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We are more than just drug pushers

I remember seeing the picture on Twitter of an anesthesia resident with a bandolier of prefilled syringes, presumably of anesthesia emergency drugs. I hoped that it was a joke, a costume, but feel like it’s more likely to be the truth.

Although I am guilty of being an “EDC” / bougie-scalpel carrying anesthestist, I think parading your emergency drugs around is foolish and potentially unsafe. When we are called to a code or resuscitation, there is usually a team assembled with individuals dedicated to drawing up medications. There is a usually a code team leader, separate from the action and in charge of dictating which medications and doses to give. However, anesthesia is used to giving their own meds in the OR while also managing the airway, but we must be able to work within a different team and dynamic. I think it’s fair to carry tools that might not be available when you arrive to a ward code, like a scalpel or bougie (which is not routinely on crash carts).

Carrying controlled substances like narcotics/benzos/ketamine around while running to a code is unsafe and unprofessional. It’s easy enough to have your pen or phone drop out of your pocket, what about syringes being held with elastic? If you lose a syringe of ketamine by accident, are you going to be honest and report it to your staff and pharmacy?

The sterility of syringes is actually not great. Drawing up the drugs and carrying them around on-call, who knows what kind of bugs you’ll pick up and be present on the inside of the plunger. That’s why you should never re-draw with syringes, the barrel will be exposed to environment and then you’re refilling it. What impression would you give to a patient or their family when they see you pull a syringe from your utility belt and inject it? They have no idea where you’ve been, how long it’s been drawn up for.

Finally, we are more than just technicians. Our contribution to a code or resus is not the drugs that we carry with us, but our experience and expertise. The drugs should take less importance to making sure there is working suction and airway is patent or clear. Maybe our image should be the ones carrying the POCUS around.

Every time I see the image on Twitter, it makes me cringe a bit.

Patients should know the cost of their care

As Canadians we live in a privileged country where almost all of our healthcare is paid for by our taxes.  The two recent articles in the New York Times and JAMA highlight the absurdity in the US where prices are so fluid and nebulous.

The original idea for this comes from my friend, another anesthesia resident.  The idea is this:

Patients should be given an itemized bill with all the costs for the care they’ve received, and the final sum they have to pay – zero.

This provides transparency of healthcare costs to the end-user and taxpayer, to the healthcare workers who are being paid by and also utilize and spend healthcare money, and may allow everyone to find opportunities to reduce cost.

I don’t think anyone in our hospitals really know how much money every device/implant, medication, or test costs the system.  Some of these costs would be incredibly difficult to calculate, but some would be fairly simple I would think.  For us, have the prices of items printed on their storage, so we know how much that IV blood set, 4×4 gauze, vial of atropine, bottle of sevoflurane really cost. Surgeons should know the costs of their implants and single-use devices, sutures, staplers, etc.

Of course, there will be people arguing that we should not be constrained by the costs but by the necessity of the intervention, and we should be doing what we think is “best” for the patient. However, I would argue that we should all know the costs to the system and to not forget that we are also managers of the healthcare system. We must be cognizant not to bankrupt the future for the benefit of the present.