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Since retirement, Dr Chadwick has been busy completing a Masters in Medical Humanities and History. In this article, he shows us how classic essays and a trip to an art gallery can enhance our skills in patient observation.

As medical students we were all taught the importance of ‘the golden minute of silence’ and of silently observing the patient and their surroundings. When conducting a weekly preoperative clinic, I always chose the room furthest from the waiting area so that I could watch the patient and accompanying partner walk the 25 metres into the clinical room.

Find out who has newly joined the College.

It all started conventionally enough – A-levels, a medical degree, house officer jobs. Nobody in my family was medical, so I had no preconceived ideas about postgraduate career pathways.

During my interview for the regional Obstetrics and Gynaecology training scheme, I was asked how I would combine this career with getting married and having a family. As I wasn’t in a relationship at the time, I didn’t feel this was a major consideration, and fortunately neither did the other members of the interview panel!

However, having completed the training scheme and obtained my MRCOG, my career then took a different path…

Find out the latest appointments approved, and with sadness, we record the deaths of some of our fellows. 

The following new appointments were approved, and with sadness we record the deaths of some of our fellows. 

Some are very familiar – a growing, aging population with increasing levels of chronic health problems and significant inequalities in care provision. Others are a factor of the Indian system which Ravi describes as ‘chaotic’.

A key issue underpinning that chaos is the distribution of physicians, 80% of whom practice in urban areas while 70% of the population live rural lives.

Ravi and colleagues are using cutting-edge digital technology to improve healthcare provision in India by introducing ‘comprehensive connected care’. This hub-and-spoke model uses digital connectivity to exchange data and information between centrally located expert clinicians and those caring for patients. For example staff in 5G-enabled ambulances transporting very sick people over long distances receive advice from critical care physicians who have all the patient’s clinical data at their fingertips.

Anaesthetists are familiar with the ‘Schimmlebusch Mask’. This article evolves from Arusha, Tanganyika and a small boy’s memory of a white mask descending over his face circa 1963, having fallen while climbing the household log heap and splitting his eyebrow open, requiring sutures by the local doctor.

Open-ether-mask anaesthesia was a common and safe technique utilised in many countries at the time. Tadeusz Szreter’s recollections of performing ether anaesthesia for children in the late 1950s in Poland is an illuminating read. He describes how two facemasks had to be prepared for each procedure, and how when one became covered in frost, it was replaced by the other. Each mask had to be covered with several layers of gauze neatly trimmed to prevent cheek frostbite. With regard to the safety of ether, Perndt in 2010 and Chang et al in 2015 wrote papers advocating a rethink of this abandoned agent.^1,2,3

Numerous articles have been written about Curt Theodor Schimmelbusch (1860–1895) and his eponymous mask; this article is not attempting to review them all, the intention is to stimulate colleagues to explore for themselves.

The concept of ‘complexity’ is synonymous with healthcare systems and is becoming increasingly prevalent in perioperative care. Advancing surgical technologies and approaches are driving the complexity of operations. 

On record waiting lists, there is a growing mix of co-morbidity, polypharmacy, and multisystem issues such as frailty. We must however, avoid a reciprocal increase in the complexity of perioperative pathways as an attempt to manage these challenges. Introducing individual clinics for each long-term condition, with each one arranging a raft of blood tests and investigations, can be overwhelming for patients and healthcare professionals. Messages can get lost in the milieu of appointments, and important work can be duplicated or missed entirely leading to disengagement with the pathway. In order to manage complexity, perioperative care pathways must simplify the message of optimisation, empower patients, and support its workforce to deliver holistic, evidence-based multidisciplinary care.

SAS doctors play a pivotal role within the anaesthetic workforce, and it is imperative for organisations to establish robust support structures to nurture their professional development. Unlocking the full potential of each SAS doctor not only benefits them personally, but also augments the services they provide and ultimately enhances patient care.

SAS doctors are crucial in anaesthesia, necessitating robust support structures for their growth. Unleashing their potential both benefits them personally and enhances patient care. Vital support includes that of an SAS tutor, a trust local negotiating committee representative, and an SAS advocate. The Guidelines for the Provision of Anaesthesia Services (GPAS) define exemplary departments and highlight non-clinical attributes vital for success. Notably, roles like ‘SAS clinical lead’ and ‘SAS mentor’ empower SAS doctors for self-determined career paths.