It is 3 o’clock in the morning and you wake up with a terrible pain in your tummy. You decide to go to the emergency room and you are lucky that is not busy and the doctor sees you in short order.
After listening to your story, asking a number of questions and performing an examination, the doctor suspects that you have an acute appendicitis.
Some tests confirm the diagnosis, the surgeon is called and you are going to the operating theater.
After all the recent publicity about anesthesiologists that do not have the certification as a full-fledged specialist, should you the worried?
The president of the British Columbia anesthesiologists’ society states that it is unsafe to use these people.
On the other hand, the registrar of the College of Physicians and Surgeons of British Columbia states that these people are qualified to put you to sleep safely.
The minister of health says the same.
Who do you believe?
In order to obtain a license to practice medicine in B.C., the college checks the applicant’s credentials carefully. Most of them have been trained in a foreign country and many have practiced there, as well, and are quite experienced, sometimes more so than a recent Canadian graduate. Usually they are given a license with some restrictions and conditions, but first and foremost, the college makes sure the public gets a well-qualified physician.
In the case of anesthesiologists, they are expected to write the Canadian specialist certification exam within a specified period of time.
During the first 35 years since our local hospital opened its doors, thousands of patients had all kinds of surgeries and received their general anesthetic from specially trained family physicians.
The certified anesthesiologists were not interested in serving our local population. First of all, there was a shortage, and secondly, their skills were better utilized in big-city hospitals, where more complicated surgical procedures were performed.
Did the patients in our local hospital receive inferior anesthesia service?
Absolutely not.
So what has changed?
Because there were more certified anesthesiologists available, they were looking for other places to practice and pushed out the family physicians that were perfectly safe to give an anesthetic for routine procedures (and cheaper, too).
Furthermore, the medical legal scene had changed considerably and the courts were more forgiving when a medical mishap happened in the hands of a specialist than if the same happened when a family physician was looking after the patient.
Ideally, every patient should receive top-notch care from top-notch physicians. What many people do not realize, though, is that a well-trained family physician can render the same high standard of care for at least 80 per cent of the medical conditions as the best specialists in the world.
You do not need a lung specialist for every respiratory ailment or a dermatologist for every rash. The same holds true for giving an anesthetic.
In the U.S., there are plenty of lawyers looking for malpractice work, yet they will use nurse anesthetists to put patients to sleep safely for routine surgeries, such as the removal of the appendix or a gallbladder. They will not touch a patient who needs a heart transplant or coronary bypass surgery. Under those circumstances, you do not want to have anybody else other than a certified anesthesiologist.
So what do you make of the current media coverage?
As the minister said, the anesthesiologists are currently in contract negotiations and it looks like that they are trying to scare the public to put more pressure on the government to give them a better deal.
There’s conflict in Victoria, where they want a dedicated anesthesia service for obstetrics. They claim they work longer hours for less pay than other provinces.
The shortage has caused the loss of more than 30,000 surgeries in 2010 and a loss of $100 million for operating room time with no care delivered.
Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.