Newsletter September 2021: What makes us good (and indispensable)?

Gabriel M. Gurman, MD
Chief Editor

This time I did not need to go searching in the literature, because what I do know, and write here, comes from tens of years spent in the operating room and near the critically ill patient.

Not long ago I touched on this subject, but I have the feeling that there is more to say on this subject.

Anaesthesiology is one of the youngest specialities in medicine. It is true, the first known ether anaesthesia was performed almost two centuries ago, but the domain of anaesthesiology became relevant only after World War II, both in Europe and North America. The scientific side of the profession came even later, when research started to be done in the main medical centres all over the world, and the number of scientific journals dedicated to anaesthesia and critical care increased each year.

This means that our tradition is based on what, in the beginning, we learned from one another and all from our own mistakes.

But little by little we transformed our speciality into a normal one, with well-established departments and units, modern technology and drugs, like any other medical field.

This was a hard way to take. As one of the profession pioneers wrote more than half a century ago: once upon a time anaesthesiologists were essentially technicians, appearing in the operating room in the morning, anaesthetising patients without seeing them beforehand, and not seeing them again after the operation, and leaving the hospital as soon as the operative schedule was completed”.

But today the situation is completely different, and there are some characteristics that contribute to differentiating us from other medical specialities.

First of all, we learned to cope with being part of a team. It means that very often we are not the “violin number 1”, we are left behind as the surgeon, who brings the patient to the operating table, is well known by his/her family, and keeps the control in his/her own hands. But we learned to behave like backstage directors of a show, being responsible for almost everything which happens “on the scene”, but not getting the applause of “the public”. This is the art of cooperation, and we are good at it.

We are not “the sleeping partner” anymore in the operating room. We learned how to use modern equipment in order to provide better anaesthesia (like using the ultrasound machine for loco-regional techniques), but also help the surgeon to reach a proper decision by offering him/her important data on the patient’s situation (see the echocardiography performed by us during cardiac surgery).

Secondly, we learned how to stay clinicians and not to lose human contact with our patients. Once upon a time, we have been seen as to be a half- a- sleep doctor near a – half-aware patient.

But, gradually, we succeeded in dividing our daily activity between the operating room and the outside fields of activity: critical care, pain, labour room, resuscitation, administration, education and research. As of today, some 35-40% of our activity is spent outside the operating theatre.

The modern organisation system of medicine, in particular surgery, created a new field, that of same-day surgery, thus obliging us to see our patient (if at all!) minutes before being brought on the operating table. But very soon we found the solution to this problem, which could have led to a complete leak of communication with the surgical patient. The outpatient anaesthesia clinics invite the patient to meet his/her future anaesthesiologist days and weeks before the time is supposed to be in the operating room. The outpatient clinic gives us the chance not only to better know our patient, but also to improve his/her medical status, by performing more lab tests and asking for the expertise of other specialists, cardiologists, pneumologists, haematologists, etc.

Finally, it proved all over the world that we are good organizers, and in many hospitals, the anaesthesiologist is in charge of the operating theatre activity.

I am proposing you a test: think of a completely unrealistic situation in which, one day, there would be no anaesthesiologists available for covering all the tasks of this speciality. You could be sure that at that very moment all the clinical activities of that medical institution would stop!

I cannot finish this without mentioning what my former Canadian director, Dr Arthur Scott (who passed away three years ago) told me many years ago: You know what we are? A DOCTOR first, and then an ANAESTHETIST.


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9 replies

Ricardo Heber
Yes, we could take all anaesthesiologists away... but who would drink all the coffee?? :) Jokes aside, I'm glad to be part of this ever evolving medical specialty. Hardened by the theatre, but still with our doctor's heart (and brains!) Couldn't imagine how, during the last two years, services would cope without anaesthesiologists. We've been put in such a central position with the pandemic that whole services have been reorganized around some of our expertise. (Or haven't they?) Kindest regards,
4 months ago
Priscila C Silva
Perfect!!!! I’m an anesthesiologist in Brasil and I’m really proud of it. Although the patient don’t look for an specific anesthesiologist, we can set a relationship during pre operative meet, the moment when we can see all their fears slipping away and the satisfaction that everything went right when they wake up from a surgery. Our specialty only grows; it’s unique, complete, very beautiful and passionate!
4 months ago
gabriel gurman
To Dr. Abdullah: the so called inferiority complex comes from our low self-estimation. Once upon a time, to my question to a student how did he see our profession he said: we see you exactly as you see yourself!!! Does a backstage director feels inferior in comparison to the actors which show up on the scene? I doubt. It is up to us to improve our own image in the eyes of public opinion and of our peers.
4 months ago
Feroz Abdullah
Dear Dr Gabriel Gurman, Thanks for describing the situation , but some times i wonder whether we Anaesthietist have inferiority complex . I think we need to be satisfied that we are doing several technical jobs in diffrent areas. And neither need appreciation from the Surgeons or patients . The greatest satisfation i feel is self satisfation which we should develop.Our Speciality will develop but working conditions will remain same .
5 months ago
gabriel gurman
You are absolutely right. Thanks GM Gurman Chief Editor
5 months ago
gabriel gurman
Dear Dr. Astrid Pratidina Susilo, many thanks for your reply. We would be interested to get some data about the Indonesian anaesthesia and our Indonesian colleagues. Please do not hesitate to send us some stuff in this subject. GM Gurman, MD Chief editor
5 months ago
Alexandre Ferraz
Perfect! Congratulations
5 months ago
Astrid Pratidina Susilo
Dear Dr Gurman, My name is Astrid Pratidina Susilo, an anesthesiologist from Indonesia. I love your letter, I can relate very mucj to what you wrote. Especially I like this part: I am proposing you a test: think of a completely unrealistic situation in which, one day, there would be no anaesthesiologists available for covering all the tasks of this speciality. You could be sure that at that very moment all the clinical activities of that medical institution would stop! I can imagine what you write and I do agree with you! Regards, Astrid
5 months ago
Cheah Kean Seng
Lovely! Before I join Anaesthesia I heard someone saying 'Anaesthetist is like a pilot in operating room, at the time of crisis, even though there is only limited time for us to react, we still need to remain calm, decisive, keeping composure and good in our skills. We need to have plan B and C in mind even before we attempt plan A. During crisis, it's okay for anyone to feel panicky but never from an anaesthetist. This caught my interest.
5 months ago

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