One of my students recently asked me what traits he should develop to become an excellent anesthesia provider. This is an interesting question, because in reality, being an excellent provider of any specialty takes more than just knowing the dosages of the medications, or how to technically perform a procedure. Let me share what we decided during our philosophical discussion.

Being Knowledgeable Takes Hard Work

Of course, to be a leader in your field you have to know your field. Even after schooling is over, that means always striving to improve and to never stop learning. On my first day of medical school at Johns Hopkins, my classmates and I were told that within 10 years, 50% of what we were about to learn would be proved wrong. We were also told that we would only remember about 25% of what we were about to be taught. Unless we continually studied, we might be unlucky enough to only remember our 25% from information that was no longer correct.

Let’s look at a few changes in anesthesia care since I started in anesthesia in 1980.

This is only a sampling, but it shows that we can’t be afraid to question what and why we do. When I started anesthesia we did not have pulse oximetry, capnography, video laryngoscopy, or ultrasound guided nerve blocks. To remain expert requires you to commit to constantly learn new things and to not be afraid of new ideas or new skills.

You are the Most Important Monitor: Focus on Your Patient

I was on a volunteer trip 20 years ago when a very good anesthesia provider spent several minutes trouble shooting a pulse oximeter that had stopped working before realizing that it wasn’t working because his patient didn’t have a pulse. Fortunately, we did manage to resuscitate the patient. You are your patient’s most important monitor in the OR. Our electronic monitors have made anesthesia much safer, but only if you use them to assist you in safeguarding your patient.

I love our modern monitors, yet I can do anesthesia without them if need be because I was trained during a time when we did not have them. Oximetry, automatic blood pressure cuffs, and end-tidal mass spectrometer readings were not yet in use when I started. I had to hardwire in myself the instinct to need to see a new blood pressure every 3-5 minutes, to manually ventilate my patient for hours without forgetting to squeeze the bag, to be able to assess cardiac output by how loud and crisp the heart tones where through my precordial stethoscope. Because of this training, I was ready the time  lightning struck the backup generator at our surgicenter during a city wide blackout leaving us with flashlights and with tour modern whistle and bells.

Most of the newer anesthesiologists in my hospital have never practiced without the newer monitors and equipment and often will rely on them heavily, especially when they are beginning their practice. I always ask my students if they would drive their car looking only at their dashboard and just glancing out the front windscreen every once in a while? Of course they wouldn’t. It’s the same in the anesthesia cockpit. I encourage my students  to first look at their patients when there is an alarm condition, and to use their monitors to assist them rather than rely on the monitors to tell them what is going on. Train yourself to assess your patient.

Be Compulsive

You must be very detail oriented when treating patients because their lives as well as your own safety depend on it. Check your equipment yourself, even if someone else has checked it for you.

Familiarize yourself with sometimes seemingly unimportant aspects of your patient’s medical history.  My patient just the other day had not had asthma since he was a child, more than 40 years ago. But that tendency to wheeze is never completely gone. So I was prepared to treat the severe asthma attack that started right after intubation. Anticipate what you need before you start so that you can have the necessary equipment and supplies and can avoid any avoidable pitfalls.

Be Neat To Be Safe

Seriously? Be neat? Absolutely. If your workstation in the OR has syringe wrappers, empty vials, and other trash scattered among your active vials and syringes, you won’t be able to find the drugs you need quickly. And in a real emergency, it becomes easier to pick up and administer the wrong medication. It also became easier to injure yourself or another provider with unguarded needles and broken vials.

Your Patient is Your Family

My sister Pam, is a recovery room nurse. In her career she has also been an emergency room nurse and an ICU nurse. In each of her specializations she has won awards of excellence for providing compassionate care. She told me recently that her secret is that she doesn’t just try to treat the patient like family; while she is caring for them the patient is her family. If the patient was your mother, sister or daughter, you would want her provider to be compassionate, to be giving undivided attention, and to be prepared for the unexpected.

Have Empathy and Respect for Everyone

Be polite at all times, no matter what is going on. Being polite and kind to people is not negotiable. Treating people with respect means valuing each others points of views. It means being open to being wrong. It means accepting people as they are.

Realize that most of the time dysfunctional behavior may actually be a poor compensatory mechanism for dealing with fatigue, stress and anxiety. A surgeon getting ready to take a patient apart and reassemble him, an anesthesia provider getting ready to induce a controlled coma in a patient and then revive her, or a nurse caring for a patient recovering from such insults are all under a great deal of pressure and stress. Give each the benefit of the doubt. We all have bad days.

Learn To Communicate Well

Obviously as health care providers we need to learn to be clear in all our instructions and comments: don’t be subtle. And for safety you should repeat any instructions you have been given to ensure you heard them correctly before executing them.

But in addition, listen deeply to truly understand. Don’t just listen superficially to the words; listen to the real meaning behind the words. Listen for that person’s core values: patient safety?, family?, honesty?, faith and belief?, healthy work/life balance. If you listen hard you will learn what that person really cares about. And if you understand those core values, then you will understand how to better communicate with that person, whether its your patient, your coworker, or your spouse.

Be humble: Don’t Be Afraid To Ask For and To Receive  Help

It’s very common for human beings to put off asking for help in an emergency until the very last moment. There are all  sorts of potential reasons for this:

• time in a crisis appears to move more slowly than it is—you don’t think you’re waiting as long as you really are to raise the alarm
• providers often feel that if they just have one more try at that difficult intubation, or whatever else is going on, that they will succeed
• ego: the concern that asking for help will make others think more poorly of us
• denial: this can’t really be happening

Asking for assistance early, if you are having problems, is the smart thing to do.

Along the same line of thought, never refuse input from someone who tells you they are concerned that something is going wrong. Don’t be the pilot that lets the plane fly into the mountain because you didn’t listen to the warning.

Learn to Critique Yourself and to Humbly Take Criticism

Life doesn’t come with an instruction manual. I am constantly learning something new about myself. Sometimes its good and sometimes it disappointing but always it lets me grow as a person and become a better provider. Don’t be afraid to place yourself under the microscope and analyze yourself. If someone provides you feedback, take a deep breath, thank them for the input, and honestly assess if there are any truths to be learned.

Learn to Focus: Dissociate From the Chaos

In anesthesia, as well as other medical specialties and professions, the ability to think in the middle of chaos when everyone around you is overwhelmed is an asset. Be calm. Not everyone deals with such stresses as well as others. If you project calm confidence, everyone around you will follow your lead. Dissociating from the emotions during the emergency will help you focus. There will be time later to feel the stress, sadness, and fear from a particular event.

Have A Sense of Humor

Life in our chosen profession is sometimes grim and always stressful. You have to be able to laugh at yourself and to laugh with others. Notice I didn’t say laugh at others —that’s not respectful.

So to summarize, to excel in your field:

• Be knowledgable
• Embrace technology for how it can help you, not tell you what to do.
• Be compulsive, detail oriented, and neat
• Be compassionate and respectful to everyone
• Be humble and open to self assessment and change
• Learn to focus and act calmly despite chaos
• Don’t be afraid to ask for help
• Have a sense of humor

May the force be with you

Christine Whitten MD