This blog provides some basic textbook-like knowledge based on every day experience. It is hoped that the content will enlighten the reader in basic teaching and furnish basis for well-provided hospital work. Currently, there is no book available which guides a qualified anaesthesiologist working in smaller nursing homes and in district and mofussil hospitals. All the practical difficulties and ways to remedy them or meet them are tackled in the current text.
After my return from the United Kingdom while on the threshold of leaving a full-time job, I was faced with the mountainous task for collecting equipment for private practice in smaller nursing homes. At this juncture I had an opportunity to meet Mr. M. R. Rao and his father. Both of them were friendly, knowledgeable, and gave me well-directed advice as also provided me with all basic equipment needed to start on my own. I am proud to state that I am still using the first bellows unit manufactured by him. Mr. M. R. Rao was truly a friend for a practising Anaesthesiologist starting on his own. Knowing the financial encumbrances that a novice faces he never insisted on advance payment for equipment. This was not solely my own experience but also of others whom I directed to his establishment “Anaesthetics”.
Always keen on being in step with the advances in Anesthesiology, Mr. Rao was very obliging about satisfying all his patrons with any kind of technological information or equipment that was needed. Shopping for new gadgets in Anaesthetics was my favourite hobby, which made me frequent Anaesthetics. He too was very good at reciprocating my interests. I could count on a telephone call from him as soon as any rare item arrived at the Anaesthetics. During my practice I felt the growing necessity of a ventilator. I remember pestering him to manufacture one. Ultimately he did succeed in manufacturing an indigenous ventilator and was open to any criticism. This was true of any apparatus or gadget that was manufactured by his establishment. Any constructive suggestions or modifications suggested to him were promptly implemented. I do not recall any single person who was unhappy with Mr. Rao of Anaesthetics. Over the years Anaesthetics has grown tremendously yet the basic principle of providing helping hand to private practising anaesthetists remains the guiding principle. The various products manufactured are helpful to the anaesthetists. “Anaesthetics” also provide the day-to-day anaesthetic drugs. This noble and helpful friend suddenly left this world without any illness or any warning of any serious illness.
His brother, Mr. Mundkur, is now carrying forward the good work done with the same zeal.
I am also indebted to some senior surgeons with small nursing homes who encouraged me to write my experiences. The surgeons definitely found the difference between the anaesthetist in private practice and those in teaching hospitals. The adaptability and compromise was totally missing in teaching hospital. The similar situation was easily tackled by anaesthesiologist in private practice without any compromise towards the safety of the patient.
Last but not in the least, this book has taken shape due to my wife’s encouragement to jot down all the interesting cases and how I surmounted them. She persuaded me to write a book. Writing another text book did not appeal to me. But in later years I did find the necessity of writing for posterity. There are plenty of textbooks on the shelves of teaching hospital libraries but practical hints are never elaborated in textbooks.
Wednesday, March 25, 2020
The inspiration for this blog
Tuesday, August 10, 2010
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:
Friday, June 6, 2008
Reporting your observations: Beyond the call?
A senior urologist had taken a patient aged 82 for cystoscopy. The surgeon was in some doubt about why he was doing the cystoscopy, but since the patient had complaints he did not want to miss anything serious. I was about to cannulate a vein for anesthesia on the left forearm which was abducted on a arm board when I noticed a thumb sized vein on the chest wall. I wanted him to see it. As soon as he saw it he know that he had missed something big. He removed his gloves and put his hand on the upper part of the abdomen. He later confirmed that it was a big gastric carcinoma with complete blockage of the vena cava. Needless to say, the scopy was abandoned.
My point is that your should report your observations to the surgeon. I asked my students whether they narrate their observations. Some did not respond, some said that it is not our job. In my opinion one of our duties is to guard the patient’s interest; if you observe anything significant report it since silence could harm the patient. When I taught, I presented my private practice cases to my students as problems, I asked them whether they would proceed with anesthesia, refuse anesthesia, or would they like to know what happened to the patient. I made them think about it and discuss it in the next meeting. In this manner they learned much more than what text books could teach them.
