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PasDeDeux465 karma

It's actually a really complex issue. It's not like the anesthesiologist just presses a couple buttons and leaves the patient on auto-pilot.

There's a thing called a "BIS monitor" that's now used by some anesthesiologists, but the problem is that it doesn't necessarily mean anything and it's debated as to whether it's useful--people at my institution don't tend to use it; when they do, it's taken skeptically.

AA (Anesthesia awareness) is a rare but surprisingly common complaint; validated, "true" AA is much more rare. 0.1 to 0.001% or so. Some people may remember immediately pre- or post- op events, which can be painful; these memories can be interpreted as being "awake" during the case. On the other hand, some patients may be afraid to talk about such a traumatizing experience.

AA is not always malpractice. Part of the problem is that the other signs of "awareness" are mostly related to vital signs, which can have the same changes as a result of surgery, even when properly "under." Movement is treated with increased paralytics, so that's not a good sign, either.

There's also the problem that we don't actually know the mechanisms behind the amnesic agents. If someone is "awake" for parts of the case, they still shouldn't really remember anything, but it's possible that they didn't get the dose they needed to forget everything.

Additionally, many anesthesia agents also are analgesic. Many surgeons use local (or have anesthesia set up regional) anesthesia, as well (in other words, lidocaine/epidural), so there shouldn't be significant pain in those cases.

Edits for some clarity/accuracy.
Edit 2: Some of the replies correctly pointed out that I poorly characterized the frequency of AA. 
    By "surprisingly common" I meant "not as unheardof as you might think," 
    but it is, as correctly pointed out, overall very rare and usually a "false positive." 
    (pre or post-op memories.) 
    The incidence of "false positive" AA is why it's a common report.
Edit 3: Quantitatively characterized AA. Added a section on local/regional anesthesia.

PasDeDeux334 karma

How's that different from a private chef?

edit: thanks for all the responses, guys.

tl;dr: private = cooks for one family only (every meal, fresh), personal = cooks and buys groceries once a week for multiple families.

PasDeDeux11 karma

A political party can't possibly follow that goal, unless their strategy is to only remove laws, programs, etc. and never create new ones e.g. as part of a transitional plan. Hence your local libertarian party needs to figure out why they're the local Libertarian Party, not the anarchocapitalist club.

PasDeDeux6 karma

From the rest of your linked article:

Americans for Fair Taxation rejects the Treasury Department analysis, objecting that Treasury considers only the income tax. By leaving out payroll taxes (which are actually regressive) Treasury’s chart makes the FairTax look worse by comparison. We found that including all the taxes that the FairTax would replace (income, payroll, corporate and estate taxes), those earning less than $24,156 per year would benefit. AFT’s Burton agreed that those earning more than $200,000 would see their share of the overall tax burden decrease, admitting that “probably those earning between $40[thousand] and $100,000” would see their percentage of the tax burden rise.

PasDeDeux2 karma

I think people generally see wanting to be called doctor as arrogant, but I actually completely agree with your approach. The way you allow people to talk to you influences how they think about and act toward you.