well hello my name is Max Feinstein and I'm an anesthesiology resident. in today's video I'm
telling you about why I chose a career in anesthesiology. there's no better place to
start than with the number one reason for why I chose this career, which is of course lifestyle.
I think there are some misconceptions around whether or not anesthesiology is
indeed a lifestyle specialty. for example I get these calls sometimes -- "Feinstein,
yeah it's Dr. Cutsalot, I wanna book an emergent case right now, I got a perf'd appy with free air
under the diaphragm and a lactate of 35, need to go to the OR STAT!" and really the only way that
I can respond is to let them know they should pencil me in for a 9 o'clock case start because
there's simply no way that I'm gonna be able to get in before then. after all, this guy's
not going to be able to walk himself.. bahaha. no but seriously, there are some misconceptions about
anesthesiology being a lifestyle specialty which I really think is a myth because the
reality is that emergency surgeries can happen at anytime-- at night, over the weekend, during
holidays-- so those of course have to be staffed by an anesthesiologist. the real number one reason
that I chose anesthesiology actually just starts in the operating room, so why don't we take a trip
to the operating room and see what it's all about! can't take you unfortunate little man.
first of all the operating room is awesome and I can't think of a cooler place to call my office,
both figuratively and literally because I'm always hot and have the AC cranked up when I'm at home so
I don't even have to think about it at work. now the question is: if you're considering a career
where you spend most of your time at work in the operating room, do you want to become a surgeon or
do you want to become an anesthesiologist? now one pearl that helped me make that decision was the
old adage: if your favorite place in the *world* is the operating room, then become a surgeon.
if your favorite place in the *hospital* is the operating room then become an anesthesiologist.
another perk is that if you like sitting, and you enjoy chairs, anesthesiology might be the
career for you. another consideration is if you prefer to primarily be working with your hands,
then surgery is probably the better option. but if you'd like to have a mix of medical
management as well as working with your hands, then anesthesiology is a great option. something
that really appealed to me about anesthesiology is the scope of medical management. I personally was
considering going into internal medicine partly because I really liked the idea of having a broad
knowledge base and having an understanding about a lot of physiology and pathophysiology as well
as medication. so anesthesiology actually requires that you have all of that knowledge because your
anesthetic management of a patient is going to be dependent upon having an understanding of the
interaction between the meds that you're giving and then also the patient's underlying conditions,
any medications they take normally, and then of course what's going on on the operating table.
you have to consider that as you start turning a patient to the left or right, or you turn them up
or down, that's actually going to change their pulmonary physiology- it may change the cardiac
physiology, and all of this is going to affect how you're managing the patient in real time.
also consider what the surgeon is doing is going to affect your anesthetic management as well. so
if you enjoy thinking about what's going on in surgery then you have to really be aware of this
as an anesthesiologist. for example if the surgeon makes a very large incision across the abdomen,
that's going to result in a lot of insensible fluid losses which are going to change your
management of the patient's fluid status. there are endless examples of the factors
that anesthesiologists have to keep in mind while they're providing anesthesia. this
can all pretty much be boiled down to knowing that there's a lot to keep in mind as you're
providing anesthesia for surgery: physiology, pathophysiology, medications, surgical physiology,
and probably a lot others that I'm not aware of as I'm just at the beginning of my anesthesia
training. another aspect of anesthesiology that appeals to me is the fact that you can get instant
gratification from providing medications to your patient and seeing the results right away,
as opposed to some experiences that I've had at outpatient clinic on internal medicine. "Okay
Bob as part of establishing care I'd like to go ahead and take your blood pressure and see
if there any changes that we need to make over time." "Okay Dr. Feinstein that sounds good,
let's see what my blood pressure is" "Oh Bob that blood pressure is pretty concerning,
I'd like to go ahead and get you started on a medication to bring that blood pressure down.
why don't you make a follow-up appointment three months from now and we'll see how that
blood pressure is doing" "Hey Bob nice to see you again" "Good to see you again Dr. Feinstein"
"Let's see how that blood pressure is going... oh, well, we made a little bit of headway here,
so I guess we'll just increase the dose of your antihypertensive by five milligrams and then
check back in in three months and see how it's going." in anesthesia if I see hypertension I can
be like-- esmolol, labetalol, hydralazine-- come at me hypertension! in addition to intraoperative
medical management anesthesiologists also do a lot of procedures. that includes intubation,
transesophageal echocardiography, nerve blocks, IV access that includes peripheral IVs,
arterial lines, central lines and so forth. overall anesthesiology includes a nice balance
between being a proceduralist and also being a diagnostician. for anyone who is multilingual
going into anesthesia, that allows you to help out patients in a really unique way. if you
consider that under ordinary circumstances, say in an outpatient clinic or the hospital floor,
if the patient and the provider don't speak the same language then you simply call an interpreter
on the phone or have an interpreter in person in order to facilitate communication. but if you
wheel the patient back to an operating room and you need to give them instructions to transfer
from the stretcher to the operating table, or you need to let them know what's going on in terms of
being able to breathe through the mask and what to expect in terms of the anesthesia, there's really
no easy way to communicate that to the patient. [German for "Take a breath"] last but not least
one of the biggest reasons that I chose to apply for anesthesiology is the people. now the only
type of physician who I like spending time with more than an anesthesiologist is a dermatologist,
but since I don't particularly enjoy dermatology, I just married somebody who's going into it,
so that I can be free to go into anesthesiology. in my personal experience I just found that I
click really well with anesthesiologists, both of my home institution and also places where I had
done aways as a medical student. well that wraps up this video highlighting some of the reasons why
I chose to go into anesthesiology. as it would have it tomorrow is actually my first day being
an anesthesia resident so be sure to check back in future videos as I assess whether anything that I
said in this video actually happens to be true. thanks for watching and I'll see you next time