I couldn't make it past the first section without stopping to comment. First, it's hard to imagine a manuscript of "The Sound and The Fury." It's one of those works that you can't see someone sitting and writing.
As to health care access, I had the privilege to work with some HCPs in Tanzania at one of their hospitals. I remember a patient, preteen girl, who came in with appendicitis, brought in over extremely poor roads by her grandfather. On a bicycle. I can't imagine the agony of that trip.
OK, second segment. First comment I'd make is that if you think physicians are jealous of the term "doctor," wait until a nurse hears a medical assistant describe her- (or him-) self as "Dr. So-and-so's nurse."
Second, I learned as a laborer in a cabinet shop that the difference between masters and apprentices is knowing how to handle unusual situations or what to do when routine things go sideways. As a generally healthy person I've had great experience with CRNAs. If I were diabetic or epileptic or had bad COPD, I'd prefer an anesthesiologist.
And lastly, as it's getting late, "Laurelyn" is definitely better with a Celtic band, but it's such a plaintive poem, I think it would be best done more slowly, with a solo voice, and maybe a fiddle or squeeze box accompaniment. Think "Danny Boy."
Out here, professor. I look forward to your stuff.
Someone along the lines of Billy Boyd was my thinking. I suppose he doesn't really need a job these days, though.
And I don't know whether to apologize for hogging this thread, or be glad that at least I commented. Lots of people lie low when Faulkner is on the menu.
Interesting that you don’t have an Anesthesiologist point of view. Don’t complain when you are not given a choice, and there are no physicians available to care for you or your family members, only mid levels, if you are going to only present one viewpoint.
Happy to have an anesthesiologist's view. Keep in mind, though, that this is a blog, not a scholarly journal. Blogs are meant to be conversation-starters, not proof texts. It's also the nature of blogging that there's a considerable element of happenstance involved in writing. In this case, I happened to have a PhD nurse anesthetist handy, as well as an MD urologist who had overseen nurse anesthetists. We presented our conversation. Glad to do another round with an anesthesiologist down the pike.
But let me toss the question back at you. If I were to go into the scholarly journals and blogs on this issue, are anesthesiologists fastidious about making sure that the views of nurse anesthetists, non-anesthesiologist MD's, and health economists are represented in their journal articles? I don't believe that they do, as a matter of course.
And I could just as easily toss your warning back in your direction: Don't complain when there is no one at all available in your area to administer anesthesia, because walls have been constructed to limit entry into the field.
Hi. I don't mind answering. When I was working in a team environment with MDAs consistently, when I would ask them something, they would contribute but I might go a month or more without asking anything. Usually, when I asked something it was to read the EKG to see if they agreed with me, for example. But if a fellow CRNA was around, I was just as likely to ask them. Moons ago, back when I was doing a lot of heart cases and taking call, we collaborated more often. I enjoyed having my docs and loved worKing with them but, I did my job independent of them. I work under my own license and make my own decisions. In my practice now, I do not have MDAs. So I can't answer a "how often" but can say, one thing they always added, was a preoperative assessment. To which, I would always do my own because, like I said, I practice under my own license and I could seldom read their writing. All minds are welcome in a crisis situation so they definitely contributed to those things, as did all CRNAs responding.
When I first started my urological practice in Flagstaff AZ in 1974 there were no anesthesiologists so I used the 3 CRNA's for all my cases as did the rest of the surgeons. I, as the surgeon, was the CRNA's legal "overseeing" physician. I cannot remember a time when I told them they were doing something wrong and directed them to change their care.
Now, of course there were times when the course of the operation changed for one reason or another (ham-handedness on my part? or pathologic findings that made us take a different tack), but those would have been the same whether the anesthesia providers was an MD or a CRNA.
About 8 years or so after I began a newly trained anesthesiologist came to town who looked down at CRNA's, but he was not very good and left town because the surgeons continued to use the CRNA's by preference.
A few years after that a group of Anesthesiologists came to town who were very good and the CRNA's joined their group and were overseen by them. But two were ready retire and did so within a short time, and the third enjoyed working with them as he had been trained many years before and they had new and improved techniques that he enjoyed. Per Nina's input, CRNA's are getting the same kind of training as the MD's now. It's a new era, after all.
BB makes a good point. It would be great to get an anesthesiologist in on this conversation.
I couldn't make it past the first section without stopping to comment. First, it's hard to imagine a manuscript of "The Sound and The Fury." It's one of those works that you can't see someone sitting and writing.
As to health care access, I had the privilege to work with some HCPs in Tanzania at one of their hospitals. I remember a patient, preteen girl, who came in with appendicitis, brought in over extremely poor roads by her grandfather. On a bicycle. I can't imagine the agony of that trip.
Thrilling to see deviations from the published version. Most remarkable handwriting I’ve ever seen. Tiny and perfectly straight and orderly on unlined paper. Example: http://faulkner.iath.virginia.edu/media/resources/MANUSCRIPTS/SandFMsP1.jpg
Tanzania story is completely believable.
