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The adversarial system in perioperative medicine


It is always assumed that the prosecution and the defense in the adversarial system may be searching for the facts that can then discover the truth. However, the whole truth may always remain undiscovered when the complete facts may not get uncovered due to competitive differences among the prosecution and the defense. This unbalanced competitiveness may arise from the perceived power held by the prosecution’s law offices contrasting with the collaborative manpower involved in the defense law firms. However, everything may boil down to the bottom line: the prosecution, as well as the defense, may be working for themselves and their needs first, even if they may appear to work for someone else (victim/defendant) to deliver something else (justice/innocence).

The same may hold true when practicing perioperative medicine, wherein anesthesiologists may be perceived to be acting to defend the physiologies of their patients receiving sedation anesthesia, while proceduralists may be perceived to be acting to prosecute the pathologies of their patients undergoing procedures. However, their disclosed as well as undisclosed conflicts of interest may come into the limelight when anesthesiologists and proceduralists find themselves on opposite sides of the adversarial system practiced to keep perioperative patients safe as well as the perioperative business viable.

Such conflicting perioperative situations can be quite numerous. Is the patient physiologically ready to undergo the procedure? Is the patient’s necessary procedure time-sensitive as well? Is the provider what the patient’s pathophysiology demands? Is the provider being reimbursed by the clock or by the procedure? Is the provider liable if ensuring the procedure gets performed at this point in time? Or is the provider liable if rescheduling the procedure to be performed at a different point in time? Does the provider risk credentialing to participate in procedures if the provider’s interpretation of standards appears to contrast with others’ interpretations of standards? Would experts concur with the provider’s interpretations when the time warrants their involvement?

In essence, just like the prosecution and the defense, proceduralists as well as anesthesiologists may be working for themselves and their needs first, even if they may appear to work for their patients to deliver them from their sufferings. However, everyone may still be hoping and expecting the adversarial system to ensure that all’s well that ends well in a day’s work, with everyone reaching home safer and happier despite heartily competing with one another as apparent adversaries during the healthy practice of perioperative medicine, which, just like the practice of law, may have always been an adversarial yet successful system.

Deepak Gupta is an anesthesiologist.






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