Hi! My name is Daniel Lim Jhao Jian. Here is where I share my experience, knowledge and ideas. You are welcome to leave comments and follow my blog. You are free to copy anything from this blog. Please recommend this blog to your friends.

Thursday 21 September 2023

Why I chose Anaesthesiology?

For the elective posting of my housemanship, I chose to do Anaesthesiology. Why did I make this decision?

During the orientation at the start of my housemanship, we were told that the 6th posting of housemanship is an elective posting, where we could choose either one of Emergency Medicine, Anaesthesiology, General Practice and Psychiatry. I had always found General Practice and Psychiatry quite interesting, and the work is generally quite relaxing in these two specialties.

I immediately told myself that I must choose General Practice or Psychiatry. However, much to my disappointment, I soon found out that at my hospital, only Emergency Medicine and Anaesthesiology are available for the elective posting. I didn't like either Emergency Medicine or Anaesthesiology. 

Anaesthesiology is an area of Medicine which I had very little exposure to. There was no Anaest rotation in my MBBS course, and I hardly ever read up anything about it. I always had the impression that Anaesthesiology is very difficult because there's so many things to learn.

On the other hand, Emergency Medicine requires doctors to work very fast, which I had always been very bad at. I need to think before doing something, or else I would make mistakes or omissions. However, patients going to the Emergency Department may be very ill which requires urgent treatment.

Having to choose between Emergency Medicine and Anaesthesiology, I felt that Emergency Medicine surely would be more suited for me. At least, I had good theoretical knowledge in Emergency Medicine, unlike Anaesthesiology which I had so little knowledge in. Therefore, I made the preliminary decision to choose Emergency Medicine for the elective posting.

During my 1st housemanship posting in Medical, I often had contact with the Anaest team, who will come to review and manage the acutely ill and unstable patients in the Medical ward. I found the Anaest team quite terrifying. Whenever I saw them, I knew it meant there's some unstable patients which require a lot of work to manage. I also never really understood the Anaest management plans which looked so complicated. That made me want to stay away from doing Anaesthesiology.

Meanwhile, I had very little exposure to the Emergency Department throughout my Medical posting, so I didn't know how working there is like. House Officers in the Medical posting generally only work in the wards and they rarely get called to the Emergency Department.

After I got into my 2nd posting in Obstetrics and Gynaecology, I was allocated to the labour room and pregnancy assessment centre (PAC) for the first 3 months. I found the labour room and PAC a very stressful place to work at. For each patient that comes to the PAC, we have to take a full history, do abdominal and vaginal examination, insert an IV cannula, take bloods, perform CTG and plan the management. We also have to document everything properly in the clerking sheet and present the case to an MO.

Clerking a new patient at the PAC is a long and tedious process, taking 30 minutes at the minimum. Patients may come to the PAC at any time of the day and it's impossible to predict that at all. Sometimes, a new patient may come in before I'm done clerking a previous patient, or two or more patients may come at the same time. Whenever that happened, I would get panicked as I knew there would be a lot of work awaiting me.

House officers have always been told to prioritise the work when it gets busy. However, even with job prioritisation, we still have to complete all of the work at the end of the day. We are also expected to work fast and to multitask, which is something I'm very bad at.

Any of the patients at the labour room and PAC may have an emergency at any time, with common examples being pathological CTG, meconium stained liquor and bleeding. Whenever that happens, we have to stop doing whatever we are doing and attend to it immediately. I don't like leaving my work uncompleted and resuming later, as that greatly increases the risk of making mistakes and omissions, yet I'm forced to do so during an emergency.

I soon realised that the PAC is basically the Emergency Department for Obstetrics and Gynaecology. I felt that working at the real Emergency Department (ED) would surely be very stressful in a similar way, in fact it likely would be even worse than the PAC. Patients with all kinds of conditions of any specialty may come to the ED anytime, and we need to be able to manage them quickly and appropriately. I began to think that Emergency Medicine isn't for me.

By April 2022, I had decided that I wouldn't want to do Emergency Medicine for my elective posting of housemanship. That meant my only option would be Anaesthesiology. I began exploring Anaesthesiology. Whenever I entered the operating theatre for caesarean sections, I would take a look at how the Anaest team performs spinal or general anaesthesia. I could gain a bit of understanding about anaesthesia and I found it rather interesting.

In the subsequent Orthopaedics and Surgical postings, I often had to go to the ED to see new cases. I never enjoyed working at the ED, as I found the work environment there so stressful, especially when there's a lot of patients. I was even more convinced that I mustn't do Emergency Medicine.

The Anaest team reviews and manages the acutely ill and unstable patients in the Orthopaedic and Surgical wards as well. I made it a point to get to know and understand the management plans by the Anaest team. I also made sure to properly carry out the plans and communicate with the Anaest MOs regarding that. That enabled me to know the Anaest MOs better, and I felt that most of them are actually quite nice. I no longer found the Anaest team terrifying.

Later, someone remarked that he thinks I'm not suitable to do Anaesthesiology, so my only option would be Emergency Medicine which I should prepare for. I don't agree with what he said at all and I am determined to prove him wrong. That gave me the push for doing Anaesthesiology.

My friends who did the Anaesthesiology posting at my hospital gave really good remarks regarding it. According to them, Anaest has a really nice work environment, and the Anaest MOs and specialists are very willing to teach and guide house officers. Moreover, the workload in Anaest is generally quite manageable and house officers in Anaest rarely have to work overtime. That made the Anaest posting even more attractive for me.

A widely touted advantage of doing Emergency Medicine for the elective posting is that it gives us the opportunity to work as locum doctors at the ED of private hospitals, getting an additional source of income. Most private hospitals will only hire doctors with work experience in Emergency Medicine to work at their ED. While I appreciate that it may be beneficial to some people, I personally have zero interest in it.

I just don't like working at EDs, whether at public or private hospitals. The work experience as a locum doctor also contributes nothing towards becoming a registered specialist. Moreover, right from the beginning, I chose to do Medicine to help people, not to make big money. Working at a private hospital would go against that very principle of mine. Therefore, there's no reason for me to do Emergency Medicine at all.

In June 2023, I made the firm decision to do Anaesthesiology for my elective posting of housemanship and I communicated my decision to the hospital. I then received confirmation in August 2023 that I have been placed in Anaesthesiology. I started the Anaest posting on 6 September 2023.

Anaesthesiology has a rather steep learning curve compared to other postings, as there's many new things to learn. Despite that, the enthusiasm of the MOs and specialists in teaching and guiding house officers has enabled me to gain a lot of new knowledge and skills without much difficulties. I am confident that I will be able to master Anaesthesiology.

I hope the Anaest posting will be a great and satisfying ending to my housemanship.