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The Surgeon and The Anaesthetist : An Enduring Professional Relationship
PB Desai
The world moves on human contact and
relations. In the entire gamut of social and professional endeavours, trust, faith, confidence, mutual understanding and interdependence play a vital and crucial role in ensuring a smooth outcome of any situation or event. This broad principle encompasses any professional, social, political, religious or interpersonal relationships.
Medical profession is a classic example of a harmonious blend of science and human values. Probably in no other profession such harmony co-exists. Medicine is much more than administration of medications or performing a procedure. Beyond this, it is a deep sojourn into the mind and lives of living people who have to deal with a temporary setback in health.
Surgery and Anaesthesia has co-existed ever since medicine began in myths, magic and mysticisms on the banks of the River Nile in Ancient Egypt. Over the preceding millenniums, things began to change slowly and steadily till that fateful day in 1845 when John Morton gave the first open Ether Anaesthesia and the world changed with his words “Mr. Surgeon your patient is ready for surgery” and the surgeon removed a Lump from the neck of the patient in Boston. Anaesthesia and Surgery has never looked back since. It all began as we know between the words spoken by the Anaesthetist to the Surgeon and what has happened since is history and today the scenario of surgery has changed beyond our wildest dreams bordering on fantasy. The single most important factor in the surgical progress of this era is the science of anaesthesia and the skills of the anaesthetist which has allowed a surgeon’s unlimited sojourn in the human system.
Let us for a moment leave behind the scientific progress and achievements in surgery and anaesthesia. Even since the exchange of those fateful words the outlook for patients in need of a surgical procedure has changed forever. Apart from the overall progress of science in the field, it is the human relationship between the surgeon and the anaesthetist that has impacted so deeply in the lives of patients.
While it may be partly true that the front façade of the treating team is mostly that of the surgeon, the anaesthetist since long is a major and equal partner. This is particularly so when surgery has almost reached its zenith. It is not unusual for a surgeon now to encounter questions from patients like “who is going to be my anaesthetist?” This clearly signifies the important and vital role that the anaesthetist and the surgeon play together in the lives of surgical patients.
In today’s day and age, medicine and surgery is rapidly becoming a technology oriented craft replacing the clinical art of medicine. The patient is acutely aware of this scenario. Commercialization is commonplace in the present environment which affects all of us, since we are a part of the existing environment.
The combined technical skills of the surgeon and the anaesthetist restores the patient to normal health in nearly 99% of the cases when the procedures are well and truly indicated and executed with care and caution. This depends a great deal on a careful pre-operative evaluation and assessment, discussion and understanding the nuances of a given case between the surgeon and the anaesthetist. This is the single most important factor in successfully piloting a patient through surgery. Indeed, there is nothing like small surgery or big surgery. The fact remains that no surgery is small to be complacent about and no surgery so big as to be daunted about.
Problems and complications can be predicted, discussed and pre-empted. There is nothing more satisfying to a patient than seeing the surgeon and the anaesthetist together before going under anaesthesia. A word of cheer and comfort and talking about sweet nothings comforts the mind, body and soul of the patient beyond any measure.
Forewarned is forearmed and surgeons and the anaesthetists who have studied and discussed the patient beforehand have won more than half the battle.
In no other branch of medicine does the patient gives away, himself or herself so totally as they do to the surgeons and anaesthetists. We literally and truly touch their tissues; but well before that we need to touch their hearts and minds. This was the era in which we started learning about medicine and these values have a permanence about them which no amount of technology or professional excellence can match.
This enduring relationship should, of necessity, must extend beyond the canvas of professional life – not only to a social level but also to stand with each other in times of need; we are living in changing times; when we began medical training in the 1950s – it was halcyon days for the profession. The practice of medicine brought much happiness, cheer and profound satisfaction; the scenario today has seen a seachange; relationships with patients based on mutual faith, trust and respect has receded into the background and is replaced by suspicion, defensive medicine and high technology devoid of appropriate patient-doctor communication due to paucity of time.
In times of stress and litigation, the surgeon and anaesthetist should stand together to support each other, to stand by truth without indulging in mutual blame and slander.
The hallmark of a true personal and professional relationship is to share – the joys, the sorrows and the problems; for sharing joy and happiness doubles it and sharing problems and sorrows halve them. In no other human relationships does professional expertise combine so efficiently to help and save a fellow human being in times of physical and mental stress.
I have been blessed with senior anaesthesia colleagues from whom I have learned much and interacting with present colleagues has brought much satisfaction, happiness, joy and education into my life. I cherish these moments intensely and they will remain deeply entrenched within me for its onward transmission to the future ages.
In our unending and unremitting quest to increase and master modern technology in medicine, there is a distinct danger that we can become slavish to technology dominance. Already the clinical bed-side art of medicine is rapidly receding and we know that the art and science of medicine is now more of a technology oriented craft.
While technology must be used appropriately to avail of its tremendous benefits we must constantly evaluate our successes against our failures, weigh the benefits versus the risks and assess the value of old treatment methods versus those of new practices. Only then can we practice medicine with a conscience. The practice of medicine without conscience is but the death of the soul.
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