Thursday, 22 January 2009

Anaesthetists "don't like talking to people"

When I was working as a general medical doctor, I had a chat with my consultant at the time about my future career. I had pretty much decided that I wanted to switch specialties and become an anaesthetist, but I still wasn’t sure so I was trying to canvass a few opinions. I remember that we had finished the ward round a bit early and the team were having a coffee before cracking on with the rest of the work. The conversation went a bit like this.

Me: I’m still not really sure about what I want to do later on, but I’m thinking of going into anaesthetics

Consultant: Anaesthetics? Why would you want to do that? Is it because you don’t like talking to people?

Me: Not really, I think it’ll be interesting, it’s hands-on and I like physiology

Consultant: Well, it seems pretty boring if you ask me and most people go into anaesthetics because they don’t like talking to people…

His attitude of “anaesthetists don’t like talking to people because your patients are unconscious” is one that I’ve come across several times.

The thing is – it’s a load of bollocks and the truth is somewhat different. I’m as sociable a person as you’re likely to meet and those who know me would say that, if anything, I talk too much. Regarding my job, yes it’s true that I can’t exactly engage in witty banter once my patient is unconscious, but people forget that I do talk to my patients before giving them their anaesthetic – both in the pre-op visit and once they come down into the anaesthetic room. This talk, is crucially important to what I do, both in terms of reassuring the often very anxious patient, telling them what to expect and getting information so I can plan a safe anaesthetic. I talk to them afterwards in the recovery room and on the wards. If I meet them in an emergency situation e.g. in A&E resus, I talk to them there, I talk to their relatives and friends as well– especially those of the patients on ITU. I talk to my staff colleagues, basically I spend a large part of my working day talking to various people about various aspects of patient care and this sharing of information makes everything much safer.

It also stikes me as odd that the “you don’t like talking to people” claim is never levelled at surgeons, after all, they don’t talk to their patients when they’re operating do they? You’ve also got to remember that the conversations I had with patients as a medical SHO weren’t exactly the most scintillating conversations either. They usually revolved around how far the patient could walk, what colour sputum they were coughing up at the time or what their toilet habits were like. I have to say, I don’t miss the conversations that my former consultants were used to having with their patients.

When things start to go tits-up, as can happen very quickly in anaesthetics, talking is crucial to keeping the patient safe. I’ll you an example. I’ve got to anaesthetise a lady with vaginal bleeding so the surgeons can have a look at what’s causing it and try to stop it. From start to end I talked to:

The Obstetrics & Gynaecology (O&G) reg: to find out what he thought was really going on and how long he expected the operation to take.
The patient: extensively, in my pre-op visit to find out about her health and to let her know about the anaesthetic
The Operating Department Practitioner (ODP): to tell her my anaesthetic plan
The theatre team: to let them know that everyone is ready and we can get the patient down to theatre
The patient, ODP and ward nurse: in the anaesthetic room before induction
The ODP and theatre team: to lead the transfer of thee now unconscious patient from the anaesthetic room to the operating table
The ODP: as I stabilise her blood pressure during the rocky first few minutes of anaesthesia
The O&G reg: to let him know that he can start the surgery
The O&G reg: to ask what’s going on as this is taking much longer than the “five minutes he said it would
The ODP: to ask him to help me get another, large-bore drip into this lady and set up a colloid infusion via a pressure bag
The O&G reg again: to ask him to tell me what the hell is going on because this woman keeps tanking her blood pressure to 50/20, forcing me to use inotropes, something I wasn’t expecting to need on this 43 year old woman. He tells me she won’t stop bleeding.
The theatre runner: to ask her to call my reg and ask him to come help me out
The ODP: to prepare to intubate this woman
The anaesthetic reg: to explain what’s going on so far
The theatre runner: to ask her to ask blood bank to cross match us some blood
The ODP: to get some “flying squad” O negative blood and set up the blood warmer
The O&G reg: to get an update on what’s going on – he’s calling his consultant.
Blood bank: to ask how long the cross matched blood will be
The theatre runner: to ask the anaesthetic consultant to attend
The O&G reg and consultant, the anaesthetic reg and consultant: to discuss the problem (D.I.C.) and decide which drugs and blood products we need to give
The haematology consultant: for coagulation advice
Blood bank: to order FFP, get an update on the cross-match and let him know we are sending an urgent sample down.
The whole the team: as we work to stabilise this woman
The ITU charge nurse: to let her know that we’re going to admit this patient to critical care and request that they get a bed ready
The O&G consultant and anaesthetic consultant: as the bleeding eventually stops, we discuss her further care
The theatre team: as we end the operation and transfer the patient to Intesive Care Unit (ICU)
The ICU charge nurse and staff nurse: I explain the events so far and the plan going forward as we settle her on the ventilator
The ICU charge nurse: as a put in an arterial line
The patient’s husband: he’s already been spoken with by the O&G consultant and ICU charge nurse, but I answer a couple of further questions that he has.
The patient: after we’ve woken her up, I explain the events and how she ended up on the critical care unit following her “quick, five-minute operation.”

