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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Balancing appointments and work schedule is always a challenge

Taking appointments is a challenging task in private practice. No matter what you do, you cannot please everyone. You have to have a clear conscience and act accordingly. You must keep your first appointment of the day on time. After that it is left at the mercy of hundreds of situations beyond your control. There is no point in secreting adrenaline and it is better to inform or arrange one of your colleagues to manage. Whatever one does, one has to hear from the surgeon “you have taken appointments very closely”. They forget that the anaesthesiologist is being delayed by one of their own kith. I once seriously consulted my teacher about this issue regarding schedule and being on time. His advices was to attend your first case in or before time and in case of delay say “sorry” and start the case. An experienced anesthesiologist can narrate hundreds of stories regarding appointments where no explanation is valid and you are blamed. Forget it and remind the surgeon of the delays that he has caused you and keep your cool; make sure that your anger is not reflected in the conduction of your next case. The surgeon will always have some explanation or excuse. Always talk to the surgeon previous day. A hernia on list can be bilateral hernia or an incisional hernia. This can upset your timing schedule. In any case inform the next surgeon about your whereabouts and the cause for your delay.
In cases you have met with complications or death, discuss the case with your teacher or any senior anesthesiologist. Narrate as things have happened truly, you will always get proper explanation. In case you are not satisfied tell the senior frankly and seek the explanation from another senior anesthesiologist. The same problem can recur in your practice and hence it is better to remember the mistake you have committed.

Read more on this article...

Balancing appointments and work schedule is always a challenge

Taking appointments is a challenging task in private practice. No matter what you do, you cannot please everyone. You have to have a clear conscience and act accordingly. You must keep your first appointment of the day on time. After that it is left at the mercy of hundreds of situations beyond your control. There is no point in secreting adrenaline and it is better to inform or arrange one of your colleagues to manage. Whatever one does, one has to hear from the surgeon “you have taken appointments very closely”. They forget that the anaesthesiologist is being delayed by one of their own kith. I once seriously consulted my teacher about this issue regarding schedule and being on time. His advices was to attend your first case in or before time and in case of delay say “sorry” and start the case. An experienced anesthesiologist can narrate hundreds of stories regarding appointments where no explanation is valid and you are blamed. Forget it and remind the surgeon of the delays that he has caused you and keep your cool; make sure that your anger is not reflected in the conduction of your next case. The surgeon will always have some explanation or excuse. Always talk to the surgeon previous day. A hernia on list can be bilateral hernia or an incisional hernia. This can upset your timing schedule. In any case inform the next surgeon about your whereabouts and the cause for your delay.
In cases you have met with complications or death, discuss the case with your teacher or any senior anesthesiologist. Narrate as things have happened truly, you will always get proper explanation. In case you are not satisfied tell the senior frankly and seek the explanation from another senior anesthesiologist. The same problem can recur in your practice and hence it is better to remember the mistake you have committed.

Read more on this article...