Bitterbarn’s Weblog

aka “The Bull” (some content not suitable for children or religous zealots)

kowtow (1)




           A deep Kowtow to my friends over at marine products. I had some work done on my boat.  I gave them the ridiculous request in doing the work in one day.  They completed the work on my boat in the time I needed.  Then, i was 30 min late to pick it up.  The store closes at 1800 I didn’t make it there until 1830 The store was closed but someone waited for me to get there to pick up my boat.  The customer service at this place is the real deal.  I have to recommend it to all my water sports comrades.

June 27, 2008 Posted by | Uncategorized | , | 3 Comments

Over Trained and not missing it.

What an eye opener I’ve had. Sometimes, When wondering when my paradigm will shift again; I imagine myself a well frog. I think about the well frogs often . The well frogs reside in the safety of a kingdom that is all theirs. Even while living in the dank and darkest recess, they are king of their Domain; and the asset of safety is the crown jewel.

I recently left my well, and have discovered the ocean. The journey from well to ocean is scary and fraught with peril. There is failure to be had.

OK time for Confucius to take a rest.

Anesthesia these days comes in many flavors. ok three flavors. When you next have an anesthetic it will come in one of the following three forms.

1. and Anesthesiologist; MD trained will preform your anesthetic by himself. He will bill your insurance and you will pay him. He alone will be responsible for your safety throughout the procedure.

2. A Nurse Anesthetist (CRNA); Nurse trained will perform you anesthetic by himself. He will bill your insurance and you will pay him. He alone will be responsible for you safety throughout the procedure.

3. ACT or Anesthesia Care Team; In this instance Both an Anesthesiologist and a Nurse Anesthetist will provide your anesthesia; (theoretically in tandem) This model is touted as the most safe because; as with all things two heads are better than one. Your insurance will be billed about 8% more for this duo but you may decide it worth it.

Millions and millions of dollars are thrown at lobbyist each year to protect both these professional from being “gobbled up” by the other. Almost no other professional “turf battle” consumes more money and time than this one.

My experience;

I am a Nurse Anesthetist and I acknowledge my bias; I was trained in the house of nursing where the patient is the center of the caring model. I only realize now that my training is unique. Though I have my roots in nursing I have spent the last 5 years in a medical anesthesia residency program. When I first came on board they were very short handed for labor so as a nurse anesthetist student I was thrown into a mix of Anesthesiology residents. I did the same cases they did, attended the same conferences they did and when I graduated, I stayed on as faculty in the School of Medicine and continued the identical “clinical training” as my physician counterparts. “Hell”, comes closest to describing my experience/training in these years. As staff we practiced the ACT model. A model in which one Anesthesiologist “presides” over 4 (ideally) nurse anesthetists. It is often stated in our craft that this model is the “MOST SAFE”. We are made to believe that it is not because Anesthesiologists are soooo much smarter than we are but rather because there is always safety in numbers. I wondered if that was some kind of sweet lullubaye sung to our conscious. Anyway, I have moved on now and am now practicing in the model of nurse anesthetist in “solo” practice. Incidentally, this is the most commonly type of model practiced in our country today. 65% of all anesthetics are by nurse anesthetist in solo practice.

In hind site I now believe the Anesthesia Care Team is the least effective, safe and economic way of delivering anesthesia. When an Anesthesiologist and Nurse Anaesthetist work together they each practice in a false sense of security.

Some patients are at higher risk than others for anesthesia as example; the pediatric patient with a cold or fever, patients who recently have had chest pain, certain disease states that put patients at risk for certain types of anesthesia. When these unfavorable conditions present themselves in the ACT ;each of the professionals may have a tendency to lapse into complacency with the ever present sub-conscious plan that if something were to go “wrong” one would simply blame the other for any resemblance of malpractice or negligence. WHEREAS, when a provider is on their own to provide anesthesia. The sense of responsibility and culpability is heightened and the above mentioned cases are treated with a far more conservative approach.

Both types of professionals are very good at their craft, each is capable of performing anesthesia and rescuing patients found in 98% of our hospitals and surgical centers. In my unique training experience I feel like I can certifiably say that there is a component of education missing in the medical model. It is intangibleand unexplainable; the years of nursing in critical care are simply irreplaceable by any amount of time or rotation in an internship. On the other hand an anesthesiologist my argue that my education as far as disease process and physiology is laking compared to his. Their is something to that argument I would concede that when it comes to the kind of fungus you can get from a hot tub, or what kind antibiotic I should prescribe for your chlamydia i am completely at a loss.

IN SHORT my new paradigm is that Anesthesiologist should work alone in their practice and Nurse Anesthetist should work alone in their practices. I have watched the ACT cost tax payers Millions over the last few years and this does not happen otherwise.

6/23/08 disclaimer; if you post a lie or attack what I have stated is my personal paradigm you will be deleted. Otherwise, all are welcome to contribute.

June 23, 2008 Posted by | Uncategorized | | 13 Comments

Garunteed PIck me uP

just for fun.

June 19, 2008 Posted by | Uncategorized | , , | Leave a comment

uniquely American

Everyday, When I hear of record gas prices, record unemployment, stock market drops I say to myself; Who is in charge? Someone wake the captain we’ve run aground. I remembered this comment That our “president” made and found it on youtube.

Dave Ramsey has said latley that we are just getting our comeupins. We’ve been “Fat and Sassy” for so long and now its time to work. The lady in this video doesn’t sound too fat or sassy.

the bull

June 15, 2008 Posted by | Uncategorized | , , | 2 Comments