My point in all of this is just to say that, contrary to what some believe, anaesthetist don’t hate talking to people. It’s good to talk and, every now and then, talking saves lives.


Ged said...

All of that puts together quite a persuading argument for a med student unsure about career choices. My final year anaesthetics attachment didn't put all that talking across nearly as well as this post did!

Hospital Lab Tech said...

Really interesting to hear the kind of things going on the other side of the wall to the blood bank. I hope you called them to say thanks (in my 16 years of practice, I have only ever been contacted twice after a trauma to be thanked for my frantic cross-matching efforts, and believe me it made a big difference to my morale).

You also don't mention calling the blood bank to tell them they could stand down. During a trauma, we often recruit in staff from other departments to help out and often keep cross-matching more than we have been asked to so that we can provide as rapid a service as possible. It's nice to be told we can stop and get on with our normal work.

Given that traumas will happen, I actually like how stressed staff can get about them. I quite often get sworn and shouted at during a trauma call, but I don't mind because I like how passionate everybody becomes about saving a life. It shows a wonderful side of human nature.

Also worth bearing in mind is that when you have had a case such as this where you relied heavily on the services offered by Pathology, we would love to hear case studies etc that are often prepared but we're not usually invited.

Keep us in mind.

Dr Michael Anderson said...

Thanks Ged, I love being an anaesthetist. I enjoy "medicine at the sharp end," I enjoy having the hands-on ability to do stuff, I enjoy making an immediate difference to my patients, I enjoy it it in so many ways.I realise that it's not for everyone though so I try to curb my enthusiasm a bit when people ask me what it's like. I think that when deciding a specialty, you should have a good think about what exactlu it is that you enjoy about being a doctor and try to do a specialty that has more of what you like and less of what you don't...

HLT - I well appreciate that the guys in blood bank were working their arses off. This woman had "lots of funny antibodies," so getting appropriate blood products took ages. I can see how you guys get the short end of the stick. At one point one of the theatre nurses said

"This is ridiculous, do you want to call(blood bank) again and try toget them to hurry up - she's still bleeding"

To which my reg replied

"Well, we've called them already and they know what's going on down here. I don't think that calling them again and harassing them will get us the blood any faster"

I initially asked for 2 units of blood because initially, the situation didn't look that bad, but the BB guys were a step ahead of me and crossmatched 4 - we ended up using 4.

I did call the haematology tech to say thank you for his hard work - I can't believe you've only been called twice! I said thank you to everyone involved.

I hadn't thought of writing this up as a case-study but I may well do that now (I'll be able to present it and put it on my CV) thanks for the idea!

madsadgirl said...

An absolutely brilliant post. It shows how important the anaesthetist is in medicine and it is somewhat disappointing that other doctors should assume that you want to work in such an area because you don't like talking to patients. I should imagine that you actually talk to them more than most of the others that are involved in their treatment.

DrJDR said...

I guess that almost every branch of medicine has its own stereotype, which is often used as a put-down by people from other specialties. These are generally ill-informed and borne out of a lack of understanding of other people's work.

These include the classic characterisation of surgeons as being people who "if in doubt, chop it out", dermatologists who "only have three diagnoses and two treatments" and so on.

