Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
Don't forget to send your questions to Dr. Brian Schmutzler on social media and his website at www.drbrianschmutzler.com.
Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Guidelines, Lawsuits, And The Art Of Care
In the Season 5 debut, Dr. Brian Schmutzler and Host Vahid Sadrzadeh open the discussion on medical guidelines and attorneys.
Paper rules aren’t supposed to replace clinical judgment, yet more care is being delivered with one eye on the courtroom. We open the season by confronting how guidelines, malpractice pressure, and hospital incentives are reshaping decisions at the bedside—and what that means for your health.
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This is going under Anesthesia answered with the biggest IU fan in the planet, Dr. Brian Schmutz.
SPEAKER_01:That may be a little bit of an exaggeration on the biggest on the planet, but I am an IU fan. Hoo hoo-hoo!
SPEAKER_00:Playing for a peach bowl title in it. Spot in the uh national championship game. That would be two national championship games in two years for you, sir. Yes, it would. I'm I if if we already talked about that.
SPEAKER_01:And me too. If IU goes, we're going. That's true. Um, yeah. So I mean, I ever and I'll get to the I'll get to our sponsor in just a second, but I'm I'm an IU school of medicine grad. Anyone who saw me last year, I had the split jersey, Notre Dame IU. Yep. I think Signetti, while he's an arrogant guy, is a very good football coach. He does great in the transfer portal. He's taken every he's been successful everywhere he's been. So I'm cheering for the Hoosiers. And they're right now their odds-on favorite. But we're sponsored by Not Kurt Signetti. Not Kurt Kurt Signetti. Although if he wants to come on the show, I'd be happy. We're happy to have him on. But we're sponsored by the Butterfly Network. So I'm going to let you in on something that's completely changed the way I practice. I've been using butterfly probes for years. It's a portable ultrasound that plugs right into my smartphone or tablet so I can start scanning at the bedside in seconds. If you've used the older versions, or even if you're new to the handheld ultrasound game, let me tell you what why this new IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster. Whether it's vascular access, procedural guidance, or just getting real-time insights for my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see short and long axis simultaneously, which is huge for procedural guidance and honestly a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally so I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ3 holds up against many of the cart base systems I've used. That's impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the latest IQ three. Check it out at Butterfly Network.com.
SPEAKER_00:And if you've seen the old cart systems, I've seen the old cart systems. Sometimes I trip over them. And they're not uh they're not butterfly. They're not small. They're not small. Uh yes, we're back. We are back. Happy New Year. Happy New Year. When is the um we were talking about this the other day in a meeting? When when is the kind of um restriction on how long you can say happy new year in the new year? Oh wow.
SPEAKER_01:Uh I I'd give you the whole month of January. Really? Yeah. Okay. Yeah. I mean, they say it to us when we go to Mexico, we go to Mexico every year at the end of January. Yeah. They say it to us then. Okay.
SPEAKER_00:Hey, happy new year. How are you?
SPEAKER_01:Happy 2026, sir.
SPEAKER_00:Yes, it is. Uh, and to start off the season, to start off this new season of going under anesthesia answered, uh, we are starting it off with medicine being addicted. Is that the right word? Yeah. Yeah. To guidelines. To guidelines, yeah. Yeah. Medicine and being addicted to guidelines and lawyers are a big reason why. So let's explain what that means.
SPEAKER_01:So, anybody who knows much about medicine, really in the past probably 30 years, we've converted to practicing what's called defensive medicine. All right. So we don't practice to do necessarily what's best for the patient a lot of times. We practice to make sure that we're doing everything that if if something were to happen, that the lawyers aren't going to sue us for malpractice. How will it look in a deposition? Yeah, how will it look like it will look in a deposition, which is crazy, right? It's just nuts. But um, and so we've been doing this for quite a long time. But what's happened in the last probably 10 to 15 years is that all the societies, including the societies I belong to, the American Society of Anesthesiologists, the American Society of Regional Anesthesia, have these guidelines they've come out with, right? And so we used to use these guidelines as, well, I don't have time to read all the papers or I haven't seen all the papers out there, and I'm gonna I'm gonna depend on my society to gather that information and tell me what's best practice for the patient. Now what happens is those guidelines are taken by the attorneys, and and now that's standard of care. And so if I don't follow the guideline, even if not following the guideline is what's best for my patient, and something happens, the attorneys can come after me for not following the guidelines. So there's been a big, big change in medicine. Um, and and we've talked about this quite a bit, but uh, you know, there's I think there's too many attorneys in medicine, and a lot of times the attorneys really dictate the way we practice medicine.
SPEAKER_00:Where when did that start? I mean, like what can you pinpoint it to a certain time or era and and why?
