Private Practice- Learning the ropes

After leaving the shelter of a teaching hospital you must spare a minimum of two to three weeks as the “learning road period”. An anesthesiologist fresh out of a teaching hospital must observe one or more anesthesiologists already in private practice. This is important since the challenges in private practice are different in many respects than in a teaching hospital. The situation and set up changes from nursing home to nursing home. During this period do not try to assist the anaesthesiologist not even preparing the drug or handing over the syringes. Just observe what he does single-handed without any help from senior, junior or even a ward boy. Observe everything and after the case you may ask explanations for each of the procedures undertaken. Do not assist the anesthesiologist unless expressly called upon to do so.
Over these two to three weeks, you may realize, as I did, that:

• You are all alone and the only expert.
  
• Your equipment is handled by you alone and no one can help you.
  
• Help may not be forthcoming as each one is busy with his own job.
  
• You may be called upon to give a helping hand as necessary.
  
• The time to understand the situation and find the solution is very short. Judge the gravity of the situation quickly and make alterations to techniques or medications quickly.
  
• Pre-operative examination and evaluation may not be possible.
  
• Pre-medication schedule may not work due to many variables.
  
• In the beginning one can expect help from a senior surgeon.
  
• Cases are better worked up by the senior surgeon; a junior surgeon may not realize the gravity of the situation.
  
• Do not depend on the nursing staff in the post-operative period in small nursing homes.
  
• Judge the gravity of the situation quickly and make alterations to techniques or medications quickly.
  
• Balancing appointments and work schedule is always a challenge.
  

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