Relationship between the surgeon and the
anaesthetist has been evolving over a long time. When anaesthesia started in 1846 and thereafter for more than 75 years, the requirements of surgery were very basic. A quick painless surgery for removal of limb, tumours, abscesses were surgical operations. One of the assistants working with the surgeon would pour ether or chloroform on the face of the patient with Schimelbush mask and that was anaesthesia. Then some vapourisors and apparatuses to administer anaesthesia started appearing, and the art of anaesthesia slowly started getting converted to a science. With this improvement, the surgical fraternity started doing more and more major, and demanding operations for the anaesthetist. Lot of pharmacological, physical, chemical and electronic research started to better the science of anaesthesia. With this there was a need to train physicians as anaesthetist, who has to know all aspects of the human body, its functioning, different drugs like sedatives, pain killers, muscle relaxants and volatile anaesthesia agents. A full fledged training and post graduate qualification became available in this branch. Till this date the anaesthetist was one of the surgeon’s assistance who administered anaesthesia. With specialized training and well developed science the anaesthesia practitioner started getting the importance and respect from his colleagues. This transition from surgeon’s assistant to an independent specialist took a very long time. Along with his routine work the anaesthetist started looking after the very sick patients in the ICU, and for more than the last 60 years it is accepted as a speciality all over the world.
After the establishment of the speciality; the pattern of anaesthetist’s relationship with the surgeon took some time to change from an assistant to a colleague of the surgeon and was gradual, changing faster with every new generation. In the early years of this period the anaesthetist had to be an assistant with little freedom and increased respect. This changed rapidly with the newer generations and today they are colleagues who respect each other’s knowledge and ability. As the patient comes first to the surgeon, he is the primary doctor of the patient and the anaesthetist is called by the surgeon for his services. The surgeon chooses his anaesthetist from his confidence in his ability, association and rapport. In this pattern of private practice, ultimately it is the prerogative of the surgeon to choose the anaesthetist , as patients rarely ask for their choice, But the time has come when the patients have started asking who will be the anaesthetist for his surgery. It is not always possible to call an entirely unknown anaesthetist for a surgeon who have not worked with each other. Many superspeciality surgeries have their fine requirements and also every surgeon is used to certain finer details and procedures of anaesthesia which a newer person may not know and one has to develop rapport with each other to work as a team. The two could have a relationship which is entirely professional where two professionals approve of each other’s method of working, their ability and temperaments. There is no interpersonal relationship of friendship. Respect for knowledge, integrity, ability are very important for lasting relationship. It is a human adjustment between two persons with a resolve to work with each other. If there develops a bond of friendship in this relationship, it is the best situation as friendship removes all barriers and helps to cement the relationship. I would any day prefer this to only a professional relationship but for that you have to choose like minded people and also be lucky. In this pattern of practice as the surgeon is the person to whom the patient comes to, and he is the one to call the anaesthetist, there is a certain degree of magnanimity expected from the surgeon in not letting his colleague feel his dependence on him for being called and give a sense of security and honour to the colleague, who contributes to the success of the surgeon. The anaesthetist has to reciprocate his surgical friend’s trust with the same amount of understanding, loyalty, sincerity, friendship and of course professional excellence. This will make a delicate relationship solid and stoic. Relations between surgeon and anaesthetist could be purely professional and go on for years but could also be fragile. I personally prefer a relationship which has an element of friendship and not existing only for monetary considerations.
Ethical and professional integrity in this relationship is also of the utmost importance. The patient comes to the surgeon, he takes it on himself to cure him of his problems. The surgeon puts all his might to make the patient better and the anaesthetist has to help him with equal sincerity. Leave aside negligence but casual attitude to the safety of the patient is not accepted. One thing the anaesthetist has to realize in his career, is eternal vigilance is required all the time from him. Professional ability, quick decisions, actions in emergency and a desire to do his best is expected of every doctor. I remember two quotations in one of our books, one say “first of all do no harm” and the other “eternal vigilance is the price for safety”, how apt these are for the young anaesthetist to keep in mind. Sincerity, utmost concern for the patient’s safety, knowledge and ability are qualities which will always be appreciated by everybody and will lead to a sound relationship with surgical colleagues.
In private practice in the city of Mumbai and places around when a patient goes to a surgeon, if he needs surgery, he is told about the surgery needed and where it could be done. The surgeon quotes his fees depending on the type of surgery needed and the patient’s ability to afford. In addition to other considerations the surgeons’ charges depend on his seniority, his busy practice, his name and fame in the field and hospital and type of room the patient has chosen. The surgeon usually quotes the anaesthetist’s fee which is 1/3rd, 1/4th, or 1/5th of the surgeon fee. This monetary transaction should be above board and never be a cause for discord between two doctors.
In government, municipal and some big hospitals where there is a full time staff, both surgeon and anaesthetist are on a salary basis, there is no room for monetary transactions between the doctors. In private and big corporate hospitals, for different variety of operations, surgeon’s fees are decided upon by the hospital and the anaesthetist usually gets 1/3rd of the total surgical fees. Monetary conflicts and interests do not play a part in these places.
At the end I would like to state that it is in the hands of both the specialities, to choose their respective colleagues and both should keep all the aspects of practice above board, make it a long relationship full of happiness. I would like to end my write up with one famous quotation which all of us should remember
“Honour and shame from no condition arise
Act well thy part and there your honour lies”
|
