After a SURGERY thank the Anesthesiologist, before you thank the Surgeon !

[World Anesthesia Day : 16th October] 

Dr Harish Shetty

[dedicated to the entire fraternity of Anesthesiologists and those who I have worked with such as Pinakin Gujjar, Mrunalini Helekar, Nalini Patel, Vishwas Sane, Sushil Sarda, Aruna Ubhaykar, Late Sameer Pradhan, Amol Pradhan, Ujjwalraj Dudhedia, Shobit, Vaibhav, Reena and so many others]

How many of us thank the anesthesiologist after a surgery? 

Almost none !

We thank the surgeon the 'hero' the 'super star' profusely. We pay him also lavishly most of the time. We invite them to our marriages, family functions and refer our relatives too for advice. After the birth of the child via a caeserin operation how many happy parents give a box of sweets to the Anesthesiologists ? How many of us know what the behoshi ka doctor does. Well S/he is the charioteer steadying the chariot while a tentative Arjun stumbles, falls, suffers from doubts or shoots his sharp arrows precisely and confidently. S/he is the Sun in the Galaxy of Medicine. Just as the Sun lightens up the earth these guys lighten up the operation theater supplying oxygen to the human body that is in deep slumber. S/he is the person between life and death. 

S/he is the one who protects the body from collapsing when the blade of the surgeon falls on the wrong tissue or moves slower than expected. You are kept alive and beating by this tribe. S/he observes like Krishna as the last part of the body is stitched  towards the final moments of the operation. S/he is the 'Krishna' and the 'Sanjay' who knows and is also the quiet witness. S/he waits till you get back to your consciousness as you gently open your eyes at the call of this behoshiwala doctor. Without this guy the surgeon is a zero. He can do nothing. 

Recently in a seminar a senior  Onco-Surgeon  remarked that he is always worried about who is on the head end of the patient that reads……'he is always worried about who is the anesthesiologist'. I had to remark that the doctor at the head end is also worried about who is wielding the blade. It is a two way process. It is a task where the behoshiwala doctor maintains the environment for the surgeon to repair, replace or resect a part of the body.The breath and the beats of the heart is in the hands of this invisible soul while the blade does its job. Your life is in his/her hands. Needless to state that the tasks are equal. I reiterate the skill set required by the anesthetist is as or more important than the surgeon. The life of the surgeon and the Anesthesiologist is entwined across life….but….

The Anesthesiologists are exploited across the country by most of the surgeons. They are paid peanuts and at times the money collected at smaller centres from the patients for the behoshiwala doctors are not passed to them. Honestly I have seen it in my own eyes. Completely dependent on the surgeon as in large parts of the country this specialty is largely unorganized and not competent to fight for their rights. Though there are wonderful pairs of Surgeons &Anesthesiologists working together in harmony and peace ,such numbers are far and few.

How many times have you been introduced respectfully to your anesthesiologist before the surgery. No ! I am not talking about the pre op check ups. I am saying how many times have these behoshi wala doctor introduced by the surgeons as their equals ? The answer is obvious by the fact that 99.9% of you guys do not remember his/her name, forget the face. 

The scenario that is visible  is that the lead role in the movie is the surgeon where as the Anesthesiologist just exists outside the frame anonymously.S/he lives anonymously, works anonymously and dies in anonymity most of the times. S/he enters the Operation theater before the surgeon and slips out after the surgeon quietly with his/her bag as you wait outside the O.T to meet the Surgeon anxiously. In most of the Continuing Medical Education activities of the Indian Medical Association I seldom see this tribe called to educate the rest of the fraternity. 

So there is no acknowledgement,praise or recognition of their services by the patient population and also by the surgeons largely reflected by the payments made. 30% is what they get as compared to the surgeons fees and that is unfair. The fees of the surgeon needs to be equal to the anesthetist. Ask these guys how many times they risk giving anesthesia in patients who are very fragile and weak. Again it is not only about money as parity is also about respect. 

The following equation is fair ! But will it ever happen is a million dollar question ! That does not mean that the cost of the surgery should increase. It only means that the package should be such that the fees are equal without a hike in the total cost. 

FEES OF SURGEON = FEES OF ANESTHESIOLOGIST

With little care of their own heart beats the anesthesiologists take a lot of risk as they shoot the intravenous injection and put the patients to sleep maintaining their vital parameters hoping that every thing will go of well. Here daring surgeons also work along and when there is a great sync patients recover. The most exploited of them are the freelance doctors who work in smaller nursing homes with hardly any infrastructure and support. 

India has only one anesthetist for every 100,000 individuals, according to a new survey which found that five billion people worldwide do not have access to safe and affordable anesthesia and surgical care.

The World Federation of Societies of Anesthesiologists (WFSA), a global alliance of anesthesiologists, has launched an online resource tool mapping the total number of anesthesia providers worldwide. A high number of countries reported a total anesthesia provider number of less than five per 100,000 population, highlighting the current crisis in the surgical and anesthesia workforce.

According to their findings presented in Geneva, Switzerland  India, with a population of 1.3 billion, has 883,812 physicians, while the number of physician anesthesia providers is only 16,500. This means the density of physician anesthesia providers per 100,000 population in India is just 1.27.

When there are fewer UBER vehicles available the fares multiply. But this rule does not apply to this profession. In the case of the Anesthesiologists the fee structure  undergoes division. 

My interaction with this tribe occurs when I give Electro Convulsive Therapy to my severely ill patients as a Psychiatrist. Here the Anesthesiologist provides the safe slumber skillfully to my patients when I give the E.C.T. 

During my early days I used to get upset and irritated when my colleague the behoshiwala doctor used to ask me about the status and the recovery of the patients. I felt it was unnecessary interference. But later I realized that this tribe devoid of patient interaction was yearning to feel the joy following the improvement of the patient whom they provided anesthesia. 

The tribe is devoid of such an interaction not out of choice but due to the forced exclusion by the rest of the fraternity especially the Surgeons. Today I see the glint in the eyes of the anesthetist when they are introduced by me to every patient as an equal before the procedure. As the patients improve, the glow in the eyes of my partner is as much as in mine . The joy experienced when they calmly talk to the relatives improves the mood of the team as well as the family recieving treatment. It gives a sense of meaning to the man or the woman holding the umbo bag. 

And when there is a failure in improvement or a mishap [outside the procedure] of any of my patients the pain is as much in their hearts as in mine. Such interactions are much more than the standard pre op or the post op assessments. As we all know when the Doctor smiles at the patient , S/he is healed and when the patient smiles back in gratitude and affection the Doctor is healed. Why deprive the Anesthesiologists of this beautiful interaction. 

So my dear friends please insist on meeting the anesthetist before the surgery in detail and ask him/her all the questions. Also make it a point to ask him/her fees for the procedure and pay him/her directly.In a corporate hospital speak to the C.E.O's to ensure that parity in fees is brought in. Just because the Surgeon solicits the patients that does not give any one a licence to short change the anesthetist. And as you leave the hospital meet the anesthetist also to say a bye bye. 

So on this World Anesthesia Day please pledge to thank the Anesthesiologist before thanking the surgeon after a surgery whenever and always !

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