Interdisciplinary Team Issues:
Case 1 Discussion
The answer to both questions is no. Anesthesiologists have special knowledge and training which are not shared by the surgeon with regard to the safe administration of anesthesia. They also have direct obligations to the patient to provide safe medical care which is as far as possible in keeping with the patient's wishes. When medical issues of safety, or specific patient goals are in conflict with the surgeon's desires, the anesthesiologist is first ethically obliged to provide the best care to the patient.
But the anesthesiologist would be incorrect to proceed at this point without some discussion with the surgeon, for at least two reasons. First, ignoring the surgeon's communication is disrespectful. Second, the surgeon may have valuable information to impart, such as "my patients achieve very good pain control with intravenous and oral medication, and end up being discharged two days sooner than epidural patients, because they do not require prolonged urinary catheterization from epidural-associated urinary retention." This dialogue between team members can result in improved team relations, and better care for the patient.
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