[From 2013, slightly updated]
A couple of things first. Medicine is the coolest job on the face of the earth, and every specialty has its own “coolness”. One of the questions you should ask is: “Do I want to be like these people (in this case, anesthesiologists) ?”. If so, read on.
Secondly, there is really no such thing as a typical day.
But here is a stab at your query.
Anesthesiology is a medical specialty dealing with the Perioperative Care of patients. Perioperative means: 1. Pre-operative care – for example making sure that the person is medically optimized so that she / he can undergo an operative intervention safely; 2. Intra-operative care – ensuring the person is monitored properly and ensuring she / he is insensate to the operative stimulus (ie, pain); 3. Post-operative care – for example postoperative pain control or care in the intensive care unit (ICU).
There are a number of sub-specialties within Anesthesiology: cardiac anesthesia, obstetric anesthesia, regional-acute pain anesthesia, regional-chronic pain anesthesia, pediatric anesthesia, Critical Care Medicine, neuroanesthesia, and so forth.
My area is Critical Care Medicine, the care of severely ill patients who have undergone – or will undergo – surgery. This includes trauma victims, transplant patients, essentially any person who is really really sick (we say: at risk for loss of life or limb, or who will lose life or limb without immediate intervention).
The Typical Day
So the clinical day begins about 0600 or 0630, reviewing patients on our ICU service. Then about 0700 I talk to the senior physician in the e-ICU (also known as tele-ICU. Leverages technology to make sure that there is always a senior-level person able to look over / care for the ICU population at any hour) who is going off after his / her shift ends.
Then talking to the bedside nurse of each patient to get more review of events from the night. This is followed by selected physical examination of those for whom there are specific issues that have been raised by this review.
At about 0800 hrs we do Interdisciplinary Rounds with the nursing and Case Management people to talk about who we think can be discharged from the unit that day.
From 0830 to about 0900 several cups of strong coffee are drunk.
At 0900 we begin daily bedside interdisciplinary rounds: Attending physician, Critical Care Medicine fellow, residents, bedside nurse, Critical Care Medicine pharmacist, nutritionist, Social Worker, respiratory therapist. Each person has a choreographed role in the bedside rounds, and each patient is discussed in detail: why were they admitted to the ICU, what keeps them in the ICU, physiologic and laboratory parameters, physical examination, medications, family issues, nutritional issues, and so forth. This usually takes several hours. In the best circumstance, while we are rounding, the physician – Surgeon or Internal Medicine specialist – who sent the patient to us is also present; the rounds are then MULTIDISCIPLINARY in addition to INTERDISCIPLINARY. When this doesn’t happen, I spend some time after rounds talking to the sending physician. We ask that the family members of the patient be present for these rounds. If they are, we incorporate them into the rounding process; if not, we make sure a daily call is made to the designated family member so they are kept up to date.
At about noon we do procedures, begin taking planned new admissions, write notes and so forth. Emergency admissions, consults, and general medical-surgical floor requests for help, and cardiac arrests come throughout all of the above.
While we continuously round and provide care after this, at about 1700 hrs we make another set of formal rounds to see what is left to be done, review new laboratory data together, and generally make sure that what we thought needed to be done is done, or if not, why not.
At about 1845 hours we do sign-out to the night team / e-ICU team.
Most things are done by about 1900 hrs and the day resident-team is then sent home. The senior people – faculty – usually are present until about 2000 or 2100 hours and then go home. The entire process begins again the next day.
We usually do this work in blocks of one to two weeks, and then have some time to recover. It is during the recovery time that we read, write, do research (unless there is specifically funded protected time) and so forth.
Again, it is the coolest job on earth; and this is just my part of it.
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