SPEAKER_01:I mean, it's been a problem for the entire time I've been in medicine. So you're talking, you know, if you talk about when I started medical school, so 20 years, 22 years ago. Um, so I mean, it's been a problem that whole time. It was probably a problem before that. I mean, once the government got involved heavily in medicine, attorneys got involved heavily in medicine. So you're probably talking the 70s, 60s, 70s. Um, but I think it's continued to get it.
SPEAKER_00:Malpractice is it, you know. I mean, like we've talked about insurance, not not insurance companies, not health insurance patrons. Yeah, not health insurance, but insurance as in you gotta be protected if somebody comes after you. Yep, yeah. That's been a thing since I've known forever.
SPEAKER_01:Yeah. So so medical malpractice became really, really big eighties um when attorneys started suing for huge, you know, you hear these like hundred million dollars because uh, you know, they left the whatever and right side, right? So that that when that started happening in the 80s, that's when medical malpractice really blew up. And so it's interesting. We had a governor in Indiana, governor Orr, I believe is who it was, who was a physician. And so he established a lot of really good rules in the state of Indiana. So we have a cap in the state of Indiana for what you can be, as long as you're in the patient compensation fund, which is something you pay into every year, you can only be sued and found liable for that amount. So in Indiana right now, it's 500,000 for uh one case and 1.5 million aggregate for multiple cases. So now if the if the plaintiff wins for more than that, then that patient compensation fund covers the difference. But your liability is only that half a million to 1.5. There's also a panel in the state of Indiana. Um so there's a three physician panel, um, and it can be actually can be APPs as well, so like uh CRNAs, for instance, in an anesthesia case. And those three um people look at the depositions, look at the case files, look at everything, and then make a decision. Is this a case that should proceed to trial or should it not? You know, what do we find? Do we find that there was liability? Typically in the state of Indiana, what happens at that panel decides what happens next. So if the panel says, yeah, there's liability of the of the provider, then the provider typically will settle. If it if it says no, there's no liability of the provider, then the provider, then the then the plaintiff's attorney typically will drop the case or shelve it until they can find some other issue that was was happening in the case. So Indiana's a good state for that. Texas is a good state for that. Um California, New York, Illinois, especially Cook County, Florida, these states are not good medical malpractice states. You know, you you can you can get sued for everything, right? They can take your livelihood, they can take they can take everything from you. Um, you know, your house, your car. You know, a lot of us have umbrella insurance on top of if we practice outside of Indiana, right, where they don't have a patient compensation fund, you know, we have umbrella insurance that will cover all that other stuff that they can try to sue you for.
SPEAKER_00:So it's it's it's good practice to have umbrella insurance anyway, if you're a business owner.
SPEAKER_01:Well, it yeah, if you have any assets at all, it's a good good idea to have umbrella insurance. But so so how does this fit in with the guidelines? Well, these guidelines keep coming out, and the guidelines are ever changing. And so if you don't stay on top of the guidelines, let's say you do what you think's best for the patient, and then all of a sudden you fall without uh you know, outside the guidelines, now you've put yourself at risk for like we talked about, being being sued. So and it's also funny. So in the state of Indiana, it's like 10 bucks to file a medical malpractice suit. That's it? Yeah. You can just yeah, and you can do it online. So you can file a medical malpractice suit online for 10 bucks.
SPEAKER_00:How many, I mean, you may or may not know the answer to this, but how many medical malpractice suits a year? I don't know. Too many to count. I would bet a lot.
SPEAKER_01:Yeah. Anybody can sue anybody for anything anytime. Um now it's much harder in the state of Indiana to win that medical malpractice suit if it's frivolous, but you can still you can sue anybody, yeah. And if it's frivolous, it's almost impossible to prove it's frivolous, and then you have no recourse as a physician to say that was a frivolous lawsuit, I'm gonna countersue you for having to put me through this. So let's talk about the guidelines a little bit. Oh man, yeah.
SPEAKER_00:You know, what what are the guidelines right now? And pro or really if you're a patient, right, are these guidelines back you? If you're a physician, do they back you?
SPEAKER_01:Are they so so the problem is that they change so much, right? So a critical example is the GLP one guidelines, right? So initially the GLP one guidelines were not even present. As these medicines were first being used, nobody knew when you should stop them, how long people taking all that sort of stuff. So so then as we saw more and more patients getting sick after surgery or during surgery, aspirating, that sort of stuff, then the guidelines came in. Well, you got to stop the injectable ones for a week, and you've got to stop the oral ones for at least 24 hours. Okay, great, fine. You know, that was a there was a little bit of angst there. There were some transitions, the surgeons got a little bit upset. Why are you canceling my case? Blah, blah, blah. But at least we had the guy. I could, I could take the guy. Okay, these are the guidelines. These are the guidelines we're gonna practice. Then the um the GI docs who do endoscopy said, Well, we've been doing this forever with these patients on GLP1s, and we don't think it's a problem. So they they publish all these papers, and then the ASA in its infinite wisdom comes out with the guidelines of um the decision should be made between the surgeon and the anesthesia provider, and based on the patient illness and the complexity of the case. Like that's not a guideline. That tells me nothing. That's just like just do whatever you want. You and the surgeon talk about it and do whatever you want. So that's a completely worthless guideline.
