To the Editor
Dr. Travis’s communication raises a parallel problem of “What to do with younger anesthesiologists?” Admittedly, this problem will (in most cases) be mitigated by the passage of time, but it can be at best irksome and at worst dangerous.
If the suggested questionnaire were modified to include the second problem, these collected data could be made available to training programs for remedial action. The problem can be broken down into five areas:
- utilization/length of stay
- materials management
- professional relations
- clinical skills
1. Cases are sometimes canceled for questionable reasons but this is documented in such a way that a more experienced colleague is precluded from proceeding. Extra days in the hospital result.
2. Cases cannot be started until at least one ampule of every drug in the anesthesia machine is drawn ready for use. Endotracheal tubes, epidural sets, I.V. solutions are opened but may be unused. Some of these drugs and sets are quite expensive.
3. Professional communications are handled along large teaching hospital residency lines. This may result in enraged attending surgeons appearing in the anesthesia director’s office or consuming his time in various committee meetings.
4. Intravenous lines, epidurals and intubations are often found to consume considerable time or the intervention of more senior colleagues. On occasion, simple cases are rendered complex. There may be a cascade of events which an individual lacking insight interprets as justifying his or her complex plan of management.
5. Present day graduates are notable for having a different and perhaps more enlightened approach to the workplace. Vacation, time off and breaks are given high priority. Complaints of overwork and fatigue may relate to greater sleep requirements in the young. At all events, it is my observation that when replacing a 60-year-old anesthesiologist, one will need two 30 year-olds.
Dr. Travis asks, ‘Are these lessons from industry (aviation)?’ As a Certified Flight Instructor with a special interest in aviation safety literature, I think I can respond. Notwithstanding the airline industry mandatory retirement of captains (which is the subject of intense debate), general aviation safety seems to improve with age. Pilots in their twenties have more accidents than those in their thirties, who in turn have more accidents than those in their forties, etc. I am wondering if a similar relationship may hold for anesthesia. The aviation analogy may not serve Dr. Travis, if he wishes to advocate for the young.
I hope the concerns raised by Dr. Travis and myself will both receive the a they deserve.
David L Atkinson, M.D. Director O Anesthesia
Cabrini Medical Center New York, NY