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Patient Selection

Anesthesiologists do not select the patients they practice on. Surgeons determine if a patient needs surgery and obtain the consent for the surgery. Once the patient has been convinced that surgery is necessary and has been admitted to the hospital, the anesthesiologist determines if the patient is a candidate for anesthesia. While the anesthesiologist should obtain an independent informed consent for anesthesia, this is impossible once the patient has been convinced the surgery is necessary. If the anesthesiologist determines that the patient is not a candidate for anesthesia, the anesthesiologist must cancel the surgery, a situation almost certain to displease the surgeon and the patient.

As independently licensed physicians, anesthesiologists cannot blame the surgeon if the patient expires because of a contraindication to anesthesia. The law expects anesthesiologists to exercise independent judgment in the evaluation of patients. While anesthesiologists were once sheltered by the captain-of-the-ship doctrine (see Chapter 6), this has been abolished in most states. The surgeon and the anesthesiologist are co-captains under modern law. Each has the right and the duty to cancel or stop surgery if that is necessary to protect the patient.

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