SPEAKER_00:Yeah.
SPEAKER_01:Totally worthless guideline. Um, there's some guidelines for whether you can do regional anesthesia. So uh Right.
SPEAKER_00:I was about to say anesthesia guidelines.
SPEAKER_01:Yeah. So so those, uh, so for instance, doing a spinal or an epidural, which is neuraxal neuraxial anesthesia, when a patient's taking a blood thinner. So those guidelines came out, I think they initially came out probably in 2008 or nine. And the guidelines were very long. Like most of the medications, they were like, you got to stop them a week or two weeks, a long period of time. And then over time, some studies have come out and they've shortened the amount of time that you you need to hold some of these medications. But there's really no, there's not a risk-benefit discussion in those. It's just a hard number, right? So Plavics, for instance, is five to seven days, period. Well, what if the patient has terrible COPD and you know, I'm I'm deathly afraid of putting this, not deathly afraid, but uh, you know, I'm nervous about putting this patient all the way to sleep and putting a tube in because I think that their COPD is so bad, but they've only been off their Plavix for four days.
SPEAKER_00:So here's where it kind of gets complicated in my brain. Yeah, and tell me if I'm wrong. But if the guidelines say five to seven days, you go outside of those guidelines because you feel like, hey, that person's thing for the patient. And something happens to the patient, they can go back and say, You didn't follow the guidelines. Yeah. Their attorneys can. Yeah. So I mean we have even though you've discussed it, even though we have the informed consent discussions, we write it down, but again, and they can consent to, but even still, they can go back and say you didn't follow the guidelines. And you know, like it's interesting because we as a company, as you know, do a lot of work with other medical companies, yeah, and and medical providers and and companies that you know work with bigger medical companies. I can't tell you how many times I've I've gone in and it is the disclaimer. It is the the those companies need to put at the bottom of the screen, even if it's a conversation, yeah. Here's the disclaimer. Yeah, here's the disclaimer. Guidelines. Yep. It's all guidelines.
SPEAKER_01:If you listen to a 30-second commercial on television about whatever guidelines, so the guidelines were meant to help us make decisions, but they've been they've been perverted into the end all be all of standard of care. There's a difference between following a guideline and performing the standard of the city. It's not the best for everybody. Correct. Standard of care is what would another person in your position, so for me and another anesthesiologist, have done in that situation. Does that match the standard of care of what somebody else would do? Not did you follow the guidelines, right? So guidelines were supposed to help us make decisions, not be the law of the land on what the decision should be, but they've been perverted.
SPEAKER_00:It's just this is interesting because it goes back to listen, uh, the the guidelines to play a cover two defense is to run the ball. Yeah. Well, not every time. You're gonna run the ball against Georgia every single day. No, you're gonna run the ball. I I feel like you get my drift here.
SPEAKER_01:Yeah, it's like there's guidelines, but then there's when you're in the moment and you need to make a decision, you do what's best for the patient, and you do it based on you do it not based necessarily just on the guidelines, but on your previous experience. Hey, I've seen this type of patient 15 other times, and when I followed the guidelines, the outcomes weren't what I wanted. I'm gonna go outside the guidelines because I think that would be better for the patient. So, what we tend to do as a company, I mean, we follow the guidelines as close as possible, but when we write up policies for our clients, we write up recommendations. We don't call it a guideline. We don't say the guideline is you can't do a patient who has a BMI over 50. The recommendation is you don't do a patient over the BMI of 50 unless they have seen the anesthesia provider. That anesthesia provider has done an airway check, has evaluated their other issues, blah, blah, blah, blah, blah. So we internally call them recommendations, and that's what we give to our clients. Now, that's not the same thing as what the American Site of Anesthesiologists gives us as an anesthesia profession as a guideline, but I'm not going to give a client guidelines because I don't want them to be bound by it. Does that hamstring you?
SPEAKER_00:Does that does that uh it's defensive medicine, right?
