In Praise of Surgeons and Anaesthetists…
2013 April 23rd Wilko Report
In praise of surgeons and anaesthetists…
One of the unintended consequences of “The War of ‘84’” – that is, the NSW Doctors’ Dispute with the Wran Labor Government, was the invention of the term, “Cognitive Specialties”. I have no idea who gave birth to this term. It was used to differentiate doctors who did not do technical and surgical procedures from those who gave thought and advice only to patients. Thus surgeons, anaesthetists, surgeons assistants and some radiologists fell into another category, “procedural specialists”. With the rise of interventional radiology, cardiology and many physicians now wielding endoscopes in the years since then, the division is very artificial.
The “procedural specialists” tended to be painted by the media as the wild, rebellious gang that had abandoned the public hospitals, whereas the “cognitive specialties” (who in the main did not resign their appointments, although with some grand exceptions). They included people like physicians, paediatricians, psychiatrists etc. To be as kind as I can to these colleagues, many of them, I think, were totally bewildered, dare I say frightened, by the events of 1984. Many of these doctors had modes of practice that did not depend much on the income generated by treating private patients in public hospitals. They had become used to sessional payment for ward rounds of patients who were often old aged pensioners of limited means – a few years before, they were expected to look after these people for nothing ( the Honorary System ). They generated most of their income in their private offices – as they do today.
The tentacles of socialised medicine had not touched their private consulting rooms. Believe me, they would have been easy prey for the “Bolsheviks” long before now if the surgeons and anaesthetists had not cocked a snook at government.
The misconception was generated in people’s minds was that surgeons and anaesthetists don’t actually ‘THINK” !! Only “cognitive Specialists” think !! What rot. The War of 84 threw me in with some of the best surgical talents in Sydney. The best surgeons do not appear fast but their operating times are short – the reason for this is that they are constantly thinking two or three moves ahead and every move has a purpose – whereas the worst surgeons ( there are not many of these, but I know a few mediocre ones) can appear to be doing a lot, but the surgery is not really progressing. I have had very competent surgeons admit they have lain awake thinking about a difficult case to be done on the morrow. Knowledge of anatomy and anatomical variants is not easily acquired.
A smooth and safe anaesthetic for a sick or frail patient is not the easy thing you might think – eg which of 4 or 5 induction agents is best, or 6 or 7 muscle relaxants ?
In a major case I would make literally hundreds of small operational decisions while procedure was under way.These were rarely verbalized.
What would you do when a phaeochromocytoma is manipulated and the blood pressure is suddenly 330/220 ? Or an old man having a lens extraction with the eye open suddenly develops acute angina from a bolus of lignocaine with adrenaline from the surgeon’s retrobulbar block and the patient is awake and trying to get off the table ?
Surgeons and anaesthetists DO have to think. We are not just “Butchers and cabinetmakers”. Who does call us that – none other than Former NSW Labor leader, Barriwe Unsworth. In labelling surgeons as such, perjoratively, in 1987, he managed only to insult every honest tradesman, those people on whose backs he had risen to power through the union movement. It is a pity we don’t have more ‘cognitive politicians’.