What qualities make for an outstanding anesthesiologist?
I’ve been practicing anesthesia since the mid 1980s. I’ve met and worked alongside hundreds of anesthesia colleagues from all corners of the globe. Some were academic professors, some were trainees at a university, and some were community anesthesiologists either in my group or in other anesthesia companies.
The bell-shaped normal curve describes the random distribution of many things. A bell-shaped curve exists for the abilities of anesthesia doctors as well.
We’re entering an era of metrics for physicians, in which the government and hospital systems will collect data to monitor quality and performance. Because the outcomes of most surgical anesthetics are overwhelmingly uneventful, the occurrence of negative metrics for anesthesia performance will be rare—too rare to quantitate whether one doctor is “better” than another.
Rather, I’m choosing to list the qualities I’ve witnessed that make physician anesthesiologists stand out as leaders.
To be an outstanding anesthesiologist, you must:
- Be smarter than other anesthesiologists. Certain anesthesiologists pride themselves on keeping up with the new developments in medicine. They also repeatedly review the essential knowledge base they learned as a trainee. Their pursuit of knowledge is multifaceted, and includes reading journals, attending lectures, attending conferences, and habitually reading textbooks, Pubmed, or Internet searches when they see an opportunity to learn. Interaction with other smart anesthesiologists is essential. I’ve seen instances where an isolated company of anesthesiologists tells themselves, “We are the best anesthesiologists,” when they rarely interact with the anesthesia world outside their group. This can be a vain conceit. Only by engaging the greater community of anesthesiologists outside your tiny geographic domain can you exchange information and grow as a doctor.
- Be prepared. The Boy Scouts of America motto is “Be Prepared.” Anesthesiologists must abide by the same value, because an anesthesia complication that goes sour can cost a patient’s life within minutes. Every anesthetic is an opportunity to care for a patient at the highest level, and an opportunity to err. Planning anesthesia care, based on your training, experience, and knowledge, is critical. You also need to be ready to manage a difficult airway, hypotension, hypertension, or the myriad of acute respiratory and cardiac complications that can occur before, during, or after a surgical anesthetic. Pay attention at every Quality Assurance meeting, every Mortality and Morbidity conference, and to every tale of a near-miss anesthesia calamity. Remember the circumstances of other doctors’ complications, and utilize the information to be a safer doctor yourself.
- Be friendly and personable. You have to get along well with surgeons, the nursing staff, the scrub techs, administrators, and the patients. If your medical colleagues look forward to working with you because you’re a pleasant individual with a positive attitude, this bodes well. If your medical colleagues find you brash, moody, or easily angered, the opposite is true. Anesthesiologists aren’t typically known to be verbose. A pathologist friend of mine, commenting on the lack of verbal skills in his profession, one said, “The extroverted pathologist looks at your shoes instead of his own shoes when he talks to you.” Don’t be like that pathologist. Polish your interpersonal skills.
- Learn how to wake up patients promptly. It sounds elementary, but I still see mid-career anesthesiologists whose patients take too long to wake up. Their patients are obtunded on arrival to the Post Anesthesia Care Unit (PACU) after surgery, and they rely on the PACU nursing staff to complete the job of anesthesia wake up. Surgeons, nurses, and other anesthesiologists notice this, and the reputation of a practitioner who can’t wake a patient on time is no secret within a surgical suite.
- Learn to perform medical procedures at the highest level. Anesthesiologists are hands-on doctors. We earn our living placing breathing tubes, IVs, arterial lines, central lines, epidural catheters, spinal blocks, and ultrasound-guided regional blocks. Some anesthesiologists are wizards with their hands. Some are not. Reputations are built and lost based on the manual skills of physician anesthesiologists. The nurses, surgeons, and techs know which anesthesiologists to recommend, and they won’t recommend you if you’re inept.
