The anesthesiologist’s role: controlling complications
fracture
COMPLICATIONS
Physician interviewees described their approach to patients eligible for REGAIN as being typical of any hip fracture case. Their first step was scanning the medical record for any features that might present complications for spinal or general anesthesia. High sensitivity to contraindications was regarded as perhaps the central trait of the good anesthesiologist, as interviewees viewed spotting and adjusting to indicators of future trouble as their primary peri- and intraoperative tasks. “Nobody comes to hospital for an anesthetic,” stated one interviewee. “They come for other things. So that’s why our job is to mitigate risks, all the time.” (interviewee 10). The choice between spinal and general anesthetic was perceived as one of the anesthesiologist’s main sources of control over a patient’s trajectory.As anesthesiologists, we like to have control. And so when some things are more risky, when some things are more unpredictable, we like to control all the things that we can. […] The drugs you do, the type of anesthetic you provide, these are things that you can definitely control. (interviewee 3)The anesthesiologists we interviewed were concerned mainly with short-term threats to patient safety: for example, issues with the delivery of the anesthetic, with completing the operation, or with how the patient recovered in the immediate post-operative period. As one interviewee put it:[W]hen you see that a patient’s journey from the admission to discharge is a line—like, we [anesthesiologists] intersect at a particular phase. So that patient actually has to travel the rest of the pathway […]. And I always feel that being an anesthetist, we actually intersect the journey for a very short duration of time. Of course, it does matter to them about what we do. […] But I don’t see or don’t decide what will happen three days postop. Do you know what I mean? (interviewee 25)