To the Editor
I respond enthusiastically to your invitation in the Winter 1994-95 APSF Newsletter to contribute to the debate on reading in the OR.
Lt. Col. Bostek (1) has demonstrated outstanding performance on two levels: personally, in eschewing the habit of reading in the OR in order to concentrate on his duties and, generally, by highlighting this major cause of poor performance in anesthesia providers.
In admitting that reading sometimes deafened him to questions from the surgeon, he has also drawn attention to an important aspect of anesthesia monitoring which is very seldom publicly addressed.
The performance of the surgeon also requires constant monitoring to help achieve a safe anesthetic!
One cannot depend upon the anesthesia machine and its concomitant gadgetry nor on the surgical assistants for the performance of this vital aspect of patient safety.
Sitting in the corner of the OR reading a journal kills the opportunity to warn the surgeon that the extra pack or retractor he is busy inserting in the abdominal cavity may very likely compress the inferior vena cava. This will ultimately trigger the cardiac monitor and initiate chaos, but an ounce of prevention is worth a ton of treatment. Experienced anesthesiologists can supply a multitude of examples of other deviations from optimal surgical practice. The complications are inevitably attributed (indirectly but rightly) to the anesthetic deliverer. He or she should not feel aggrieved if all had apparently been peaceful while they were engrossed in reading a journal!
One must, of course, possess the background knowledge to be able to detect defects in surgical technique. One must also be very diplomatic in drawing these to the attention of the surgeon except in those few cases where it is necessary to arouse him or her from a trance like state.
One of the virtues of the old-fashioned open-drop ether technique was the absolute necessity for the anesthetist to watch everybody and everything that went on in the OR every minute of the anesthetic; and very particularly what the surgeon was doing!
This excluded any possibility of developing boredom.
Boredom is the primary reason for seeking distraction by reading in the OR. A bored anesthetist is a very dangerous anesthetist. In the several departments I controlled during my career, a bored anesthetist was a candidate for the firing squad and was told not to approach the hiring squad while I was still around! Lt. Col. Bostek has my fullest support.
I received in the same postal delivery the April issue of the continuing education organ of the South Africa Medical Association and include below the editors comment in an amateur’s translation of the Afrikaans. Of course, radiology (or whatever that discipline is now termed) and pathology are also refuges for doctors who discover too late that they should have been in another professional field entirely.
I wonder what percentage of anesthesiologists have drifted into the specialty for this reason? I have never seen any in-depth study of the ideal psychological profile to a good anesthetist. This is an aspect of safety in the specialty which may be of much greater importance than one realizes.
Reprinted from CME, April 1995, vol, 13, no. 4, p. 347: Caveat medicus
by F. N. Sanders, BDS
A young doctor who worked in a family-oriented general practice said to me one day: ‘I wish these people would stop bringing me their problems. What do they expect me to do about them?’ A few further remarks made me realize that the doctor believed that these patients, who sought advice and reassurance, were weak and stupid. One wonders how the patients would have felt if they had been aware of his attitude. The doctor happens to be extremely intelligent, but as a student should perhaps have been advised to choose another profession. That particular doctor now specializes in anesthesiology which suggests a wish to divorce the patient from the doctor. This practitioner should actually realize that an anesthetist cannot necessarily avoid contact with patients. This is an instance where the doctor-patient relationship is threatened and apparently irreparably damaged. AB doctors should guard against this concept.
Cecil Stanley Jones, D.A. Consultant Anaesthetist Sangrove Rondebosch, Republic of South Africa
- Bostek, CC. Is it OK to read during OR cases?(Letter) APSF Newsletter 1994-1995,9:45.