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Feel bad for this PA.


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http://www.fresnobee.com/news/local/article194247139.html

The Surgeon left the OR, leaving the PA to close as usual. But the surgeon left the hospital and the patient tanked. The problem here is obviously the surgeon leaving the hospital too soon, but I'm sure they will point the finger at leaving the PA alone to close, even though that is done everywhere. 

 

"Before Chaudhry returned, the physician’s assistant reopened the chest, massaged his heart and tried to hook him up to a heart-lung machine while on the phone with Chaudhry for instructions, but was unsuccessful, Echeverria said.

But Goodman said whether Chaudhry was in the hospital or not is not a factor in what happened. Even if Chaudhry had stayed at the hospital, “the same massive bleeding would have occurred.”

 

........Never mind the 's .... typical. 

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I feel bad for both of them, PA and surgeon. Sounds like the standard of care was possibly met, hard to say without reviewing the records, sometimes you can do everything right and things still go wrong. Now there will probably be a knee jerk reaction and hospital policy preventing PAs from closing any surgery.

now if the surgeon knew there was bleeding, the PA probably knew too and should’ve told the surgeon that he wasn’t going to accept the care of such. Surgeon nor PA should have closed a unstable patient. Unless it started after the surgeon left? Lots of questions. 

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This is one of the biggest problems with being a PA. When your an MD, theres a brand. People believe you are best person for the job, whether it is true or not. The truth is this patient was ultimately poor protoplasm (all CT and vascular patients are) who likely would of passed no matter who was in the OR and even if they did not, likely would not of made it out of the hospital. But because it was a PA at the reigns the general public assumes there is some magic that could of been done, but thats likely not the case. So even though the PA did everything right, they are taking the blame because of some fantasy of what a CT surgeon is capable of doing. Its unfortunate, but all PAs risk being a scape goat not because of what we do, but because of public opinion.

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Guest HanSolo

Might be missing something here, but I don't see how this article blames the PA for anything. Seems like they are saying the PA was just doing his job and the surgeon bailed. 

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Just speculation that people will jump to conclusions and assume PAs shouldn't be left alone to close. The obvious issue here is the Surgeon leaving the hospital too soon, but its easier to assume PAs are not qualified to close on their own--even though they are, and have been doing so for a long time.

Do you blame them? Why should an ASSISTANT be closing the patient by themselves?!?!? Absurd!

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Was actually talking with my supervising surgeon about this same topic this morning.  I'm in CV and after the bulk of the case is finished, I do the rest-drying up, placing temp pacer wires, sternum wires and then the rest of the closure.  The surgeon never leaves the hospital but will sometimes go back to his office which isn't that close to the OR or see patients and what not.  I've had a few crash while closing or after we've wired the sternum back together or even better when the last suture is thrown, and we open back up and do what we have to do.  Could I place someone back on CPB emergently?  Possibly... can't say I've ever done it alone and so many variables go into place as well, like, is the pump set-up and ready to go again? Is the patient heparinized and the ACT satisfactory...the list goes on.  

I could see a surgeon throwing someone under the bus to save their own arse, but the hospital should have policy in place safeguarding the PA by their credentials.  At one facility I cover, it is a vague credentialing policy regarding vessel harvesting and first assisting.  At another facility, its down to the letter about closure and when the surgeon can technically "leave" the OR.

I hope the poor chap has his ducks in a row with credentialing.  Definitely feel sorry for the fella. 

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