SPEAKER_01:It's 100% defensive medicine, right? This is why we order a bunch of tests. Why do I order an EKG on almost every patient, right? Well, an EKG, first of all, is it's a very benign test, right? I'm not I'm not even putting anything inside your skin. I'm not pulling blood out. I'm just sticking stickers on your chest. Benign, it's a benign test, so I order it. It's an inexpensive test, so I order it, and it gives me some information. But there's a percentage of patients that is going to show something that probably never would have been caught otherwise and is not that important. But if I didn't do that and they had a bad outcome, some attorney's gonna come say, well, why don't you do an EKG on that patient? The guidelines say anybody over 65 should get an EKG. Well, that patient was totally healthy. They run marathons every week. Right. Why do I need an EKG on that patient? But I'm still gonna get it. So it it's it's created defensive medicine. Now, anesthesia is not quite as bad as let's say ER medicine, right? Emergency medicine. Those guys order tests all the time. Right. You know, that because they have to. Because if they miss something, it's life and death, you know.
SPEAKER_00:So let's talk a little bit about um what does this do for the overall ethos of thinking, right? Like free thought in anesthesia or not in just in medicine in general, right? Critical thinking, you know, in terms of making autonomy. Making the best decision for that patient rather than following a guideline from somebody who's writing it up from somebody who's not in your position in the OR, in a hospital.
SPEAKER_01:So it's it the there's a lot of problems, right? So it's so it goes back to loss of autonomy, and we've started to lose autonomy in a bunch of different areas. In particular, hospital administrators and insurance companies are driving a lot of what we do, right? And we've talked about that before. Yeah, we we are no fan of the insurance companies, that's for sure. But um, it it's also, you know, I think that um in residency, I had even even 20 years ago, 15 years ago, I had a little bit more ability to think on my own and to do things that may not have been protocolized. I think that residents now are basically learning protocols. X, if X happens, you do Y, and you lose a lot of the art of medicine. I think that there's a lot of fear, like we said, defensive medicine, right? Well, if I don't do this, even though I don't think the patient needs it, or I do think the patient needs it, but the guidelines say I can't, there's this fear of, well, I'm gonna get sued. So I'm just gonna do, I'm gonna do the path of least resistance, even though it might not be best for the patient.
SPEAKER_00:State to state, does it does it? I mean, I know guidelines are pretty standard across the board, but state by state does it differ?
SPEAKER_01:Most of the guidelines come from national societies or or national organizations. So state to state it doesn't necessarily differ. What differs is the consequences, right? So the the the legal frameworks in each state are different.
SPEAKER_00:Not knowing, I I really don't know if this is a dumb question or it truly are people thinking about this. But this is why I'm asking it. We've talked about the rise of um health care workers that are not medical healthcare workers, right? We've talked about the CEOs and the people who are administrative that come in 92% of every hospitals.
SPEAKER_01:92 cents of every dollar in healthcare goes to those people.
SPEAKER_00:Are the guidelines being affected or changed because of those people?
SPEAKER_01:No, because they have no risk. A hospital CEO, if if I don't go by a guideline and I do what I think's best for the patient and a bad outcome happens, and I get sued, the hospital CEO has no skin in that game. It doesn't matter to him or her what I did. So no, it's not being driven by them. It's it's being driven by our own societies. Um and it's being driven by, again, attorneys who are pressuring our societies to set specifications. Are they making it more difficult?
SPEAKER_00:Are the guidelines basically? No, no, no, no. Are are those healthcare administrators?
SPEAKER_01:Uh when they want to. Some of those administrators will use those guidelines to say you're not meeting benchmarks and therefore we're not going to pay you as much, or we're not going to give you your bonus.
SPEAKER_00:So they're not helping, certainly.
SPEAKER_01:No, they're not helping. No. I I I don't think that those I don't think that most hospital administrators really care that much about the guidelines in terms of patient care or fear of being sued, but I think they're they're used to again control physicians, right?
SPEAKER_00:And we're not hating on obviously attorneys, right? This is not a hate against attorneys.
SPEAKER_01:Medical malpractice attorneys.
SPEAKER_00:But medical malpractice attorneys, right?
SPEAKER_01:I mean, I like my defense medical malpractice attorneys. I'm but I'm not a big fan of people. So Because they're coming. Coming after the the the nuance, right? It's not I think there are I think that there are a lot of medical malpractice attorneys who come after physicians and clinicians for frivolous things. But do I think there is a place for them? Yes, I think there are people like you look at Christopher Dench or Dunch or whatever his name was, Dr. Death in you know in in Texas, that guy needed to be prosecuted. But I would say 90 to 95% of physicians are just trying to do what's best for the patient, right? They're not out there intentionally, knowingly, or even because of their own mal like their own um malfeasance or their own issues trying to cause harm or causing harm to patients. I think almost every clinician is trying to do what's best for the patient at all times. And if there is a bad outcome, that does not always mean there's malpractice. Bad outcomes happen even if you do everything within the standard of care. But patients don't fully understand that. Well, I had a bad outcome. Okay, you had a bad outcome because of X, Y, and Z, but that does not mean that it was medical malpractice.
