Expert: Ronald Levy, M.D. - 4/17/2010

Question
I know little about  anesthesia, but unfortunately need to have a very large polyp removed from my large intestine as well as a having another colonoscopy.  I asked my PCP about getting an anesthesiologist to do the anesthesia and she suggested an anesthesiologist for the colon sugery and that she would not do it with a CRNA, supervised or not.  She teaches at the university med school and is pretty sharp.  I tried to get an anesthesiologist for the colonoscopy; the told me that normally the  GI doc gives sedation (my PCP says this is less than ideal and that he has enough to do performing the scope) so they schedlued me with an "anesthsiologist" and propofol.  But when I reported for the test, they told me that they didn't have one available and that I would get a nurse.  Same price, higher risk, so I skipped the test.  Yesterday, I got the colonoscopy done without drugs (ow!, but my choice,  albeit a bad one).  The preop anesthesiologist told me that I had to accept a CRNA/anesthesiologist team and explained how great CRNA's were etc...and that he would be watching the CRNA (and several others at the same time) and that they worked great together.  I asked to speak to the CRNA and she was o.k., but it was the interaction between the anesthesiologist and the CRNA  that bothered me. They wasre less than cordial to each other.  When I asked the anesthesiologist if this particular CRNA would be the one working with him for my surgery, he said that he didn't know.  I asked if it might be a different  collegue or his and he said that his collegues are physicians not CRNA's (nurses) and that she was just a worker.  Not to be outdone, the CRNA responded that she could do the case perfetly well without supervision etc.  So I told them that I would have to think about  having the surgery done.  I know one of the OR nurses and she told me that the CRNA's and the MDA do not get along at all and that they brely talk to one another.  This has scared the heck out of me.  If I can't get an anesthesiologist doing my anesthesia, I at least want a team who isn't constantly fighting.  If they act this way in front of a patient facing surgery, I wonder how they are when I am unconscious.   The OR nurse told me that this is not an isolated incidence.  My question:  have you ever heard of such antimosity between the CRNA's and the anesthesia doctors?  I looked the CRNA vs anesthesiologist issue up on the internet and find mostly websites where the fight like cats and dogs.  Any opinion would be helpful. Thanks

Answer
It is not unheard of but it is certainly not the general rule. I work in an academic center also (with residents and CRNAs) and we all get along fine. This is the case at most places. Most likely at your place, one or the other teams was there first and then the other showed up. They each feel the other is taking over there turf. I hate to get involved in these issues on this website because each time I say anything that is even slightly negative towards CRNAs I get a bunch of letters telling me I should not say that. I think CRNAs are an important part of the workforce and do an excellent job but they are not the equivalent of an MDA. That being said, I am sure that a CRNA could easily do your anesthetic but I agree that if the anesthesia care team does not work well together, this is not a situation you want to be involved in because if you should have a complication, you don't want them arguing over who is right with the management. I would ask you GI doc if he works at any other institution not serviced by this anesthesia team and go there. I would also send a letter to the hospital administration pointing out the potential liability of having an anesthesia care team like this.

Ronald Levy. MD
Professor of Anesthesiology
UTMB-Galveston