Regarding the Lazy Ass on the Other Side of The Curtain / by Muhammad Amir Ayub

An interesting comment posted on Anesthesiology News regarding the identity of anesthetists. To read the full article you need to register for the website (for free). And it really does highlight the fact that we sometimes know more about the physiology (on a much wider scale of practice) than even the “more theoretically-inclined” medical fields. And we have to know the basis of various surgeries of various surgical fields to plan our anesthetic technique. Almost every thing has it’s basis in well-reharsed (for exams) physiology, pharmacology, physics and chemistry, along with medicine and surgery. But the quote is more informative than whatever I can say about the field: 

Our identity has been chosen for us already: We are the “second-most” specialty. We are required to be conversant in multiple specialties. An obstetrician, when she calls, expects us to have a working understanding of preeclampsia, placenta previa, placental abruption and fetal monitoring.

A neurosurgeon wants to work with a clinician who understands intracranial compliance and interventions to modify intracranial volume without compromising cerebral perfusion pressure. I suspect our comprehension of pulmonary physiology exceeds that of anybody except the pulmonologist. We have to have an understanding of the same concepts and some facility with a bronchoscope. One can’t improvise care of a patient requiring a double-lumen endotracheal tube; a solid comprehension of ventilation/perfusion physiology is required. Would you rather have an anesthesiologist manage your ventilator and treat your asthma or have a pulmonologist conduct your anesthetic?

We also have to have a robust understanding of cardiology, including coronary anatomy, pacemaker/implantable cardioverter defibrillators, valvular disease and the difference between systolic and diastolic failure, and are frequently expected to place and interpret a transesophageal echocardiogram probe. When an orthopedic colleague calls to say he has an open fracture, he knows we know the import and also expects us to know the difference between a subcapital and an intertrochanteric hip fracture.

General surgeons want us to understand the physiology of a perforated viscus and to institute appropriate transfusion decisions in trauma patients. We, of course, have to understand internal medicine—rheumatoid arthritis and diabetes cause anatomic and physiologic derangements that anesthesiologists must understand and anticipate.