SPEAKER_00:So And to be fair, there's you know, the world's not full full of 100% great doctors. No, right. That's what I'm saying.
SPEAKER_01:90, 95%, right? But when you look at a billboard and they're like, oh, uh, you know, did you have a medical malpractice case? Call whatever. Joseph. Yeah, call, yeah, call that that there's there's a problem there, right? There's there's too much money to be made where you're putting up billboards and going after well-meaning and high-quality clinicians. That's my problem. But would I say we have to eliminate all medical malpractice? No, absolutely not. There are a very small percentage of clinicians out there who are practicing outside of the standard of care, either intentionally or unintentionally, and causing harm. So it's about trusting your doctors.
SPEAKER_00:Yeah. It's about trusting the people that you put in charge of your health. Yeah. And to, hey, you know what? Like they know best.
SPEAKER_01:But also, attorneys should not be the ones deciding whether you're practicing medicine correctly or not. That should be your medical board and your licensing board, right? So the licensing board and the medical board in every state, and or the nursing board if you're talking about CRAs or whatever, they're the ones who are supposed to be protecting the patients. Yeah. Right. And that's to be supposed to be preemptively protecting the patients. So if I apply for a license in another state and I've had 75 malpractice cases that I've had to settle because I was in the wrong, that medical board in that state should say, we're not granting you a license. Yeah. I I mean, right.
SPEAKER_00:I mean that that's what you would think. Right.
SPEAKER_01:So that's where the protection should come in, not some attorney suing you.
SPEAKER_00:Speaking of guidelines, I just want to shift it just a little bit here. Let's do it. Um speaking of guidelines, the guidelines for vaccinations and vaccinating babies children. Give us an update on those because I know we've talked about this before.
SPEAKER_01:Yeah, so so the HHS um guidelines have changed now from the I think it was 17 shot panels to 11, which matches the majority of Europe, right? So um we're not gonna take an official stand at this very moment, but um, I guess what I would say is um there are a few of them that maybe are less necessary than others, right? So if you get polio or smallpox, that's a big deal. If you get the chicken pox or rotavirus, which is a GI bug, not such a big deal. Guess who's gotten chicken pox? Yeah, uh me. I've got I've got one right, I got a little spot right here where I one pox. Yeah. So now there is an interesting thing that came out. Um, the uh shingles vaccine has been shown in a couple of studies now um that if you get it when you're 50, that your likelihood of Alzheimer's or any dementia goes way down. Really? Nobody knows exactly why. Is the shingles vaccine something you get as an adult? Yep. Okay, yep. So so shingles is the same virus as chicken vaccines.
SPEAKER_00:Chicken pox, but an older adult, right?
SPEAKER_01:And it reactivates as you get older, right? So, but there is no evidence that the varicella, so the chickenpox vaccine prevents dementia. It's only when you get that shingles vaccine in your 50s, which is which is interesting. So um, you know, and but I think at that point you're in your 50s. How much risk is there to that vaccine? So I'm all about risk versus benefit. We talked about it through this whole process here. Sure. I'm risk versus benefit. So is there some risk to a baby getting a bunch of shots that are they we have not studied um and done the randomized controlled trials of giving all these medications or all these vaccines together? Yeah, there's probably some risk to that, right? Now, how much risk? We don't know because we haven't done the studies. Is there a lot of risk for me at 50 years old to get the shingles vaccine? Probably not. Because there actually have been randomized control studies. So are we I mean in terms of vaccines, are we doing studies along the way? Are there No, we're not because so there's a couple things going on. Uh, one, these have been in practice for so long that anybody who tries to challenge it gets silenced. So there's nobody out there trying to study these things because they're just getting silenced. Nobody will fund in the past anyway. Nobody will fund it. Vaccine research? Not for current vaccines. It's crazy. We research everything. Nobody will fund it. That's one. Two, uh, and I don't think a lot of people know this, but in the 90s, uh, late 80s, early 90s, all the vaccine companies said we're gonna stop making vaccines unless you give us full immunity. Anything that happens, we have full immunity. So all those vaccines fall under this whatever the law. Immunity immunity to any any lawsuit. So you cannot sue a vaccine company. They are completely immune based on the federal. And who's a vaccine company? There's a lot of vaccine companies. Right. Pfizer makes vaccines, Johnson Johnson makes vaccines. Now you can sue those companies for other things, but you can't sue them strictly on the vaccines. Interesting. Yep. Because they said we're gonna stop making them. Now, why would they do that? The conspiracy theorist would say because they knew that there were big problems. Whether that's true or not, I cannot say. I'm when I was never in a meeting with any of these people to know whether or not there was actual harm cause, but they haven't been studied. So that's interesting. But again, I go back to everything's risk benefit. Right. So would I want would I want my kids to get polio or smallpox or some of these other no, absolutely not. I don't want that, I don't want them necessarily to get pertussis either. Right. So, or tetanus, right? Tetanus is a big one that people get vaccinated and boosters for. Those are terrible, terrible illnesses.
