Specialties in the spotlight: anaesthetics

Overview

To outsiders, anaesthetics can seem a mysterious and intimidating specialty, full of complicated equipment, pungent vapours and impenetrable physiological formulae. Anaesthetists have at their fingertips useful skills that are the envy of their peers: airway management, fluid management, venous access, analgesia and resuscitation of the critically ill. When a patient is really sick, everybody wants an anaesthetist nearby. Anaesthetists are found all over the hospital, although the operating room, the labour ward, the intensive care unit, the emergency department and the pain clinic are their commonest habitats.

Anaesthetics is the largest hospital specialty. Figures from the Royal College of Anaesthetists indicate that there are more than 10,000 anaesthetists practising in the UK. Anaesthetists are mostly friendly, well-adjusted people who enjoy their jobs, work hard, treat their juniors well and hardly ever shout or throw things. It’s a specialty that is somewhat more family friendly than others, so there are opportunities to train and work part-time, and there are good opportunities to train abroad.

The pattern of work is quite linear and predictable, with few interruptions. Sometimes anaesthesia is likened to flying an aeroplane: the complicated parts are the take-off and the landing, but once in midair it is usually quite relaxed. Technical skills play a large part in anaesthetic practice, and anaesthetists become adept at inserting needles into some very elusive places.

Anaesthetists also have many roles in other areas. Intensive care is a specialty that, until recently, was almost entirely populated by anaesthetists; now other specialties are becoming involved, such as:

• Obstetric anaesthesia, which deals with providing pain relief in childbirth, either analgesia for a labouring woman, or anaesthesia for an operative delivery.
• Pain medicine, which is a small, but fast-growing subspecialty.
• Paediatric anaesthesia, where you might anaesthetise a baby only a few days old.
• Cardiothoracic anaesthesia, where you might anaesthetise a patient whose heart is deliberately stopped for an hour during an operation and then restarted again.

The mainstay of anaesthetic practice is providing anaesthesia for surgery. This generally involves assessing and working up patients preoperatively, which often requires an early start, then performing general anaesthesia (or sometimes a regional or neuraxial block, such as a spinal or epidural anaesthetic) on the patient. The anaesthetist remains with the patient throughout the operation, making sure that the patient remains comfortable and safe throughout. Afterwards the patient is taken to the recovery room, and the next anaesthetic is begun.

The anaesthetist is usually responsible for postoperative analgesia, and care of the patient doesn’t end at the door of the theatre. Like Jedi, anaesthetists frequently work in pairs, which means that coffee and meal breaks are generally very reliable.

Personality: Good technical skills, calm under pressure, attention to detail, patience, sense of humour, leadership.

Best bits: Rewarding, one-to-one consultant training, high level of colleague support, patients nearly always feel better after you treat them.

Worst bits: Little continuity of care, fellowship exams can be a real barrier for some people, your patients will generally not remember or credit you for their care, finishing work half an hour after the slowest surgeon in the hospital.

Stress: Generally low to modest; occasionally high during emergencies or around exam time.

Competition: Moderate.

Advice for trainees

Working nights and weekends is part of the package for anaesthetists. Trainees may have blocks of night shifts, although consultants still usually take calls from home, and most departments are large enough for on-call nights to be acceptably infrequent.

Anaesthetists have a very different pattern of work from other hospital doctors. Their life is generally free from ward rounds, clinics, paperwork, dictation, heartsink patients and winter beds crisis. Each day begins afresh with a new operating list. On the other hand, there is little continuity of care, and opportunities to follow an individual patient through an illness or a crucial period of life are few.

Working in anaesthetics is great, but it isn’t for everyone. The best way to experience it is to do it. However, foundation posts in anaesthetics are rare. Explore taster weeks, which are offered in most hospitals – also, most departments will have a selection of friendly approachable anaesthetists who will be happy to let you shadow them for a day.

At its core, anaesthesia is about relieving human suffering. It’s also tremendous fun, and offers the daily opportunity to make a real difference in someone else’s life. This means it is a very enjoyable and rewarding specialty.

Useful links

• Health Careers –www.healthcareers.nhs.uk
• The Royal College of Anaesthetists – rcoa.ac.uk
• The Association of Anaesthetists – aagbi.org
• Robinson, Neville; Hall, George. How to Survive in Anaesthesia: A Guide for Trainees, 2nd edition, Blackwell (2007)
• Visit YouTube and watch “The Anaesthetist’s Hymn” by Amateur Transplants.

Dr O’Donnell is a consultant anaesthetist who trained and worked as a consultant in the UK for several years.