This week Dr Helgi Johannsson is talking to us about Anaesthetics. A seasoned blogger on all things TGDed (trauma gas education) he is a consultant anaesthetist and clinical director for theatres, anaesthesia, pre-op assessment and pain at Imperial College HT in North West London. His interests include education, simulation, safety, trauma, upper GI anaesthesia and social media in medicine. We were lucky to get a few minutes of his time to grill him on all things anaesthetics…

Right now junior doctors are applying to ST1/ CT1 positions, so when did you realise you wanted to be an anaesthetist? Was this always the path you decided to take?

I had the idea of being an anaethetist as a student, then the medics got me for a bit. However, towards the end of my SHO rotation, I realised I hated ward rounds and clinics so was looking for a change. I nearly went into radiology but found it too dark and went into anaesthesia. No regrets yet.

So what are the best bits about being an anaesthetist? What has been hard?

I enjoy anaesthetics because I like working in a team and doing practical procedures. The worst bit was the exams, they are hard – the Primary I think is unnecessarily difficult with too much esoteric content

What’s the single worst thing about being an anaesthetist?

The status of anaesthetists in medicine and society: half the population don’t think we’re doctors, anaesthesia hardly features in many undergraduate curricula, anaesthetists get much fewer clinical excellence awards in the NHS, and anaesthetists are paid much less for private practice than surgeons. And we hardly ever get speaking parts in hospital dramas.

Could you share with us your most challenging moment during your anaesthetic training?

As a SHO resuscitating a 22-year-old asthmatic who arrested in front of me. (He survived thankfully, I don’t think he had any idea how close to death he came).

What’s your response to those who say you’re just putting people to sleep? Don’t you get bored and how do you keep challenging yourself?

You’d be amazed at how varied my job is, but it changes over time. The most satisfying part now is training people to do what I can do, and being a clinical director brings a whole lot of interest on a much more strategic level. Despite that I still love treating patients – the amount of trust people put in you is humbling and getting them through their operation in a good state is immensely satisfying.

What do you think are the most critical personality traits that a doctor should possess for a career in anaesthetics?

Good situational awareness, communication skills, insight, and good manual dexterity.

A concern of many trainees applying for anaesthetics is the work-life balance; how do you / did you cope with so many nights and weekends and is really it as bad as everyone says?

I grew up in an on-call system where we’d do a single night starting at 5pm and finishing the next morning, which made you tired but didn’t affect your circadian rhythm. I found consecutive nights very difficult as I’m not good at all at sleeping during the day, but got used to it. Bear in mind it’s 7 years as a trainee and over 30 years as a consultant which is much more work-life balance friendly.

What do you see as the biggest challenge facing anaesthetics training in the next 10 years?

Recruitment.

Many members of the public (and some doctors!) think of anaesthetists as technicians. How do you deal with that and is it bruising to your ego having gone through so much training?

Sometimes we don’t help ourselves when we introduce ourselves. I think the term anaesthetist isn’t descriptive and creates confusion as in the US anaesthetists are nurses in and anaesthesiologists are doctors. I think with the increase in perioperative medicine this is lessening and people are realising we do so much more.

Finally, what’s your number one piece of advice to junior doctors who are considering applying for anaesthetics?

Find someone whose opinion you respect to mentor you, ask for help with the application form, get some experience – most of us are very happy to have you tag along, and finally enjoy the privilege of treating people during a really critical time for them when they feel at their most vulnerable.

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