SPEAKER_00:GI bugs? Yeah. Let me say this, and I and I, you know, again, by no means am I trying to make a political stand here, but I'm just going by what the information I have at hand. Yeah. And the information I have at hand happened six years ago. Uh-huh. COVID-19. Yeah. Why aren't you questioning? If you're a parent out there, why aren't you questioning the COVID vaccine? Correct. Why aren't you questioning, and and maybe that leads to questioning other vaccines, right? Why aren't you questioning what you're putting in your body at all times? Why aren't you having discussions about it?
SPEAKER_01:And that doesn't mean don't get it. Correct. That means ask the question. What like how's this going to benefit me? Before you eat something at a restaurant, you say like, what does it contain? What kind of meat is this? You're not just going to be like, just give me whatever off the menu. No, you're going to say, okay, that's a fillet. Great. That's I want the fillet, right? So I have no problem with people questioning that. Um, you know, and I think there was also the discussion of risk benefit with the COVID vaccine. Right. Right? What you if you're young and healthy, do you need the COVID vaccine?
SPEAKER_00:But we've seen, we've seen the other side of it. Right. We've seen the other side of it. And I've directly been a part of some of those conversations with parents who are like, mm-hmm, no. Yeah. You know, no research.
SPEAKER_01:Right. You know? Right. And it's a fundamentally different vaccine. MRNA vaccines are fundamentally different in the way that they work, as opposed to like live attenuated or um uh and I can't remember the name of the other vaccines. So so there's vaccines where you uh you take the bug itself and you create either antibodies or you put the bug in the body in small doses so you can create the antibodies to it, right? So those are the vaccines that have been around forever. The mRNA vaccines, which are some of these newer ones like HPV and COVID, um, actually have a portion of mRNA in them, those the building blocks, so that your body integrates that and creates the antibodies against it. That's different. That's you could probably even argue that's not even what a vaccine truly is. That's more of a gene therapy. So there are some differences, right? And again, it just goes back to risk-benefit. Are you are you getting the education? Right. Are you digging into it? Yeah, you should under you should understand what you're putting in your body, whether that's a vaccine, whether that's what you're drinking, whether that's what you're eating. But no, doc, the guidelines Yeah, the guy we're back to the guidelines. The guidelines said so. And here's my other problem with all of that is that the guidelines are not always based on science. There is always a political, either way, right? You can have a political aspect, right.
SPEAKER_00:That's kind of what I was asking when talking about COVID. And talking about some of these administrators that are involved in this, right? In the guidelines. Maybe they're not directly involved with the guidelines, yeah, but enforcing the guidelines is that a political move?
SPEAKER_01:You've got to ask the question if a study came out, so so number one, who's pushing it and why? Correct. There's always an agenda, right? You've got to ask that question again with anything. Who's pushing food dyes and why? Who's pushing the food pyramid and why? Who's pushing the vaccines and why? And then you've got to go back and look at the research. Who funded the research and what's their angle? And you need to do that with anything. I mean, you need to do that with aspirin.
SPEAKER_00:You need to do that with anything that research. I'm not gonna go out and buy an electric vehicle that I know nothing about and didn't know who manufactured it, don't know where it's made, don't know what harm it could cause, benefits it can cause. It's all about risk benefit. Are you doing the research? And I think that's what it comes down to, right? It's it's yes, there can be guidelines. And if I'm a patient, right? Yes, there can be guidelines, but am I doing the best thing for my patient? Am I doing the best thing for my body?
SPEAKER_01:The real question you need to ask, not being a medical person, is when you go to see your physician or your primary care, whomever, have they done the research for you? And can they explain the risks and benefits? Not just you should do this, no matter what it is, whether it's a vaccine, whether it's a medication, whether it's an exercise, diet, whatever. Can they say to you, here's the potential benefits and here's the risks? I recommend yes or no, based on what I know about the benefits and the risks, but you can make your own decision. These are the benefits, these are the risks, right? That's what about and we talked about this with the Tylenol Tylenol recommendation, right? Benefits and risks. So now I want to tell you, I I took Tylenol today.
