Intended for healthcare professionals

Feature BMJ Christmas Appeal 2012

Lifebox: the difference a donation makes

BMJ 2012; 345 doi: (Published 12 December 2012) Cite this as: BMJ 2012;345:e8407
  1. Jane Feinmann, freelance journalist
  1. 1London, UK
  1. jane{at}

Atul Gawande, writer, and surgeon at Brigham and Women’s Hospital in Boston, US, is also chair of Lifebox, chosen as the BMJ’s Christmas charity. Jane Feinmann asked him just what a BMJ reader donation means

There are 20 national and international anaesthesia societies and associations backing the Lifebox campaign. Why are anaesthetists so passionate about these devices?

Pulse oximetry has enormous symbolic as well as practical value for anaesthetists in the West. The technology is a key component in the revolution in anaesthesia care over the last generation that has brought down the death rate from anaesthesia by over 95%. Anaesthetists were pioneers in bringing concepts of patient safety into medicine, and the oximeter is emblematic of these improvements. These advances, not just in technology but also in ideas, have not made their way into low income countries or even, in many cases, into middle income countries, where most anaesthetists are not doctors but medical officers with more limited training and much lower professional status and do not have the voice to make changes. The enthusiasm for Lifebox is because it is working to bring about the technological and cultural advances in safety that have not so far occurred in over 70 000 operating theatres in the world today.

Can you recall the first time you witnessed a pulse oximeter being used?

In the 1970s, my father, a surgeon in rural Ohio, complained bitterly about the common practice of anaesthestists leaving the room to smoke a cigarette while the patient was asleep. The anaesthetist would say to my dad: “Call me if you have any trouble.” When the first guidelines on monitoring the patient during anaesthesia were published, my dad was almost waving them in the air. He insisted the hospital spend the money on a pulse oximeter and also that the anaesthetist …

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