- Enjoy your 10 minutes with each patient prior to surgery. The preoperative evaluation is a medical interview to review the history, physical examination, and laboratory tests, and the evaluation is followed by a discussion of the anesthetic alternatives and risks—but those 10 minutes are much more than that. It’s your chance to get to know this person you’re about to render unconscious. You have an opportunity to converse about their heritage, the geographical course of their life to date, or their hobbies. The patient wants to like you and trust you, because you’re about to take his or her life into your hands. Take the time to connect with your patient before the anesthetic, and you won’t regret it. In our anesthesia company’s practice, we MDs have always inserted our own preoperative IVs. This gives us more face time with the patient to converse with them and comfort them, and perhaps make them laugh prior to rendering them unconscious. Many hospitals and surgical centers prefer to have an RN place the preoperative IVs. This may save 3-5 minutes of time. I’m all for efficiency, but this time is better spent with the doctor applying his or her skills at IV insertion while chatting and putting the patient at ease.
- Avoid letting surgeons boss you around. Many surgeons are excellent co-professionals to work with, and some are not. Some surgeons are bullies, and are condescending in their remarks and attitudes toward the anesthesia provider they’re working with. I implore you to never submit to this abuse. The most important value in the operating room is to care for the patient, but this value is never best served with a surgeon intimidating the operating room staff. Stick up for yourself. Stick up for the circulating nurse and the scrub tech as well, if necessary. In the long run this will result in excellent care for more patients. The other medical professionals in the operating room will respect you for it.
- Cultivate your speaking and writing skills. It’s difficult to rise among the ranks of your fellow physicians unless you’re a superior communicator. Speaking skills are essential in every doctor-patient conversation. You’re selling yourself to the patient and their family as a confident practitioner. They’re nervous, they’ve never met you, and they’re forming their first impression of the individual who will soon be responsible for keeping them alive. Your abilities to communicate with surgeons, nurses, and techs before, during, and after a surgical anesthetic are also important. To rise to leadership roles, you must eventually speak at committee meetings, clinical conferences, administrative meetings, and possible at community, county, or state level medical meetings. Likewise, the ability to express yourself via the written word is critical. Some physicians will find themselves authoring peer-reviewed publications in scientific journals or chapters in textbooks. Others will author columns or opinion pieces in hospital, community, county, or state newsletters. Even routine communications via email are opportunities to produce eloquent, well-organized thoughts to your medical colleagues.
- Avoid being a “locker-slammer.” In anesthesia jargon, a locker-slammer is a practitioner who finishes his or her day of operating room anesthetics, goes directly to the locker room, changes out of his or her scrubs, slams the locker shut, and goes home. A locker-slammer will shun hospital politics, meetings, and out-of-the-operating room medical interactions. A true locker-slammer may practice at a given hospital for years and be unknown to anyone outside of the operating room suites. To avoid this fate, get involved. Anesthesiologists are vital on hospital committees such as the Quality Assurance Committee, Pharmacy Committee, Critical Care Committee, Emergency Room Committee, Medical Executive Committee, and many more.
- Trust your gut, and choose a line of work you love. The saying goes, “If you love what you do, you’ll never work a day in your life.” Outstanding anesthesiologists love their career. If you don’t love managing Airway, Breathing, and Circulation in surgical patients at all hours of the night and day, perhaps you’ve chosen the wrong specialty.
- Avoid complaining about long days or short days in the operating room. In my first year of private practice I used to moan about days with little or no work, because I wasn’t making any income that day. Two days later I’d have a 30-hour shift where I was working constantly without sleep, and I’d grouse about that. A senior anesthesiologist took me aside and said, “Richard, don’t complain about the short days. Get out there and enjoy your free time. And don’t complain about the long days. Those are the days you’re making money, and be happy about that fact, too.” He was right, and I share his advice with you as well.
- Understand the economics of anesthesia practice, billing, and reimbursement. I knew very little about these topics when I finished my residency training. Graduating residents in the 21st Century still know very little about these topics, which puts them at high risk to accepting low-paying jobs with little upside for leadership. Anesthesiologists earn solid money, but different job descriptions pay markedly different wages. Shop around. Attend the American Society of Anesthesiologists Practice Management Conference. If you’re ambitious, why would you take a job as a 40-hour per week employee for a large corporation, if that corporation is billing high fees for your service and then paying you 50% of what they collect? Physician anesthesia leaders must become skilled businessmen and businesswomen as well as clinicians.
These are a dozen traits I see in outstanding anesthesia colleagues. How many of these traits do you have? If there are traits you lack, I hope this column inspires you to gain them. Be patient with yourself. A career in anesthesia is a marathon, and these 12 tips are guideposts for your journey.
Published in September 2017: The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
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