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nesthesiologist Benjamin Jacobs, MD, never forgot
what a surgeon told him many years ago: "You never
regret the case you canceled." Those wise words ring
especially true today, when everything in surgery is
on the rise: the weight of the patients, the complexity
of the cases, the competition for volume and the pressure to operate
on patients you might never have considered for same-day surgery a
few years ago. It's almost enough to blur the lines and make you
accept a borderline case you might not otherwise.
"The questionable case that you don't cancel — the entire time
you're worried," says Dr. Jacobs, the co-director of anesthesia services
at Paoli Surgery Center in suburban Philadelphia. "During the case,
you're looking at the monitors and at the patient and praying that all
goes well. You actually are worried until the patient physically leaves
the facility. You check with the nurse who made the post-op phone
calls to confirm that the patient is doing well."
Do what 's best for the patient
Nobody wants to cancel or postpone a case. It's bad for business, and
it's inconvenient for the surgeon and the patient, who's been NPO
since midnight, took time off from work and arranged for a ride. Yet
even when there's pressure from all sides to do the case, "you just
have to stand your ground and do what's best for the patient," says Dr.
Jacobs. "One bad case can ruin your center."
Just recently, Dr. Jacobs turned a patient away and referred him to
the hospital 100 yards up the driveway from the ASC. "We turfed him
up to the hospital," is how Dr. Jacobs puts it. The reason? Dr. Jacobs
foresaw a difficult intubation. The 59-year-old male was scheduled for
right shoulder arthroscopic surgery to be performed in the sitting
position. His medical history was unremarkable: no significant car-
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