SPEAKER_00:No, hold on, hold on. So every time I pick up an acetaminophen bottle, yeah, Tylenol, what do you look at the back? No, and I see acetaminophil, I think about you because we had the discussion. Yep. Is acetaminophin the right thing to do? Right? Depends. And I was faced. Acetaminiphine, advil. Right. Right? The generic, whatever, ibuprofen. Yep. And today, because of how I felt, I'm like, normally I don't really like to take acetaminophen. Yeah. Today I did. Yeah. That's the risk benefit you take.
SPEAKER_01:Yep. You know, and and there's risks and benefits with we talked about this with ibuprofen. Correct. Kidney and stomach ulcers, right? Those are two risks of ibuprofen. Do I take ibuprofen sometimes? Yes, because it helps with my headache.
SPEAKER_00:But guess what? Now, after doing some research and discussion, now I know, okay, what am I putting into my body? Yep. Right? Yeah. That that's all that's really what it comes down to.
SPEAKER_01:Yeah. The other thing we can talk about is the food dye thing, which is crazy to me. Did you see the the state of West Virginia declined to take the food dyes out? Like again, okay, so what's the benefit of a food dye? It makes your food look better. Correct. Okay, what's the potential? I'm not even saying there actually is real risk, but what's the potential risk? There are some studies out there that show it maybe, not proven, but maybe could cause some detrimental things. So why would you not just say, okay, well, my fruit loops are going to be a little bit pink instead of bright red? Like it just doesn't make any sense to me unless there is somebody out there driving for financial reasons this discussion.
SPEAKER_00:It's the something else is going on, right? Always question. Yep. Always question. Yeah. I mean, it's not to say that you can't, you know, make an educated decision.
SPEAKER_01:And I'm sure we'll get lambasted about this. Like, how can you, as a physician, say this? Blah, blah, blah. I I mean, come on. Yeah. We're we're not we're not advocating for one thing or another except to talk about risks and benefits. Correct. Yeah.
SPEAKER_00:What a great discussion. And if you have a question, please put it down in the comment section below. We'll we'll answer that question. And we've gotten a lot of emails too. Oh, yeah. Um, and so uh you know where to find But we are taking a stand on the Hoosiers. We are. Um, I was gonna get to that. Okay, what are your guidelines for a victory uh for the Hoosiers?
SPEAKER_01:I think they're the best team right now by far. Uh, you know, they already beat Oregon once, and I think they beat Oregon with a so that I think um You think it's gonna be Surratt. Surratt was out, wasn't he? Part of that game.
SPEAKER_00:And then uh no, I think it Well, you know, one of the best players I think has has left uh Oregon, entered the transfer portal.
SPEAKER_01:Yeah, I can't remember who that was. I can't either. Um so I I think IU probably wins by 10. Um same score as last time, 30 to 20.
SPEAKER_00:No, 27-17. The offense um well, the defense for Oregon looked good against Texas Tech, but Texas Tech's offense was yeah.
SPEAKER_01:I I think IU's got a very potent offense. It may be. So I wouldn't have predicted 38 to 3 over Alabama. I I think there's a chance. My best guess is 27-17. There's a chance it's another 35 to 10 game, though. Like huge blowout for no for uh IU.
SPEAKER_00:I think it's gonna be closer. I think it's hard to beat a team twice. I do. I think it's hard to beat a team twice, but you're not A, you're not playing at Austin Stadium, which is fantastic. Neutral field, neutral field. Um, IU listen, I mean, if you I've been listening to some of those press conferences, just seeing Sig and his reactions, they are very, very confident. They listen, they're out to prove that that IU belongs in a conversation with some of those greats. And honestly, if if you're Alabama and you have this type of season, everybody's like, oh, it's the best season of all time, it's the greatest season of all time, right? Um, so I think I think they will win. I think it's gonna be close. Yeah. Um What's your prediction? Uh I'm gonna say Oregon's gonna put up some points here. I'm gonna say 27-24. Okay, close, real close. I'm gonna say close. Um what about the flip side? What about Miami and uh I think Miami's a team of destiny. Do you think so? I think they're playing extremely well. How in the world did Ole Miss be James? I don't know. I don't I don't really think Ole Miss um the fourth best team here. Okay. To me, they're the fourth best team. Okay. I think uh IU and Miami are close. And then I'll put uh Oregon at three and then Ole Miss way down. Ole Miss way down at four. They got lucky against the game. I think it's I don't even I don't know if this game's gonna be close. I think I think Miami, they're they're on a destined path, and I think the other team from in this is what I've been saying for the last week. The other team from Indiana is gonna go to Miami and end the season for the hurricanes. Something that Notre Dame should have done in the first game.