Better URL: https://faulkner.iath.virginia.edu/media/resources/MANUSCRIPTS/SandFMS1.html
Wow. Somehow I'm not surprised. I almost would have expected him to write a page over rather than leave scratch-outs like that.
No, lots of very neat scratch-outs.
OK, second segment. First comment I'd make is that if you think physicians are jealous of the term "doctor," wait until a nurse hears a medical assistant describe her- (or him-) self as "Dr. So-and-so's nurse."
Second, I learned as a laborer in a cabinet shop that the difference between masters and apprentices is knowing how to handle unusual situations or what to do when routine things go sideways. As a generally healthy person I've had great experience with CRNAs. If I were diabetic or epileptic or had bad COPD, I'd prefer an anesthesiologist.
Both are great points.
And lastly, as it's getting late, "Laurelyn" is definitely better with a Celtic band, but it's such a plaintive poem, I think it would be best done more slowly, with a solo voice, and maybe a fiddle or squeeze box accompaniment. Think "Danny Boy."
Out here, professor. I look forward to your stuff.
I've thought this, too, at times. Tried to get it in front of a couple of singers who might have done what you suggested. -- Bob
Someone along the lines of Billy Boyd was my thinking. I suppose he doesn't really need a job these days, though.
And I don't know whether to apologize for hogging this thread, or be glad that at least I commented. Lots of people lie low when Faulkner is on the menu.
I know not Mr Boyd, but shall check. And no apologies accepted. Your comment are always excellent and always welcome.
Interesting that you don’t have an Anesthesiologist point of view. Don’t complain when you are not given a choice, and there are no physicians available to care for you or your family members, only mid levels, if you are going to only present one viewpoint.
Happy to have an anesthesiologist's view. Keep in mind, though, that this is a blog, not a scholarly journal. Blogs are meant to be conversation-starters, not proof texts. It's also the nature of blogging that there's a considerable element of happenstance involved in writing. In this case, I happened to have a PhD nurse anesthetist handy, as well as an MD urologist who had overseen nurse anesthetists. We presented our conversation. Glad to do another round with an anesthesiologist down the pike.
But let me toss the question back at you. If I were to go into the scholarly journals and blogs on this issue, are anesthesiologists fastidious about making sure that the views of nurse anesthetists, non-anesthesiologist MD's, and health economists are represented in their journal articles? I don't believe that they do, as a matter of course.
And I could just as easily toss your warning back in your direction: Don't complain when there is no one at all available in your area to administer anesthesia, because walls have been constructed to limit entry into the field.
Great point. Just for fun, ask the CRNA and Urologist how often the overseeing doc had anything to add to the anesthesia care.
I don’t read articles that politicize MD versus CRNA.
I work in an at will state, so CRNA’s can and do practice independently, and we are fortunate to have them.
I'll follow up with them. Maybe they'll comment here. Are you an anesthesiologist, BTW? (If you don't mind my asking.)
Hi. I don't mind answering. When I was working in a team environment with MDAs consistently, when I would ask them something, they would contribute but I might go a month or more without asking anything. Usually, when I asked something it was to read the EKG to see if they agreed with me, for example. But if a fellow CRNA was around, I was just as likely to ask them. Moons ago, back when I was doing a lot of heart cases and taking call, we collaborated more often. I enjoyed having my docs and loved worKing with them but, I did my job independent of them. I work under my own license and make my own decisions. In my practice now, I do not have MDAs. So I can't answer a "how often" but can say, one thing they always added, was a preoperative assessment. To which, I would always do my own because, like I said, I practice under my own license and I could seldom read their writing. All minds are welcome in a crisis situation so they definitely contributed to those things, as did all CRNAs responding.
When I first started my urological practice in Flagstaff AZ in 1974 there were no anesthesiologists so I used the 3 CRNA's for all my cases as did the rest of the surgeons. I, as the surgeon, was the CRNA's legal "overseeing" physician. I cannot remember a time when I told them they were doing something wrong and directed them to change their care.
Now, of course there were times when the course of the operation changed for one reason or another (ham-handedness on my part? or pathologic findings that made us take a different tack), but those would have been the same whether the anesthesia providers was an MD or a CRNA.
About 8 years or so after I began a newly trained anesthesiologist came to town who looked down at CRNA's, but he was not very good and left town because the surgeons continued to use the CRNA's by preference.
A few years after that a group of Anesthesiologists came to town who were very good and the CRNA's joined their group and were overseen by them. But two were ready retire and did so within a short time, and the third enjoyed working with them as he had been trained many years before and they had new and improved techniques that he enjoyed. Per Nina's input, CRNA's are getting the same kind of training as the MD's now. It's a new era, after all.
BB makes a good point. It would be great to get an anesthesiologist in on this conversation.