Middle Market Doctors
Okay the title sounds stupid, but hear me out. If you needed surgery, ANY surgery, that required general anesthesia how would you go about that? Would you be fine with any random level 1 hospital, or would you only choose to use the absolute top teaching hospitals like NYP, JHU, Mass, UCSF etc....? Personally I wouldn't be super picky for a surgery that requires local anesthesia, but I feel like having a top hospital anesthesiologist is a must if general anesthesia is used. I feel like general anesthesia is the one place in healthcare you absolutely don't fuck around in. If you've never heard of anesthesia awareness, its a phenomenon where an anesthesiologist, or more commonly CRNAs (who are NURSES not doctors), messes up the anesthesia. There are really only three components to anesthesia: paralysis, sedative, pain. If the pain portion works but paralysis fails, no big deal, easy to notice and easy to fix. If sedative fails and the other two don't, it's would be pretty scary but ultimately not that bad. The nightmare scenario is when the paralysis works but the pain relief and sedative don't. This is an absolute nightmare scenario and it is estimated to occur in 1 to 2 per 1000 surgeries in the United States. There are interviews of victims of this say it was pretty much the absolute worst thing to happen to them. Most end up with PTSD. In some cases, the anesthesiologist will notice that your heart rate and blood pressure are nearing heart attack level due to a combination of pain/anxiety; though it's possible that your heart rate and BP stay low due to some other medications. There are reports of people committing suicide afterward because it's that bad. They also made a Hayden Christiansen movie about it.
The cherry on top of this is that it's very rare that somebody wins a malpractice suit against the anesthesiologist. Can you guess why? Because the victim technically has no way to prove they were actually awake since they were paralyzed. There was one individual in Canada who was able to win a case since she was able to recount the conversations of the doctors. Most of the time, you're just out of luck. Even if the docs do know they fucked up, they won't say anything.
This brings me to my initial point. Given everything I've said, would you pretty much refuse anybody but the best? There are also some machines that can detect if the anesthesia is working properly; God knows why these aren't universal as they only cost $4k - $(for comparison, a low level MRI machine cannot be bought new for anything less than $200k & the best ones can be close to $1mm). This came up as I recently got into a heated argument with a mutual friend who is a nurse. She was talking about how she "does the same amount of work as a doctor but doesn't get nearly the same recognition." If this is an emergency surgery, you're options are more limited. If you can wait though, I believe it's totally worth it to wait for the best to be bookable (they usually are eventually). Regardless, you can also demand that a CRNA not be allowed. They can refuse the operation, but I'm sure you'd be able to find one top place that wouldn't.
Like I mentioned earlier, it's not a big deal in most things, but in the event of a surgery requiring general anesthesia, I would not fuck around. Imagine somebody operating on you for hours, and you can feel everything and not at all move or tell anybody. Then afterward, they just deny it.