SPEAKER_01:So here so here's the question: When does the real Carson Beck come out? Because he is the reason that Georgia has lost multiple seasons. Oh, because he gets in a big game here, right?
SPEAKER_00:He gets in a big game and he doesn't play well. He didn't really play well. So we've seen it a couple times. Yep. SMU, he played horrible. Um Notre Dame, he played okay. He's he's listen, he is not the Carson Beck of last year. Carson Beck of last year was not a game manager. He went out and affected games. Okay. Carson Beck to me, you you he is not um he's not the game wrecker. It's the guys around him that make Tony.
SPEAKER_01:Yeah, Tony's a big the running back traditionally. Carson Beck in big games he makes mistakes, has had two or three critical mistakes.
SPEAKER_00:I think it's in the national championship game. You think it is? You don't think it's against Ole Miss? I I do think the one problem that Indiana has, I don't think it's against Ole Miss. I think he listened against Ole Miss, you throw a couple interceptions, you still have a chance to win that game. Yeah, because your defense is pretty good and their offense is not great. If you play Indiana and you make those mistakes, yeah, you're you're in trouble. You're in trouble. If you play Notre Dame, you should have been in trouble. Yeah, you know, and and we saw it in the third and fourth quarter against Notre Dame. Notre Dame started to mount a little bit of a comeback and started to play their game a little bit. Back through a pick. And back through a pick. So I think it's not gonna be here. Um, but I do think that playing Miami in Miami is gonna be tough. That is that is a tough place. The Miami score is Miami, Miami will miss. I think it's gonna be lower scoring. What's the score? Miami. Uh I'm gonna say And that game's in Phoenix, right? That game is the VRBO Fiesta Bowl. Yeah, so it's Phoenix. Glendale. Yeah, I'm I I just I couldn't remember if it was on a turf. Um it's the uh it's the um Yeah, it's the rubberzona Cardinals. The stadium. Yeah. Um I'm gonna say 24-10. Okay.
SPEAKER_01:So double digit win. Double digit win. And so we'll we'll have another discussion next week about the national championship game for. Oh boy.
SPEAKER_00:That is a I'm telling you, I I I've been down there three times in the last 12 months. Yes, you have. That is a tough place to play, not for the Dolphins, for the to play the hurricanes in that can and those in that stadium in those conditions, it's a tough place to play for anybody. That's fair. But I I think Hoosiers almost seem like that team of destiny that are doing what Notre Dame couldn't do the last couple of years. That's beat Ohio State and beat Miami. Yep. In Miami. Yep. That now, if Indiana goes into Miami and beats the Hurricanes, they deserve that championship, man. That would be crazy in front of a home crowd. That would be crazy. That would be nuts. I don't know if we've ever seen that.
SPEAKER_01:I'm gonna make a bold prediction. Okay, who you got? Ole Miss is gonna win on a last second field goal.
unknown:Woo!
SPEAKER_00:He's a heck of a kicker.
SPEAKER_01:He is. He's uh you got a heck of a kicker. Ole Miss wins Carson Beck throws three picks. Okay. And I could be totally wrong on this. This is just a sense I get Carson Beck throws three picks and Ole Miss wins by a field goal, last second field goal, and then I use. Stomps Ole Miss in the national championship.
SPEAKER_00:Okay. Stomps him. Just make sure we're speeding still. Uh-oh. Yeah, I had technical problems, but we're speeding still. Okay, great. Um, that's a bold prediction. So you think you think they go into uh Ole Miss goes to the national championship? All right. Well, hey, if that happens, I get to see an old friend of mine. Do you? Yeah, because um he's the the general manager of a couple TV stations down in uh in uh Pattysfield or what he he's in um well they're in Jackson. Okay, but they have a show and they cover Ole Miss. Okay, gotcha. Just like we do for Notre Dame. Yeah, yeah, right. Um, but he'll be there. He'll definitely be there. So yeah. And if we're going to if Indiana makes the championship game, we're gonna do a show there. So yeah. We'll go. All right, cool. All right, man. Nice. This has been going under Anesthesia Answer with Dr. Brian Schmutzler. Go, Hoosers. Hoosiers. Do you have your championship gear? Do you have your Rosebowl gear yet? Uh we'll have to we'll have to break that out next time.
SPEAKER_01:But I do have some IU gear. I've had IU gear forever. We'll I'm gonna post a picture of it. My dad, my dad was a huge IU fan. Like this this year would have like just blown his mind.
SPEAKER_00:Well, I think the Hoosier's gonna get it done. All right, great. We'll see you in the next one. Butterfly Network. Oh, yeah, thank you, Butterfly. Thank you, Butterfly Network. Go, Hoosier.
