A sleepy physician or a true partner?

A sleepy physician or a true partner?

  • Issue 61

Gabriel M. Gurman | Editor
gurman@bgu.ac.il

Anaesthesiology as a profession came out of the need to ease the performance of surgery by alleviating patient’s sufferance and assuring his/her homeostasis during operation.

As such, the anaesthesiologist became an irreplaceable member of the surgical team, and as a perioperativist, his/her activity and responsibility starts long before the appearance of the patient in the operating room.

Those are trivial thoughts about a reality which became many, many years ago a banal fact in every healthcare institution dealing with surgical management of patients.

So, how come that I was feeling the need to remind our readers about a situation which is very well known in the medical community, but also in the public opinion in almost every country in the world?

Here is the explanation.

As an anaesthesiologist, I always felt that understanding surgery and learning about its novelties, innovations and achievements represented part of my duty. Many years ago I got in to the habit of reading articles dealing with new aspects of surgical activity and trying to find out it meant for my daily routine.

This habit stays with me even today. So a couple of weeks ago I found an article reproducing the inauguration speech of the current president of the European Surgical Association. I read it with a vivid interest, since the author/speaker touched interesting, and sometimes painful, aspects of today’s situation of surgery, as a medical profession, among them the creation of new subspecialties, the difficulty in recruiting young physicians to this medical domain, the need to cope with mistakes as part of daily reality and mainly the pleasure and satisfaction of being a surgeon.

The author mentioned some of his closest professional associates and partners, young residents, peers, operating rooms nurses, hepatologists, oncologists, not forgetting the fact that he works as a member of a multidisciplinary team.

I read the paper twice and some paragraphs three times even. I was looking for one single word: anaesthesia or anaesthesiologist. No, the distinguished surgeon, now president of a much esteemed European professional body, simply forgot to mention the existence of that medical specialty which makes surgery possible!

My interest grew in reading other inaugural speeches by the new presidents of the European Surgical Association. I found four more papers, all dealing with important aspects of surgery and its current problems. Out of the four papers only one (2006) mentioned, not only once but three times, the important contribution of anaesthesiology as a profession, and of the anaesthesiologist as a significant member of the surgical team!

I do hope that one of the next history flashes to be written by Prof. George Litarczek, will address with this very interesting topic: the development of the anaesthesiologist position in the operating room, in the hospital and also in the medical community.

But even before looking for specific literature concerning this subject, everyday evidence clearly shows that today there is no surgery without anaesthesia and there is no management of a surgical patient without tremendous contribution of the anaesthesiologist.

During my training, many years ago, I heard a sentence that I have never forgotten: “a good surgeon deserves a good anaesthesiologist, a bad one badly needs it!” One of my well known professors, a dedicated general surgeon, used to call us, the anaesthesiologists, the internal medicine physicians of the operating room. Every single anaesthesiologist sees during their life more operations than any surgeon has performed, and not only accumulates tremendous experience in the operating room but also outside of it.

We teach young anaesthesiologists to perform as members of the surgical team, to prepare the patient for the anaesthetic and surgical act, to be useful during every single stage of the surgical procedure, to carefully watch what the surgeon is doing and to adjust the anaesthesia technique to the demands of each phase of the operation. We also try to teach them that our job is not finished once the last skin suture is done, but goes on up to the moment the patient is alert, stable and ready to leave the post-anaesthesia care unit in their way to the surgical ward. We demand that every single anaesthesiologist visit their patient after surgery and try to find out if our technique produced the desired effects regarding postoperative pain, cardiovascular and respiratory stability, etc. We strongly recommend that the anaesthesiologist takes an active part to the postoperative management of the surgical patient, including postoperative analgesia, administration of fluids, anticoagulants, etc.

In one of my lectures about the role of the anaesthesiologist in the operating room I compared them to a backstage director, that professional who makes the “show” possible, who takes care of many “peripheral” things, like the good functioning of the monitors, the availability of stored blood, the need for an intensive care bed for a complicated patient,.etc. I am aware of the fact that sometimes (may be too many times!) it would be difficult for an outsider to understand what our role in the operating room is exactly. In some countries the average citizen does even not know what our tasks are in the management of the surgical patient.

For all these reasons, one could easily accept the fact that the patient and their family do not always have the necessary tools to judge and appreciate the role of the anaesthesiologist in the operating room. But to me it is completely unacceptable that a leading figure in the surgical world would ignore our existence and not feel the need to mention the anaesthesiologist as a member of the surgical team.

I am sure that this sad fact does not reflect the surgeon-anaesthesiologist cooperation and relationship in most hospitals on our continent. I am also sure that the vast majority of our surgical colleagues clearly understand the magnitude of our contribution for the sake of the operated patient. But I felt that it would be unforgivable to oversee this important omission from written and published documents, which could and must guide further generations of surgeons.

The new millennium reality shows that 40% of any anaesthesia department activity is done outside the operating room. We are in almost every single place and corner of the hospital, in the outpatient anaesthesia clinic, in the emergency room, in the intensive care units, in the gastroenterology department, in the paediatric ward. In other words, and only as a speculation, one may say that our profession could survive without any activity in the operating room. But surgery cannot exist even one single hour without the continuous and dedicated help of anaesthesia. We are ready to help and cooperate and we exist in order to make surgery possible.

We do it without asking for anybody’s gratitude or compliments. We do it because it is our duty. However, each of us would be pleased to know that this reality is recognized and appreciated by our partners in the operating room.