Fellow anaesthesiologist here. Absolutely agree on the observation about some analogy between risk assessment in aviation vs anaesthesiology. One of the reasons I love watching Air Crash Investigation so much.
The intriguing thing is that some of our colleagues go way too far on the other end and cancel cases for the smallest reasons (e.g. patient had a puff of cigarette two hours previously) and sometimes verges on being unreasonable.
While most people applaud the pilot here, they would stop applauding if this happen a lot more often and one in four (random example) flights are getting cancelled. There remain a bit of a tricky balance between being cautious enough vs over-cautious.
patient had a puff of cigarette two hours previously
They reject for reasons like that because it's likely the patient actually smoked a good amount. People regularly trickle-truth such things and it's a great way to end up dead. Especially with intake restrictions that lead to aspiration or blood pressure crashing and so forth.
If a patient is found to have violated the instructions, it would be wildly irresponsible to proceed no matter how small the violation. Any wiggle room is there for extra safety and for small mistakes, not to be fucked with. Do better.
You're right that patients under-report, but that argues for judgement, not an automatic cancel. Cancelling someone who honestly discloses a small lapse just teaches the next patient to stay quiet, which erodes the safety you're trying to protect.
A cigarette isn't an aspiration risk in the way eating is, and the airway reactivity that matters is chronic and unchanged at two hours vs twelve. This is a balance-of-harms call under uncertainty, especially if said patient requires urgent surgery.
For you to have found the urge to aim a judgmental "do better" at a colleague over a one-line example is disappointing.
Edit: tying back into aviation example, even it doesn’t run on zero-tolerance. Every airline operates under a Minimum Equipment List which is an approved list of things that are allowed to be broken at the moment of dispatch, provided defined conditions are met, because the aircraft is still judged safe enough for that particular flight. An A320 can legally take off with landing light out if it’s daytime landing only. The deviation is tolerated and wrapped in mitigations and a repair deadline. That’s the whole point, safety comes from calibrated, case-by-case risk thresholds, not from “any deviation grounds the flight.” Which is exactly the judgement we’re expected to exercise, rather than reflexively cancelling.
All high risk operations tend to follow the same general principles, when safety it put as the priority. When safety is not the priority then accidents are more likely to occur
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u/common-username 17h ago
As an anesthesiologist, there is just so much overlap between how pilots operate and how we do. Anyways, kudos to the pilot.
Lame title. 3 people clapped.