get to form a longer relationship with follow-up visits or various phone calls. Anesthesiologists don’t have that luxury. We have to rely on just a few minutes with the patient before surgery to make them feel supported and safe.
I always tell my medical students and residents that each specialist has their own personality. Typically the personality of an anesthesiologist is somebody who’s very easy-going. I mean how can we not be? We literally push drugs for a living. This is kind of a necessity of the job because I only have about two to four minutes to gain that person’s trust.
I have to use my personality to gain this trust and any little thing can help! From sharing a patient’s experience to validating their emotions, to joking around with them, it’s about being personable and human. I try to remind myself to look at it from the patient’s perspective. They don’t know who you are. You’re going to put them to sleep and you’re going to have complete responsibility for their well-being. You owe it to them to gain their trust.
A lot of building trust comes down to being open with the patient. That’s where true informed consent starts when you’re open as you can be to the patient and provide them with as much information and discuss all risks and alternatives for the anesthesia.
The biggest thing about anesthesia that people fear is losing control, so part of what I do is to let people have some of that control back. Giving good informed consent and telling them exactly what’s going to happen during the operation is a huge part of empowering the patient. I tell them exactly what medications are going to be given and if they’ve had other experiences with those medications, I let them dictate a little bit about what may work better for them.
I always start with the question ”Hey, have you ever had anesthesia before?” If they say yes, I ask if there were any issues. If there were, I tell them about how I am going to tweak the plan to prevent the same things from happening again. Bringing the patient into the decision-making process helps them trust you and empowers them to feel slightly more in control of the journey.
Being An Anesthesiologist At A Chronic Pain Management Clinic
APC is a multi-disciplinary institution, meaning that we’ve got anesthesia, pain specialists, and neurosurgery under one roof.
I think our institution is very unique because we’re so close-knit and collaborative. For example, last month a patient was a little bit nervous about pain following her total knee surgery. She wanted to have surgery at a hospital because she wasn’t sure if her pain could be adequately managed in a surgery center. I got a phone call from the doctor asking me to contact the patient and help alleviate some of the stress or fear about the surgery. Now if a surgery center that primarily focuses on treating pain can’t manage a patient’s pain, then who can?
Fast forward a few weeks later, the patient is recovering well and has already scheduled her other knee for another month. During my post-op call, she told me that if she knew how easy it was going to be she would have scheduled the surgery years ago. Because my specialty is in regional anesthesia and pain medicine, I provided her with nerve blocks that made her knee numb for a few days to allow for an easier recovery.
It’s not uncommon that people start to get nervous about surgery weeks in advance. And it’s not uncommon for me to reach out to our patients to give them an opportunity to ask me questions and get to know me. Where else does the anesthesiologist call patients way in advance to answer any questions- Nowhere. I even provide them with a few things I want them to research before the surgery. I find that it can help the patient feel better about the surgery and about myself as their anesthesiologist.
Many anesthesiologists around town jump from hospital to hospital when there’s a need for them. The difference at APC is that I’m strictly employed, site-based, and serve the purpose of all these other pain doctors and neurosurgeons. It’s a lot easier to get a hold of somebody when everyone is under one roof.
I’m always available for patients to get in touch with and that makes a big difference when it comes to trust and openness around the process. My colleagues are also strictly employed at APC, which is huge because we get to know each other on a much deeper level than is common at most clinics.
We know exactly what the other person’s thinking because we’ve worked together every single day. It allows us to provide better care because we trust each other, and there are no strangers or temporary staff coming through our facility. Everybody’s worked together side by side day in, day out, five days a week.
When you know the next move already and you know what your surgeon likes or what your pain doctor likes your work becomes more efficient. Which in turn, means that it’s better care. The less time patients are under anesthesia, the better the outcome.
Anesthesia is safe, but it can still cause problems. Time is the thing that matters the most in the end. The same goes for surgical complications. Infection becomes a risk the longer the duration that surgery lasts. We minimize these risks and the time it takes to undergo surgery through efficiency and teamwork.
It’s the kind of place that all of my peers in medical school dreamed about working. We all like each other, love the administration, and enjoy coming to work each day. Of course, this also translates to a higher quality of care for our patients.
What’s Special About Working At APC As An Anesthesiologist
At APC, I get to live every anesthesiologist’s dream. I work with the same amazing team every day, getting to know them deeply and working with them to solve complex problems. I get to put my unique knowledge as a pain specialist and anesthesiologist to use when advising patients and other care providers on chronic pain management, and I can take the time to make my patients feel as comfortable as possible. I pride myself on good outcomes and providing great pain relief, and I take our motto to heart when I say- The Pain Does Stop Here!
