Life as an anaesthetistBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4751 (Published 26 July 2019) Cite this as: BMJ 2019;366:l4751
Anaesthetists are trained to provide pain relief services, to manage resuscitation problems, and to support and manage life functions while a patient is unconscious. They have been closely involved in patient care during surgery for a long time, but they are becoming increasingly involved before, and after, operations as well.
They work in a range of settings, and also provide sedation and anaesthesia for patients undergoing procedures outside the operating theatre, including endoscopic procedures, interventional radiology, and dental surgery. They may work in obstetric units providing pain relief and anaesthesia to women during childbirth, or they may be involved in the resuscitation and stabilisation of patients in the emergency department, in intensive care medicine, or in interhospital transfers of critically ill patients.
A typical day
Anaesthetics is a varied specialty. During one day an anaesthetist may perform an epidural for pain relief for a woman in labour and then later anaesthetise a football player with damaged knee ligaments. They may resuscitate a sick patient in the intensive care unit in the morning and then work in a chronic pain clinic in the afternoon.
The perioperative anaesthetic care of the surgical patient makes up the core of their work. A typical day would start with the anaesthetist checking on drugs and machines. They would then look over the day’s list and have a discussion with other members of the surgical team in order to put an anaesthetic plan in place.
This would be followed by a visit to patients on the day ward to discuss their planned surgery. Patients may be frightened of being “put to sleep” or of feeling pain, so the anaesthetist will need to be calm and reassuring while explaining the procedure. The anaesthetist would read through the patient’s chart to gather information from previous anaesthetics and admissions as well as looking at their current blood results and investigations.
In theatre the anaesthetist administers the anaesthetic and continues to monitor and adjust drugs or fluid as necessary. When the procedure is complete, the anaesthetist wakes the patient and transfers them to the care of the recovery nurses, making sure they are calm and comfortable. This is then repeated for the next patient on the list.
The day will be interspersed with visits to the recovery room to check on postoperative patients, visits to the ward to review patients planned for surgery, and doing preoperative visits for the next day.
Many anaesthetists specialise in a specific area outside of the operating theatre, such as intensive care or pain management. Within anaesthetics itself they may specialise in paediatric, cardiac, or obstetric anaesthesia.
Anaesthetists often take a leading role in coordinating the multidisciplinary perioperative medicine team which aims to deliver the best possible care for patients before, during, and after major surgery. The teams assess and prepare patients for surgery to optimise the treatment of coexisting disease. They plan the care in hospital and support the patient during the days after surgery.
Professional development and revalidation
Revalidation is the process where all licensed doctors have to demonstrate to the GMC that they are up to date and fit to practise. The Royal College of Anaesthetists has published supporting information required by anaesthetists for appraisal and revalidation at www.rcoa.ac.uk/document-store/supporting-information-appraisal-and-revalidation-guidance-doctors.
Continuing professional development (CPD) is any learning outside of undergraduate education or postgraduate training that helps doctors maintain and improve their performance. It can include external activities such as attending educational meetings organised by national bodies, specialist societies, or commercial providers, and internal activities such as locally organised teaching programmes, clinical governance meetings, and personal study.
The college recommends that doctors should complete a minimum of 50 hours per year of CPD which should be a mix of internal and external activities. The college’s guidance for continuing professional development is available at www.rcoa.ac.uk/node/1922.
Attractions of being an anaesthetist
· Immediacy of care
· Allows for flexible working
· Mix of acute and elective work
· Work in many different areas of the hospital
· Build relationships with patients and colleagues
Challenges of being an anaesthetist
· Unpredictable situations can arise
· It can be stressful and pressurised
· Lack of public and professional appreciation and recognition
· There are irregular night, weekend, and on-call shifts
The Association of Anaesthetists Support and Wellbeing service gives support and guidance https://anaesthetists.org/Home/Wellbeing-support. The BMA Counselling Service is open 24 hours a day, seven days a week. Call 0330 123 1245.