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Re: Assistants at CESAREAN SectionFrom: Arthurfree@aol.comSun Aug 4 16:00:30 1996
In a message dated 96-08-03 12:30:38 EDT, you write: << I always had the opinion that this was part of the Family Physician's JOB, to be the assistant at any surgery on HIS patient. If Mrs. Jones has to have a c/s, then HE should assist the OB (and take care of the baby). If Mrs. Jones needs her appendix out, then HE should assist the surgeon. I see absolutely no problem with this...
Joe P.
>> Joe, I obviously agree with you wholeheartedly, it makes it much easier to care for the patient to know *exactly* what occurred in the OR, not to mention that an intimate knowlege of the patient is often of great help the the anesthetist and surgeon. A good assistant can afford to be less focused and more aware of the whole clinical situation than the surgeon often is (more than once I've found myself reminding a surgeon to complete the abdominal exam after the acute problem is controlled, and pushed for a liver biopsy on a couple of occasions where it really made a difference). One of my major concerns about family practice (sorry about the US centric thread for international participants) is the tremendous variability in training focus across the country. I suspect that there are areas where surgical assisting has left the realm of FP's years ago. In some communities it was probably by choice, and in others a bit of turf they didn't push to keep. The reality, as I'm sure you're aware, is that more and more primary care physicians are eschewing time in the OR as first Medicare, and now other third party payors are racheting down on reimbursing for assistants. The reality is, if the surgery occurs while my office is open, the fee for assisting rarely even comes close to covering my overhead for the time I'm out of the office. I continue to assist because I enjoy it a great deal, and I feel more assured as to the quality of care our mutual patient receives if I'm actually there. I do agree with the other poster that it is something which must be done regularly to be done well. In the long run, except for extraordinarily complicated cases, I suspect that physicians will be replaced as surgical assistants unless we feel strongly enough that it is a quality issue to enlist our patients en masse to lobby their employers (and thence the payors). Arthur Freeland Centerville Iowa
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