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Tuesday, August 25, 2009

Think doctors know everything?

I love watching my patients interact with various health care personnel. So many patients completely change their demeanor when any doctor walks into the room, whether it is THEIR doctor or not. Sometimes it is as if an angel had fallen from heaven. A lot of people think doctors know everything about everything.

Today I anesthetized two people who were being banded, and one who was having a gastric bypass. I was really glad my second band patient was already asleep when my anesthesiologist started talking about how ridiculous it is that we are doing these surgeries at all. (Good thing the surgeons weren't in the room; these surgeries are how they make their livings, and they happen to think they are doing a good thing.) Dr. R started talking about how there is a TV show that shows them how to do it--The Biggest Loser. (I'm not kidding.) Then he stated that those people probably keep their weight off (no, they don't) because they learned how to do it on the show (um, 6 hours of exercise a day, and a chef?) and their metabolisms go up when they lose weight. (I know.) Then he said something about how these surgery patients don't learn how to eat, they just get forced to stop eating because of their stomachs, and something about how lap bands are basically the same as the gastric bypass.

Yeah, I couldn't hold my tongue anymore.

Mind you, this Dr. R is about 6'5" and probably has a BMI of 19. He's like a stickman. I can tell you with every assurance that he has never struggled with obesity in his life.

I explained to him that I've had a band for 2 1/2 years, and I can eat whatever I want. Not everyone is like that, but it's always been that way for me. I explained that we have to learn how to eat, just like everyone else, and the surgery--whatever one it is--doesn't do all the work by a long shot. I didn't explain the differences between the band and bypass because I was busy, intubating the patient.

I think he was a little chagrined, and surprised. The last acceptable form of bias is against obese people, and it is terrible in the OR. I am so sick of hearing people bashing obese people and reciting every variation of the basic theme, "Why can't they just stop eating?" I doubt he would have spouted his ignorance if he knew I was banded. And this is an extremely competent and well-trained anesthesiologist, who knows a lot about clinical anesthesia and has a lot to teach us students. But they don't know everything about everything, even if they think they do.

And I didn't have near enough time to cite the research showing that patients who have recently undergone major weight loss experience a decline in metabolic rate of up to 50%, which is why it is so easy to regain weight after it is lost...

The upside was that I got to pick the surgeons' brains a little bit about my band leak. They seemed to think that replacing the port would probably solve the problem, because it was likely the tubing nearest the port that is leaking, and that gets replaced. The port is attached to about 6" of tubing that then attaches to the long piece that comes off the band itself. They thought it would have to be done in the OR under general anesthesia, though. I think I've spoken to bandsters who have had their ports replaced in the office--anyone out there verify this? I may have to price-shop if I have to self-pay for any of this work, so I may end up having one of them do it. (Although I think my surgeon would help me figure out how to afford it. He knows about my program, and he likes CRNAs, since the hospital he operates in only uses CRNAs.) These surgeons I was with today didn't know of many bands that developed a leak at 2 years post op. They also thought I should probably have some imaging done, i.e. a scope and/or fluoro to check everything out. More money...sigh. We'll see. I'm trying not to worry about any of that before I have to, but that isn't easy.


Kinzie said...

Standing up and clapping. Bravo!

Heather said...

Good for you! I was a bit self-conscious about just being laid out there in the OR, esp with all those people. Glad I didn't read this before surgery because given that it was surgery for a lap-band, I assumed it'd be a supportive environment. But people are people, whether they are doctors or not.

Diz said...

Sister...as usual...YOU ROCK!