Psychiatrists of course get it more than most - one I remember from my days in general hospitals was "oh, you're going to be one of those people who write 6 pages in the notes and then always write the same thing at the bottom - 'suggest paroxetine 20mg'". Or the not infrequent comments that psychiatrists are "not proper doctors" etc. My medical consultant nearly fell off his chair when I told him that I wanted to be a psychiatrist, and another friend was told when asking for a reference "yes, of course I'll give you a reference so long as you don't want to be a psychiatrist".

I guess taking a broader view what we're really talking about is stigma. It's probably stretching it a bit to say that anaesthetists are stigmatised (I wonder if you feel that this is true at all in your experience?) but certainly I remember surgeons speaking in rather disparaging tones about the anaesthetist reading the newspaper during the operation etc.

We don't talk about stigmatisation within medical specialties, but it is definitely there. GOing back to my world, the attitudes of hospital doctors to psychiatrists is often quite flippant - until in the middle of the night they have a highly disturbed and physcially unwell patient trying to leave the hospital, and they have no idea what to do. More than once I have been summoned to general wards to give advice about detention under common law, section 5(2) of the Mental Health Act etc. A rare occasion when the tables are turned!

Dr Michael Anderson said...

MSG - I think that this attitude is becoming less prevalent as time goes on. This is partly because anaesthetics is an expanding specialty and we are comng into contact with more and more medics from ther pecialties. As this happens, more and more people see what we actually do.

DrJDR - I agree with you completely about stereotypes and medical specialtis. I don't think that anaesthetists are stigmatised particularly badly, to be honest with you and I'd take anything that surgeons say about anaesthetics with a large pinch of salt, because - as a whole - they know bugger all about it.

I agree with you that, as a whole, psychiatrists are the most stigmatised of the medical specialties. One of my old consultants called you guys the "thought police" and I distinctly remember one of the med regs going on a five minute rant about psychiatry which ended up in him declaring that they "should just have their medical degrees taken away from them, at least that way we'd all know where we stand"

But you are right - what it comes down to is just a lack of knowledge of what other people do.

Hospital Lab Tech said...

It's fab you picked up the phone to the lab to say thanks, it's very, very rare. I wish you worked at my hospital! (Maybe you do, we wouldn't know!)

For example: years ago there was a maternal haemorrhage in DIC (she died - it is without doubt my most traumatic shift). I had two police cars blue-lighting blood in for me from the Transfusion Centre - it was *that* bad. I broke so many rules, guidelines and protocols just to get that blood / FFP etc out the door. At the time I figured I'd be up for suspension at the very least - but I didn't care. I was willing to put my job on the line because I could say hand on heart that I was acting in the patient's best interests (and I would do the same again). It took me a long time to get over the shock of this (I was delivering the blood to the ward myself and saw first hand the state of the patient - I'm not used to seeing such things and it affected me deeply). After the event, there was a big de-briefing about it all, and thank-yous and counselling offered to all involved. All except me. We're always the forgotten ones. I'm not expecting a 21-gun salute but my input being completely ignored wasn't a great moment in my career... (I didn't get suspended, or even investigated, I had to write up what I did and why and nothing more was ever said).

Do that case study - and invite the lab to hear it.

Well done for opening people's eyes to the role of an anaesthetist...

Alister said...

Dear Dr Anderson

I am currently a hospital pre-registration pharmacist considering returning to university to study medicine with a view to becoming an anaesthetist. When I tell people about my choice, they think it is a bit odd, but to be honest I don't care what people think; That is my goal and I would do anything to achieve it.
I found your post very interesting and entertaining and would recommend it to anyone who would say 'well, all they do is just putting people to sleep'.

Any advice in order to enhance my chance getting into medical school will be greatly appreciated. Do you think that a pharmacy background would be helpful for an anaesthetist?

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Anonymous said...

Nice post!

Eddie said...

Maybe the consultant was just pulling your leg. When I first read what he said, I chuckled a bit. It's like one of those dentist jokes. I happen to know that anesthetists are also sociable people, like you and my brother's Atlanta sedation dentist. In fact, they really have to talk to their patients to check if they feel any pain during a dental procedure.

You're absolutely right. Talking can save lives. Here in Atlanta, sedation dentistry often entails talking between dentists and patients, especially when discussing about anesthesia alternatives. So I guess, you shouldn't take remarks like that seriously. Just laugh it off!